Measurement of blood pressure. Algorithm of actions for measuring blood pressure: basic methods and rules SOP algorithm for performing blood pressure actions of a nurse

14.07.2019 -

To adequately assess the state of the cardiovascular system, it is important to know the measurement algorithm blood pressure. The correctness of the final indicators depends on the correctness of the preparation for the procedure, knowledge about the operation of the tonometer and the behavior of the patient during the diagnosis. Blood pressure control will allow you to respond in time to possible health problems and take appropriate therapeutic measures.

Measurement methods

Methods for determining blood pressure:

Invasive - the most accurate manipulation, used in cardiac surgery, based on the introduction of a transducer catheter directly into the artery. The data is transmitted through the tube to the pressure gauge. The result is displayed on the pressure fluctuation curve.
Non-invasive methods for measuring blood pressure:
- Dr. Korotkov's method (using a mechanical tonometer);
- oscillometric (measurement by an automatic electronic device);
- palpatory (based on squeezing and relaxing the hand in the area of proximity major artery to the skin and subsequent palpation of the pulse).

Korotkov method

The standard type of determination of blood pressure in any medical institution is the Korotkov method.
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The technique was invented in 1905. Otherwise, the method is called auscultation. Device for diagnostics - mechanical tonometer, consisting of:

cuffs;
gauge-manometer;
air blower;
phonendoscope.

Measurement of blood pressure according to the method proposed by Korotkov is based on compressing the brachial artery with a cuff and listening to the heart pulsation through a stethoscope. Advantages:

cheapness and availability of mechanical devices for measuring blood pressure;
the accuracy of the results.

Among the shortcomings that the procedure involves, it is difficult to measure the pressure with a mechanical device for oneself. In outpatient clinics, this is usually done by a nurse. Also, devices of this type are very sensitive to sound and noise, any violation of silence during diagnostics can distort the result. The skill level of the nurses who take the measurement can also affect the result.

Oscillometric

The procedure for measuring blood pressure by the oscillometric method involves the use and automatic counting of the pulse under the cuff when the artery is compressed. Such devices are designed for home use. The presence of a nurse for the diagnosis is not required. The disadvantages include the fact that the operation of the electronic tonometer is affected by electromagnetic waves, and the battery may also be discharged. A number of advantages of the method:

noise does not affect the result of the study;
special knowledge and skills are not required to perform the algorithm;
no need to bare your arm to measure blood pressure.

Always measure blood pressure at the same time.

Before taking a measurement, it is important:

sleep well;
empty the bladder;
do not eat 2 hours before the diagnosis;
do not smoke for at least an hour;
do not drink coffee;
do not take alcoholic beverages on the day of diagnosis;
do not use drugs that constrict blood vessels - eye drops, nasal drops;
rest and relax for 10 minutes;
maintain the temperature in the room 20-23 degrees.

The arm on which the measurement will be taken should not be squeezed by tight cuffs of the sleeves, bracelets, bandages, watches, otherwise the blood circulation will be disturbed and the result will be incorrect. There should be no wounds, abrasions, scars on the limbs that interfere with blood circulation. Measurement of blood pressure is always desirable to carry out in the morning after sleep. During manipulation, you can not move, talk with a nurse, hunch over, cross your legs - the accuracy of blood pressure measurement depends on this.

Flowchart for Non-Invasive Blood Pressure Measurement

Algorithm of the auscultatory method:

Relaxed and rested for 5-10 minutes, the patient is placed on a chair with a back.
The patient's hand lies freely on a flat surface.
The forearm is freed from foreign objects and clothing.
The cuff is applied over the elbow bend with the tubes down.
The phonendoscope membrane is tightly applied to the inner side of the elbow bend.
The valves on the pear are closed.
Inflate the cuff with air, squeezing the pear until the arrow on the pressure gauge reaches 200-220 mm Hg. (in some cases - up to 300).
Slowly release the air by opening the valve.
The purpose of listening is to notice the pulsation that has begun.
The beginning of listening to beats is the value of systolic pressure.
The lower pressure is recorded when the heart rhythm through the phonendoscope is no longer audible.
Next, the air is completely released from the cuff.
If necessary, repeat all over again after 10-15 minutes.

The preferred position for measuring pressure is sitting, but it is possible to measure lying down if the person's arm is along the body at the same level as the heart muscle.

Before measuring, carefully read the instructions for using the tonometer.

To measure blood pressure with an electronic tonometer, the principle of operation and the algorithm for preparing for manipulation are the same as with a mechanical device. It is important to put on the cuff correctly - the bottom edge should be located 2 fingers above the elbow bend. While measuring, keep mobile phones and other electronics are better away from the automatic device. It is strictly forbidden to move and talk (the results will be greatly distorted). It is better to take measurements on both hands several times. The technique for measuring blood pressure on the wrist differs in the location of the cuff (at a distance of 1 finger from the hand). The palm of the examined hand should be placed on the shoulder of the other hand, the hand of which, after pressing the start button, is placed under the elbow of the examined.

It is extremely important for future doctors and nurses to understand what a blood pressure measurement algorithm is. The blood pressure indicator is one of the first to be paid attention to during the examination of the patient. Even slight deviations up or down can be the beginning of a severe pathology. Accuracy plays an important role in such procedures.

Why is it so important?

Jumps in blood pressure increase the risk of developing diseases, including heart failure, heart attack, stroke, ischemia. Hypertension often does not manifest itself at the stage of initial development and proceeds with the absence of pronounced symptoms. A person may not be aware of a possible danger. Noise in the ears, a feeling of pulsation in the head, a feeling of weakness and dizziness are the first reasons to check the state of pressure.

The level of blood pressure should not rise above 140/90 mm Hg. Art. If it consistently exceeds these figures, the person needs medication to stabilize blood pressure.

How can pressure be measured?

invasive

The technique is mostly intended for cardiac surgery and measures the true (lateral) pressure. A needle is inserted into the vessel or directly into the heart itself. It is connected by a thin tube to a special device that records pressure - a manometer. The tube itself is filled with a special fluid that does not allow blood to clot at the time of measurement. Scribe records the oscillation curve that results.

indirect methods

The oscillometric method is the most convenient for measurement.

Auscultatory and oscillometric are the main methods for measuring blood pressure, which are indirect. They determine the sum of the lateral blood pressure and the hydrodynamic impact of the blood flow. Their basic principle is to listen to tones on the peripheral vessels, in the place of the elbow bend of the arm. To measure pressure using the first (auscultative) method, use:

balloon cuff;
phonendoscope;
manometer.

A cuff is tightly applied to the bare shoulder of a person. With the help of a pump, air is forced in, creating pressure that will be enough to block the blood flow of the artery. After that, the air is gradually released through the valve, and the resulting noises are listened to. The readings of the pressure gauge at the moment the tones appear will be equal to the upper pressure, and after their disappearance, the lower one is fixed. This measurement technique is considered the standard. Its main advantage is that the movement of the hand will not give an error in the result, but in general there are much more disadvantages. Among them, sensitivity to noise, obligatory contact of the cuff with the skin, the need for special training and overall technical complexity.

The oscillometric method implies the use of a tonometer - a special electronic device that captures the pulsation in the vessels squeezed by the cuff through which blood circulates. This technique has only one main disadvantage - while the procedure is being carried out, the hand must be kept motionless. Otherwise, measuring blood pressure in this way is much more convenient.

Devices for measuring blood pressure

Apparatus for measuring blood pressure indicators are mainly mechanical and electronic.

Tonometers are divided into two main types: mechanical and electronic. They have the same purpose of use, however, the former are used only in hospitals and require certain skills, since if used incorrectly, they can give inaccurate results. The second type is suitable for home regular use. There are automatic blood pressure monitors that pump in and pump out air without assistance and semi-automatic, into which a person pumps air with a pump.

Action algorithm

Each manipulation will affect the final result, therefore, in order for everything to work out in practice, future doctors and nurses must know how to measure pressure correctly. You need to follow a certain clear sequence of actions:

Make sure that the equipment is in good condition, choose a cuff that will fit in size.
Properly prepare and position the patient. The nurse must make sure that the patient did not consume nicotine substances, drinks containing alcohol or caffeine half an hour before measuring pressure. It should be placed in a relaxed sitting position with your back against a chair. The hand on which the measurement will be directly taken should be bared, straightened in elbow joint and fix it in that position. The legs are placed so that the feet are completely on the floor surface. During the manipulation, the patient should not speak.
Place the cuff on the upper arm so tightly that one finger fits into the space between it and the arm.
The phonendoscope used by the nurse is placed on the arm on which the pressure will be measured, in the area of \u200b\u200bthe shoulder bend. Before starting the procedure, you should make sure that the pressure gauge scale is at “0”.
With the help of a pump, air is pumped into the cuff until the pulsations are no longer heard.
Through the valve, air gradually descends, noises are heard in parallel. At the first pulsations, systolic pressure, after the noises stop - dystonic.
To double-check the results, you will need to measure the pressure first on one, then on the second hand, there should not be a significant difference.

To determine the activity of the heart, vascular system and kidneys, it is necessary to measure blood pressure. The action algorithm for determining it must be followed in order to obtain the most accurate numbers.

It is known from medical practice that the timely determination of pressure helped a large number of patients not to become disabled and saved the lives of many people.

The history of the creation of measuring devices

For the first time, blood pressure was measured in animals by Hales in 1728. To do this, he inserted a glass tube directly into the horse's artery. After that, Poiseuille added a mercury scale manometer to the glass tube, and subsequently Ludwig invented a float kymograph, which made it possible to record continuously. These devices are equipped with mechanical stress sensors and electronic systems. Direct blood pressure by vascular catheterization is used for scientific purposes in diagnostic laboratories.

How is blood pressure formed?

Rhythmic contractions of the heart include two phases: systole and diastole. The first phase - systole - is the contraction of the heart muscle, during which the heart pushes blood into the aorta and pulmonary artery. Diastole is the period during which the chambers of the heart expand and fill with blood. This is followed by systole and then diastole. Blood from the largest vessels: the aorta and pulmonary artery passes the way to the smallest - arterioles and capillaries, enriching all organs and tissues with oxygen and collecting carbon dioxide. Capillaries pass into venules, then - into small veins and into larger vessels, and finally - into veins that approach the heart.

Blood pressure and heart

When blood is ejected from the cavities of the heart, the pressure is 140-150 mm Hg. Art. In the aorta, it decreases to 130-140 mm Hg. Art. And the farther from the heart, the lower the pressure becomes: in the venules it is 10-20 mm Hg. Art., and blood in large veins - below atmospheric.

When blood is poured out of the heart, a pulse wave is recorded, which gradually fades away as it passes through all the vessels. The speed of its spread depends on the magnitude of blood pressure and the elasticity or elasticity of the vascular walls.

With age, blood pressure rises. In people from 16 to 50 years old, it is 110-130 mm Hg. Art., and after 60 years - 140 mm Hg. Art. and higher.

Ways to measure blood pressure

There are direct (invasive) and indirect methods. In the first method, a catheter with a transducer is inserted into the vessel and blood pressure is measured. The algorithm of this study is such that with the help of a computer, the signal control process is automated.

Indirect way

The technique of measuring blood pressure indirectly is possible by several methods: palpation, auscultation and oscillometric. The first method involves gradual squeezing and relaxation of the limb in the region of the artery and finger determination of its pulse below the site of compression. Rivva-Rocci at the end of the 19th century proposed the use of a 4-5 cm cuff and a mercury pressure gauge scale. However, such a narrow cuff overestimated the true data, so it was proposed to increase it to 12 cm in width. And at present, the technique for measuring blood pressure involves the use of this particular cuff.

The pressure in it is pumped up to the point where the pulse stops, and then slowly decreases. Systolic pressure is the moment when a pulsation appears, diastolic - when the pulse attenuates or noticeably accelerates.

In 1905 N.S. Korotkov proposed a method for measuring blood pressure through auscultation. A typical device for measuring blood pressure according to the Korotkov method is a tonometer. It consists of cuff, mercury scale. Air is pumped into the cuff with a pear, and then the air is gradually released through a special valve.

This auscultatory method has been the standard for measuring blood pressure for more than 50 years, but surveys show that physicians rarely follow the recommendations, and the technique for measuring blood pressure is violated.

The oscillometric method is used in automatic and semi-automatic devices in intensive care units, since the use of these devices does not require constant air injection into the cuff. Blood pressure is recorded on various stages reduction in air volume. Measurement of blood pressure is also possible with auscultatory dips and weak Korotkoff sounds. This method is least dependent on the elasticity of the walls of blood vessels and when they are affected by atherosclerosis. The oscillometric method made it possible to create devices for determining the upper and lower extremities. It allows you to make the process more accurate, reducing the influence of the human factor

Rules for measuring blood pressure

Step 1 - choose the right equipment.

What you will need:

1. Quality stethoscope

2. Correct cuff size.

3. Aneroid barometer or automated sphygmomanometer - a device with a manual inflation mode.

Step 2 - prepare the patient: make sure he is relaxed, give him 5 minutes of rest. For half an hour to determine blood pressure, smoking and drinking alcohol- and caffeinated drinks are not recommended. The patient should sit upright, free the upper part of the arm, position it comfortably for the patient (you can put it on a table or other support), feet should be on the floor. Remove any excess clothing that may interfere with airflow into the cuff or blood flow to the arm. You and the patient should refrain from talking during the measurement. If the patient is in the supine position, it is necessary to place the upper part of the arm at the level of the heart.

Step 3 - choose the correct cuff size depending on the volume of the arm: often errors occur due to incorrect selection of cuffs. Put the cuff on the patient's arm.

Step 4 - Place the stethoscope on the same arm where you placed the cuff, feel around the elbow to find the location of the strongest impulsive sounds, and position the stethoscope over the brachial artery at that location.

Step 5 - Inflate the cuff: Start inflating while listening to the pulse. When the pulse waves disappear, you should not hear any sounds through the phonendoscope. If the pulse is not heard, then you need to inflate so that the pressure gauge needle is on the numbers above from 20 to 40 mm Hg. Art., than at the expected pressure. If this value is unknown, inflate the cuff to 160 - 180 mmHg. Art.

Step 6 - Slowly deflate the cuff: deflation begins. Cardiologists recommend slowly opening the valve so that the pressure in the cuff decreases by 2 to 3 mmHg. Art. per second, otherwise a faster decrease may result in inaccurate measurements.

Step 7 - listening to systolic pressure - the first sounds of the pulse. This blood begins to flow through the patient's arteries.

Step 8 - listen to the pulse. Over time, as the pressure in the cuff decreases, the sounds disappear. This will be the diastolic, or lower pressure.

Checking indicators

It is necessary to check the accuracy of the indicators. To do this, measure the pressure on both hands to average the data. To check the pressure again for accuracy, you should wait about five minutes between measurements. As a rule, blood pressure is higher in the morning and lower in the evening. Sometimes the blood pressure figures are not reliable due to the patient's concern about people in white coats. In that case, use daily measurement HELL. The algorithm of action in this case is the determination of pressure during the day.

Disadvantages of the method

Currently, auscultatory method in any hospital or clinic is used to measure blood pressure. The action algorithm has disadvantages:

Lower SBP and higher DBP than those obtained with an invasive technique;

Susceptibility to noise in the room, various interference during movement;

The need for proper placement of the stethoscope;

Poor listening to low intensity tones;

The error of determination is 7-10 units.

This technique for measuring blood pressure is not suitable for a 24-hour monitoring procedure. To monitor the patient's condition in intensive care units, it is impossible to constantly inflate the cuff and create noise. This can negatively affect the general condition of the patient and cause his anxiety. The pressure readings will be unreliable. In the unconscious state of the patient and increased motor activity, his hand cannot be laid at the level of the heart. An intense interference signal can also be created by uncontrolled actions of the patient, so the computer will fail, which will nullify the measurement of blood pressure, pulse.

Therefore, cuffless methods are used in intensive care units, which, although inferior in accuracy, are more reliable, efficient and convenient for constant monitoring of pressure.

How to measure blood pressure in pediatrics?

Measurement of blood pressure in children is no different from the technique for determining it in adults. Only an adult cuff will not fit. In this case, a cuff is required, the width of which should be three-quarters of the distance from the elbow to the armpit. Currently, there is a large selection of automatic and semi-automatic devices for measuring blood pressure in children.

Numbers normal pressure depend on age. To calculate the numbers of systolic pressure, you need to multiply the number of the child's age in years by 2 and increase by 80, the diastolic is 1/2 - 2/3 of the previous figure.

Blood pressure devices

Blood pressure monitors are also called blood pressure monitors. There are mechanical and digital are mercury and aneroid. Digital - automatic and semi-automatic. The most accurate and long-term device is a mercury tonometer, or sphygmomanometer. But digital ones are more convenient and easy to use, which allows them to be used at home.

Equipment
1. Bed linen set (2 pillowcases, duvet cover, sheet).
2. Gloves.
3. Bag for dirty linen.

Preparation for the procedure
4. Explain to the patient the course of the upcoming procedure.
5. Prepare a set of clean linen.
6. Wash and dry your hands.
7. Put on gloves.

Performing a procedure
8. Lower the rails on one side of the bed.
9. Lower the head of the bed to a horizontal level (if the patient's condition allows).
10. Raise the bed to the required level (if this is not possible, change the linen, observing the biomechanics of the body).
11. Remove the duvet cover from the duvet, fold it and hang it on the back of a chair.
12. Make sure you have clean bedding ready for you.
13. Stand on the opposite side of the bed that you will be making (from the side of the lowered handrail).
14. Make sure that there are no small personal items of the patient on this side of the bed (if there are, ask where to put them).
15. Turn the patient on his side towards you.
16. Raise the side rail (the patient can keep himself in a position on his side by holding on to the rail).
17. Return to the opposite side of the bed, lower the handrail.
18. Raise the patient's head and remove the pillow (if there are drainage tubes, make sure they are not kinked).
19. Make sure that the patient's small items are not on this side of the bed.
20. Roll up a dirty sheet with a roller towards the patient's back and slip this roller under his back (if the sheet is heavily soiled (with secretions, blood), put a diaper on it so that the sheet does not come into contact with the contaminated area with the patient's skin and a clean sheet).
21. Fold a clean sheet in half lengthwise and place its center fold in the center of the bed.
22. Unfold the sheet towards you and tuck the sheet at the head of the bed using the "bevel corner" method.
23. Tuck the middle third, then the bottom third of the sheet under the mattress, with your hands palms up.
24. Make the roll of the rolled up clean and dirty sheets as flat as possible.
25. Help the patient "roll" over these sheets towards you; make sure the patient is lying comfortably and, if there are drainage tubes, that they are not kinked.
26. Raise the side rail on the opposite side of the bed where you just worked.
27. Go to the other side of the bed.
28. Change bedding on the other side of the bed.
29. Lower the side rail.
30. Roll up a dirty sheet and place it in a laundry bag.
31. Straighten a clean sheet and tuck under the mattress first its middle third, then the top, then the bottom, using the technique in p.p. 22, 23.
32. Help the patient turn on his back and lie down in the middle of the bed.
33. Tuck the duvet into a clean duvet cover.
34. Straighten the blanket so that it hangs equally on both sides of the bed.
35. Tuck the edges of the blanket under the mattress.
36. Remove the dirty pillowcase and throw it into a laundry bag.
37. Turn a clean pillowcase inside out.
38. Take the pillow by its corners through the pillowcase.
39. Pull the pillowcase over the pillow.
40. Raise the patient's head and shoulders and place a pillow under the patient's head.
41. Raise the side rail.
42. Make a fold in the blanket for the toes.

Completion of the procedure
43. Remove gloves, place them in a disinfectant solution.
44. Wash and dry your hands.
45. Make sure the patient is comfortable.

Patient Eye Care

Equipment
1. Sterile tray
2. Sterile tweezers
3. Sterile gauze wipes - at least 12 pcs.
4. Gloves
5. Waste tray
6. Antiseptic solution for the treatment of mucous eyes

Preparation for the procedure
7. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain his consent
8. Prepare everything you need

Equipment
9. Wash and dry your hands
10. Examine the mucous membranes of the patient's eyes in order to detect purulent discharge
11. Wear gloves

Performing a procedure
12. Place at least 10 wipes in a sterile tray and moisten them with an antiseptic solution, squeeze the excess on the edge of the tray
13. Take a napkin and wipe her eyelids and eyelashes from top to bottom or from the outer corner of the eye to the inner
14. Repeat the treatment 4-5 times, changing the wipes and placing them in the waste tray
15. Wipe the remaining solution with a dry sterile cloth

Completion of the procedure
16. Remove all used equipment with subsequent disinfection
17. Help the patient get into a comfortable position
18. Place wipes in a container with a disinfectant for subsequent disposal
19. Remove gloves and place them in a disinfectant solution
20. Wash and dry your hands
21. Record in medical card about the patient's response

Examination of the arterial pulse on the radial artery

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparation for the procedure
4. Explain to the patient the purpose and course of the study.
5. Obtain patient consent for the study.
6. Wash and dry your hands.

Performing a procedure
7. During the procedure, the patient can sit or lie down (hands are relaxed, hands should not be on weight).
8. Press with 2, 3, 4 fingers (1 finger should be on the back of the hand) the radial arteries on both hands of the patient and feel the pulsation.
9. Determine the rhythm of the pulse for 30 seconds.
10. Choose one comfortable hand for further examination of the pulse.
11. Take a watch or stopwatch and examine the pulsation of the artery for 30 seconds. Multiply by two (if the pulse is rhythmic). If the pulse is not rhythmic, count for 1 minute.
12. Press the artery harder than before against radius and determine the voltage of the pulse (if the pulsation disappears with moderate pressure - the voltage is good; if the pulsation does not weaken - the pulse is tense; if the pulsation has completely stopped - the voltage is weak).
13. Record the result.

End of procedure
14. Tell the patient the result of the study.
15. Help the patient to take a comfortable position or stand up.
16. Wash and dry your hands.
17. Record test results on a temperature sheet (or nursing care plan).

Technique for measuring blood pressure

Equipment
1. Tonometer.
2. Phonendoscope.
3. Handle.
4. Paper.
5. Temperature sheet.
6. Napkin with alcohol.

Preparation for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before it starts.
8. Clarify the patient's understanding of the purpose of the study and obtain his consent.
9. Ask the patient to lie down or sit down at the table.
10. Wash and dry your hands.

Performance
11. Help take off clothes from your hand.
12. Put the patient's hand in an extended position with the palm up, at the level of the heart, the muscles are relaxed.
13. Apply a cuff 2.5 cm above the cubital fossa (clothes should not squeeze the shoulder above the cuff).
14. Fasten the cuff so that two fingers pass between the cuff and the surface of the upper arm.
15. Check the position of the pressure gauge arrow relative to the zero mark.
16. Find (by palpation) the pulse on the radial artery, quickly inflate the cuff until the pulse disappears, look at the scale and remember the pressure gauge readings, quickly release all the air from the cuff.
17. Find the place of pulsation of the brachial artery in the region of the cubital fossa and firmly place the membrane of the stethophonendoscope on this place.
18. Close the valve on the pear and pump air into the cuff. Inflate the air until the pressure in the cuff, according to the readings of the tonometer, does not exceed 30 mm Hg. Art., the level at which the pulsation of the radial artery or Korotkoff's tones ceases to be determined.
19. Open the valve and slowly, at a speed of 2-3 mm Hg. per second, deflate the cuff. At the same time, listen to the tones on the brachial artery with a stethophonendoscope and monitor the indications of the manometer scale.
20. When the first sounds appear above the brachial artery, note the level of systolic pressure.
21. Continuing to release air from the cuff, note the level of diastolic pressure, which corresponds to the moment of complete disappearance of tones on the brachial artery.
22. Repeat the procedure after 2-3 minutes.

Completion of the procedure
23. Round off the measurement data to the nearest even number, write it down as a fraction (in the numerator - systolic blood pressure, in the denominator - diastolic blood pressure).
24. Wipe the membrane of the phonendoscope with a cloth moistened with alcohol.
25. Write down the research data in the temperature sheet (protocol to the care plan, outpatient card).
26. Wash and dry your hands.

Determining the frequency, depth and rhythm of breathing

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparation for the procedure
4. Warn the patient that a pulse test will be performed.
5. Obtain the consent of the patient to conduct the study.
6. Ask the patient to sit or lie down so that you can see the upper chest and/or abdomen.
7. Wash and dry your hands.

Performing a procedure
8. Take the patient by the hand as for a pulse test, hold the patient’s hand on the wrist, put your hands (your own and the patient’s) on the chest (in women) or on the epigastric region (in men), simulating a pulse test and counting the respiratory movements for 30 seconds, multiplying the result by two.
9. Record the result.
10. Help the patient to take a comfortable position for him.

End of procedure
11. Wash and dry your hands.
12. Record the result on the nursing assessment sheet and temperature sheet.

Measurement of temperature in the armpit

Equipment
1. Clock
2. Medical maximum thermometer
3. Handle
4. Temperature sheet
5. Towel or napkin
6. Container with disinfectant solution

Preparation for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before it starts
8. Clarify the patient's understanding of the purpose of the study and obtain his consent
9. Wash and dry your hands
10. Make sure that the thermometer is intact and that the readings on the scale do not exceed 35°C. Otherwise, shake the thermometer so that the mercury column drops below 35 °C.

Performance
11. Examine the axillary area, if necessary, wipe dry with a napkin or ask the patient to do so. In the presence of hyperemia, local inflammatory processes, temperature measurement cannot be carried out.
12. Place the thermometer reservoir in the armpit so that it is in close contact with the patient's body on all sides (press the shoulder against the chest).
13. Leave the thermometer for at least 10 minutes. The patient should lie in bed or sit.
14. Remove thermometer. Evaluate readings by holding the thermometer horizontally at eye level.
15. Inform the patient of the results of thermometry.

Completion of the procedure
16. Shake the thermometer so that the mercury column falls into the tank.
17. Immerse the thermometer in the disinfectant solution.
18. Wash and dry your hands.
19. Make a note of the temperature readings on the temperature sheet.

Algorithm for measuring height, body weight and BMI

Equipment
1. Height meter.
2. Scales.
3. Gloves.
4. Disposable wipes.
5. Paper, pen

Preparation and conduct of the procedure
6. Explain to the patient the purpose and course of the upcoming procedure (learning to measure height, body weight and determine BMI) and obtain his consent.
7. Wash and dry your hands.
8. Prepare the stadiometer for work, raise the bar of the stadiometer above the expected height, put a napkin on the platform of the stadiometer (under the patient's feet).
9. Ask the patient to take off their shoes and stand in the middle of the stadiometer platform so that it touches the vertical bar of the stadiometer with the heels, buttocks, interscapular region and the back of the head.
10. Set the patient's head so that the tragus of the auricle and the outer corner of the orbit are on the same horizontal line.
11. Lower the bar of the stadiometer onto the patient's head and determine the height of the patient on the scale along the lower edge of the bar.
12. Ask the patient to get off the platform of the stadiometer (if necessary, help to get off). Inform the patient about the measurement results, record the result.
13. Explain to the patient about the need to measure body weight at the same time, on an empty stomach, after visiting the toilet.
14. Check the serviceability and accuracy of medical scales, set the balance (for mechanical scales) or turn it on (for electronic ones), lay a napkin on the scale platform
15. Invite the patient to take off their shoes and help him stand in the middle of the scale platform, to determine the patient's body weight.
16. Help the patient get off the scale platform, tell him the result of the body weight study, write down the result.

End of procedure
17. Put on gloves, remove wipes from the platform of the height meter and scales and place them in a container with a disinfectant solution. Treat the surface of the height meter and scales with a disinfectant solution once or twice with an interval of 15 minutes in accordance with the guidelines for the use of a disinfectant.
18. Remove gloves and place them in a container with a disinfectant solution,
19. Wash and dry your hands.
20. Determine BMI (body mass index) -
body weight (in kg) height (in m 2) Index less than 18.5 - underweight; 18.5 - 24.9 - normal body weight; 25 - 29.9 - overweight; 30 - 34.9 - obesity of the 1st degree; 35 - 39.9 - obesity of the II degree; 40 and more - obesity of the III degree. Write down the result.
21. Inform the patient of BMI, write down the result.

Applying a warm compress

Equipment
1. Compress paper.
2. Cotton wool.
3. Bandage.
4. Ethyl alcohol 45%, 30 - 50 ml.
5. Scissors.
b. Tray.

Preparation for the procedure
7. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain his consent.
8. It is convenient to seat or lay down the patient.
9. Wash and dry your hands.
10. Cut off with scissors necessary (depending on the area of application, a piece of bandage or gauze and fold it into 8 layers).
11. Cut out a piece of compress paper: around the perimeter 2 cm more than the prepared napkin.
12. Prepare a piece of cotton around the perimeter 2 cm larger than the compress paper.
13. Fold the layers for the compress on the table, starting with the outer layer: at the bottom - cotton wool, then - compress paper.
14. Pour alcohol into the tray.
15. Moisten a napkin in it, squeezing it slightly and put it on top of the compress paper.

Performing a procedure
16. Put all layers of the compress at the same time on the desired area (knee joint) of the body.
17. Fix the compress with a bandage so that it fits snugly against the skin, but does not restrict movement.
18. Mark the time of applying the compress in the patient's chart.
19. Remind the patient that the compress is set for 6-8 hours, give the patient a comfortable position.
20. Wash and dry your hands.
21. After 1.5 - 2 hours after applying the compress with your finger, without removing the bandage, check the degree of moisture in the napkin. Secure the compress with a bandage.
22. Wash and dry your hands.

Completion of the procedure
23. Wash and dry your hands.
24. Remove the compress after the prescribed time of 6-8 hours.
25. Wipe the skin in the compress area and apply a dry bandage.
26. Dispose of used material.
27. Wash and dry your hands.
28. Make an entry in the medical record about the patient's reaction.

Staging mustard plasters

Equipment
1. Mustard plasters.
2. Tray with water (40 - 45 * C).
3. Towel.
4. Gauze napkins.
5. Clock.
6. Waste tray.

Preparation for the procedure
7. Explain to the patient the purpose and course of the upcoming procedure and
get his consent.
8. Help the patient to take a comfortable position, lying on his back or stomach.
9. Wash and dry your hands.
11. Pour water into the tray at a temperature of 40 - 45 * C.

Performing a procedure
12. Inspect skin patient at the place of setting mustard plasters.
13. Immerse mustard plasters alternately in water, allow excess water to drain and place on the patient's skin with the side covered with mustard or the porous side.
14. Cover the patient with a towel and blanket.
15. After 5–10 minutes, remove the mustard plasters by placing them in the waste material tray.

End of procedure
16. Wipe the patient's skin with a damp warm cloth and dry with a towel.
17. Used material, mustard plasters, a napkin should be placed in the waste material tray, then disposed of.
18. Cover and lay the patient in a comfortable position, warn the patient that he must remain in bed for at least 20 to 30 minutes.
19. Wash and dry your hands.
20. Record the procedure performed in the patient's medical record.

Heating pad application

Equipment
1. Heating pad.
2. Diaper or towel.
3. A jug of water T - 60-65 ° "C.
4. Thermometer (water).

Preparation for the procedure
5. Explain to the patient the course of the upcoming procedure and obtain his consent to the procedure.
6. Wash and dry your hands.
7. Pour hot (T - 60–65°C) water into a heating pad, squeeze it slightly at the neck, releasing air, and close it with a cork.
8. Turn the heating pad upside down to check the water flow and wrap it with a veil of some or
towel.

Performing a procedure
9. Put a heating pad on the desired area of the body for 20 minutes.

End of procedure
11. Examine the patient's skin in the area of contact with the heating pad.
12. Pour out the water. Treat the heating pad with rags abundantly moistened with a bactericidal disinfectant solution twice with an interval of 15 minutes.
13. Wash and dry your hands.
14. Make a note about the procedure and the patient's reaction to it in the inpatient chart.

Setting up an ice pack

Equipment
1. Bubble for ice.
2. Diaper or towel.
3. Pieces of ice.
4. A jug of water T - 14 - 16 C.
5. Thermometer (water).

Preparation for the procedure
6. Explain to the patient the course of the upcoming procedure and obtain consent to the procedure.
7 Wash and dry your hands.
8. Put the pieces of ice prepared in the freezer into the bubble and fill them with cold water (T - 14 - 1b ° C).
9. Place the bladder on a horizontal surface to expel air and screw on the lid.
10. Turn the ice pack upside down, check the tightness and wrap it in a diaper or towel.

Performing a procedure
11. Put the bubble on the desired area of the body for 20-30 minutes.
12. Remove the ice pack after 20 minutes (repeat steps 11–13).
13. As the ice melts, the water can be drained and pieces of ice added.
End of procedure
14. Examine the patient's skin, in the area of application of the ice pack.
15. At the end of the procedure, treat the water from the bladder with a cloth moistened with a bactericidal disinfectant solution twice with an interval of 15 minutes.
16. Wash and dry your hands.
17. Make a note about the procedure and the patient's reaction to it in the inpatient chart.

Care of the external genitalia and perineum of a woman

Equipment
1. Pitcher with warm (35-37°C) water.
2. Absorbent diaper.
3. Reniform tray.
4. Vessel.
5. Soft material.
6. Kortsang.
7. Capacity for discarding used material.
8. Screen.
9. Gloves.

Preparation for the procedure
10. Explain to the patient the purpose and course of the study.
11. Obtain the consent of the patient to perform the manipulation.
12. Prepare the necessary equipment. Pour warm water into a pitcher. Put cotton swabs (napkins), forceps in the tray.
13. Fence off the patient with a screen (if necessary).
14. Wash and dry your hands.
15. Put on gloves.

Performing a procedure
16. Lower the head of the bed. Turn the patient to the side. Place an absorbent pad under the patient.
17. Place the vessel in close proximity to the patient's buttocks. Turn her on her back so that the crotch is over the opening of the vessel.
18. Help to take an optimally comfortable position for the procedure (Fowler's position, legs slightly bent at the knees and separated).
19. Stand to the right of the patient (if the nurse is right-handed). Place a tray with tampons or napkins in close proximity to you. Fix the swab (napkin) with a forceps.
20. Hold the jug in the left hand, and the forceps in the right. Pour water on the woman's genitals, use tampons (changing them) to move from top to bottom, from the inguinal folds to the genitals, then to the anus, washing: a) with one tampon - the pubis; b) the second - the inguinal region on the right and left c) then the right and left labia (large) lips c) the region of the anus, the intergluteal fold The used tampons should be thrown into the vessel.
21. Dry the pubis, inguinal folds, genitals and anus area of the patient with blotting movements using dry wipes in the same sequence and in the same direction as when washing, changing wipes after each stage.
22. Turn the patient on her side. Remove the vessel, oilcloth and diaper. Return the patient to the starting position, supine. Place the oilcloth and diaper in a container for disposal.
23. Help the patient to take a comfortable position. Cover her. Make sure she feels comfortable. Remove screen.

End of procedure
24. Empty the vessel from the contents and place it in a container with a disinfectant.
25. Remove gloves and place them in a waste tray for disinfection and disposal.
26. Wash and dry your hands.
27. Record the performance of the procedure and the patient's response in the documentation.

Bladder catheterization of a woman with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Sterile gloves.
3. Clean gloves - 2 pairs.
4. Sterile wipes medium - 5-6 pcs.

6. Pitcher with warm water(30–35°С).
7. Vessel.

10. 10-30 ml of saline or sterile water, depending on the size of the catheter.
11. Antiseptic solution.

13. Urinary bag.

15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. Korntsang.
19. A container with a disinfectant solution.

Preparation for the procedure
20. Clarify the patient's understanding of the purpose and course of the upcoming procedure and obtain her consent.
21. Fence off the patient with a screen (if the procedure is performed in the ward).
22. Place an absorbent pad (or oilcloth and diaper) under the patient's pelvis.
23. Help the patient to take the position necessary for the procedure: lying on her back with her legs apart, bent at the knee joints.
24. Wash and dry your hands. Put on clean gloves.
25. Carry out hygienic treatment of the external genitalia, urethra, perineum. Remove gloves and place them in a container with a disinfectant solution.
26. Wash and dry your hands.
27. Put large and medium sterile wipes into the tray using tweezers). Moisten medium wipes with an antiseptic solution.
28. Put on gloves.
29. Leave the tray between the legs. Spread the labia minora to the sides with your left hand (if you are right-handed).
30. Treat the entrance to the urethra with a napkin soaked in an antiseptic solution (hold it with your right hand).
31. Cover the entrance to the vagina and anus with a sterile napkin.
32. Remove gloves and place them in a waste container.
33. Treat your hands with an antiseptic.
34. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
35. Open a bottle of glycerin and pour into a beaker
36. Open the package with the catheter, put the sterile catheter into the tray.
37. Put on sterile gloves.

Performing a procedure
38. Take the catheter at a distance of 5–6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
39. Lubricate the catheter with glycerin.
40. Insert the catheter into the opening of the urethra for 10 cm or until urine appears (direct the urine into a clean tray).
41. Dump urine into the tray.
42. Fill the balloon of the Foley catheter with 10 - 30 ml of sterile saline or sterile water.

Completion of the procedure
43. Connect the catheter to a container for collecting urine (urinal).
44. Tape the urinal to your thigh or to the edge of your bed.
45. Make sure that the tubes connecting the catheter and the container do not have kinks.
46. Remove waterproof diaper (oilcloth and diaper).
47. Help the patient lie down comfortably and remove the screen.
48. Place the used material in a container with des. Solution.
49. Remove gloves and place them in a disinfectant solution.
50. Wash and dry your hands.
51. Make a record of the procedure done.

Bladder catheterization of a man with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Sterile gloves.
3. Clean gloves 2 pairs.
4. Sterile wipes medium - 5-6 pcs.
5. Large sterile wipes - 2 pcs.
b. Pitcher with warm water (30 - 35°C).
7. Vessel.
8. Bottle with sterile glycerin 5 ml.
9. Sterile syringe 20 ml - 1-2 pcs.
10. 10 - 30 ml of saline or sterile water, depending on the size of the catheter.
11. Antiseptic solution.
12. Trays (clean and sterile).
13. Urinary bag.
14. Absorbent diaper or oilcloth with a diaper.
15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. A container with a disinfectant solution.

Preparation for the procedure
19. Explain to the patient the essence and course of the upcoming procedure and obtain his consent.
20. Protect the patient with a screen.
21. Place an absorbent pad (or oilcloth and diaper) under the patient's pelvis.
22. Help the patient to take the necessary position: lying on his back with legs apart, bent at the knee joints.
23. Wash and dry your hands. Put on clean gloves.
24. Carry out hygienic treatment of the external genital organs. Remove gloves.
25. Treat your hands with an antiseptic.
26. Put large and medium sterile wipes into the tray using tweezers). Moisten medium wipes with an antiseptic solution.
27. Put on gloves.
28. Treat the head of the penis with a tissue soaked in antiseptic solution(hold it with your right hand).
29. Wrap the penis with sterile wipes (large)
30. Remove gloves and place them in a container with des. solution.
31. Treat your hands with an antiseptic.
32. Put a clean tray between your legs.
33. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
34. Open a bottle of glycerin.
35. Open the catheter package, put the sterile catheter into the tray.
36. Put on sterile gloves.

Performing a procedure
37. Take the catheter at a distance of 5-6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
38. Lubricate the catheter with glycerin.
39. Insert the catheter into the urethra and gradually, intercepting the catheter, move it deeper into the urethra, and “pull” the penis up, as if pulling it on the catheter, applying a slight uniform force until urine appears (direct the urine into the tray).
40. Dump urine into the tray.
41. Fill the balloon of the Foley catheter with 10 - 30 ml of sterile saline or sterile water.

Completion of the procedure
42. Connect the catheter to a container for collecting urine (urinal).
43. Attach the urinal to the thigh or to the edge of the bed.
44. Make sure that the tubes connecting the catheter and the container are not kinked.
45. Remove waterproof diaper (oilcloth and diaper).
46. Help the patient lie down comfortably and remove the screen.
47. Place the used material in a container with des. Solution.
48. Remove gloves and place them in a disinfectant solution.
49. Wash and dry your hands.
50. Make a record of the procedure done.

Cleansing enema

Equipment
1. Mug of Esmarch.
2. Water 1 -1.5 liters.
3. Sterile tip.
4. Vaseline.
5. Spatula.
6. Apron.
7. Taz.
8. Absorbent diaper.
9. Gloves.
10. Tripod.
11. Water thermometer.
12. Container with disinfectants.

Preparation for the procedure
10. Explain to the patient the essence and course of the upcoming procedure. Obtain patient consent for the procedure.
11. Wash and dry your hands.
12. Put on an apron and gloves.
13. Open the package, remove the tip, attach the tip to Esmarch's mug.
14. Close the valve on Esmarch's mug, pour 1 liter of water at room temperature into it (with spastic constipation, the water temperature is 40–42 degrees, with atonic constipation, 12–18 degrees).
15. Fix the mug on a tripod at a height of 1 meter from the level of the couch.
16. Open the valve and drain some water through the nozzle.
17. Lubricate the tip with petroleum jelly with a spatula.
18. Place an absorbent pad on the couch with an angle hanging down into the pelvis.

20. Remind the patient of the need to retain water in the intestines for 5–10 minutes.

Performing a procedure
21. Spread the buttocks 1 and 2 with the fingers of the left hand, with the right hand carefully insert the tip into the anus, moving it into the rectum towards the navel (3–4 cm), and then parallel to the spine to a depth of 8–10 cm.
22. Slightly open the valve so that water slowly enters the intestines.
24. Invite the patient to breathe deeply into the abdomen.
24. After introducing all the water into the intestine, close the valve and carefully remove the tip.
25. Help the patient get up from the couch and go to the toilet.

Completion of the procedure
26. Disconnect the tip from Esmarch's mug.
27. Place used equipment in a disinfectant solution.
28. Remove gloves and place in a disinfectant solution for subsequent disposal. Remove the apron and send for recycling.
29. Wash and dry your hands.
30. Verify that the procedure was effective.
31. Record the performance of the procedure and the patient's response.

Siphonic bowel lavage

Equipment

3. Gloves.
4. Container with disinfectant solution.
5. Tank for taking wash water for research.
6. Capacity (bucket) with water 10 -12 liters (T - 20 - 25 * C).
7. Capacity (basin) for draining wash water for 10 - 12 liters.
8. Two waterproof aprons.
9. Absorbent diaper.
10. Mug or jug for 0.5 - 1 liter.
11. Vaseline.
12. Spatula.
13. Napkins, toilet paper.

Preparation for the procedure
14. Clarify the patient's understanding of the purpose and course of the upcoming procedure. Obtain consent for manipulation.
15. Wash and dry your hands.
16. Prepare equipment.
17. Put on gloves, an apron.
18. Lay an absorbent pad on the couch, angle down.
19. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought to the stomach.

Performing a procedure
20. Remove the system from the packaging. Lubricate the blind end of the probe with Vaseline.
21. Spread the buttocks 1 and II with the fingers of the left hand, insert the rounded end of the probe into the intestine with the right hand and advance it to a depth of 30-40 cm: the first 3-4 cm - towards the navel, then - parallel to the spine.
22. Attach a funnel to the free end of the probe. Hold the funnel slightly obliquely, at the level of the patient's buttocks. Pour 1 liter of water into it from a jug along the side wall.
23. Invite the patient to breathe deeply. Raise the funnel to a height of 1 m. As soon as the water reaches the mouth of the funnel, lower it over the lavage basin below the level of the patient's buttocks, without pouring water out of it until the funnel is completely filled.
24. Drain the water into the prepared container (basin for washing water). Note: The first wash water may be collected in a test container.
25. Fill the funnel with the next portion and lift it up to a height of 1 m. As soon as the water level reaches the mouth of the funnel, lower it down. Wait until it is filled with washing water and drain them into the basin. Repeat the procedure many times until clean rinsing water, using all 10 liters of water.
26. Disconnect the funnel from the probe at the end of the procedure, leave the probe in the intestine for 10 minutes.
27. Remove the probe from the intestine with slow translational movements, passing it through a napkin.
28. Immerse the probe and funnel into the disinfectant container.
29. Wipe the skin around the anus with toilet paper (for women, away from the genitals) or wash the patient in case of helplessness.

Completion of the procedure
30. Ask the patient how they feel. Make sure he feels okay.
31. Ensure safe transportation to the ward.
32. Pour the wash water into the sewer, if indicated, carry out preliminary disinfection.
33. Disinfect used instruments with subsequent disposal of disposable instruments.
34. Remove gloves. Wash and dry hands.
35. Make a note in the patient's medical record about the procedure performed and the reaction to it.

Hypertonic enema

Equipment

3. Spatula.
4. Vaseline.
5. 10% sodium chloride solution or 25% magnesium sulfate
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Tray.
10. A container with water T - 60 ° C for heating a hypertonic solution.
11. Thermometer (water).
12. Measuring cup.
13. Disinfectant container

Preparation for the procedure

15. Before setting up a hypertonic enema, warn that pain may occur during manipulation along the course of the intestine.
16. Wash and dry your hands.
17. Heat the hypertonic solution to 38°C in a water bath, check the temperature of the drug.
18. Draw a hypertonic solution into a pear-shaped balloon or Janet's syringe.
19. Put on gloves.

Performing a procedure

26. Warn the patient that the onset of the effect of a hypertonic enema occurs after 30 minutes.

Completion of the procedure

28. Place used equipment in a disinfectant solution.
29. Remove gloves and place them in a disinfectant solution.
30. Wash and dry your hands.
31. Help the patient to go to the toilet.
32. Verify that the procedure was effective.
33. Make a record of the procedure and the patient's response.

Oil enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas tube.
3. Spatula.
4. Vaseline.
5. Oil (vaseline, vegetable) from 100 - 200 ml (as prescribed by a doctor).
b. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen (if the procedure is performed in the ward).
10. Tray.
11. Tank for heating oil with water T - 60°C.
12. Thermometer (water).
13. Measuring cup.

Preparation for the procedure
14. Inform the patient of the necessary information about the procedure and obtain his consent to the procedure.
15. Put up a screen.
16. Wash and dry your hands.
17. Heat the oil to 38°C in a water bath, check the temperature of the oil.
18. Draw warm oil into a pear-shaped balloon or Janet's syringe.
19. Put on gloves.

Performing a procedure
20. Help the patient lie on the left side. The patient's legs should be bent at the knees and slightly brought to the stomach.
21. Lubricate vent tube petroleum jelly and insert it into the rectum 15–20 cm.
22. Release air from the pear-shaped balloon or Janet syringe.
23. Attach a pear-shaped balloon or Janet syringe to the gas outlet tube and slowly inject the oil.
24. Without expanding the pear-shaped balloon, disconnect it (Jane's syringe) from the gas outlet tube.
25. Remove the gas outlet tube and place it together with the pear-shaped balloon or Janet syringe in the tray.
26. In the event that the patient is helpless, wipe the skin around the anus with toilet paper and explain that the effect will come in 6-10 hours.

Completion of the procedure
27. Remove the absorbent pad, place in a container for disposal.
28. Remove gloves and place them in a tray for subsequent disinfection.
29. Cover the patient with a blanket, help him to take a comfortable position. Remove screen.
30. Place used equipment in a disinfectant solution.
31. Wash and dry your hands.
32. Make a record of the procedure and the patient's response.
33. Evaluate the effectiveness of the procedure after 6-10 hours.

Medicinal enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas tube.
3. Spatula.
4. Vaseline.
5. Medicine 50-100 ml (chamomile decoction).
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen.
10. Tray.
11. Container for heating the drug with water T -60°C.
12. Thermometer (water).
13. Measuring cup.

Preparation for the procedure
14. Inform the patient of the necessary information about the procedure and obtain his consent to the procedure.
15. Give the patient a cleansing enema 20-30 minutes before setting the medicinal enema
16. Put up a screen.
17. Wash and dry your hands. Put on gloves.

Performing a procedure
18. Heat the drug to 38°C in a water bath, check the temperature with a water thermometer.
19. Draw a decoction of chamomile into a pear-shaped balloon or Janet's syringe.
20. Help the patient lie on the left side. The patient's legs should be bent at the knees and slightly brought to the stomach.
21. Lubricate the gas outlet tube with petroleum jelly and insert it into the rectum 15–20 cm.
22. Release air from the pear-shaped balloon or Janet syringe.
23. Attach a pear-shaped balloon or Janet syringe to the gas outlet tube and slowly inject the drug.
24. Without expanding the pear-shaped balloon, disconnect it or Janet's syringe from the gas outlet tube.
25. Remove the gas outlet tube and place it together with the pear-shaped balloon or Janet syringe in the tray.
26. In the event that the patient is helpless, wipe the skin around the anus with toilet paper.
27. Explain that after the manipulation it is necessary to spend at least 1 hour in bed.

Completion of the procedure
28. Remove the absorbent pad, place in a container for disposal.
29. Remove gloves and place them in a tray for subsequent disinfection.
30. Cover the patient with a blanket, help him take a comfortable position. Remove screen.
31. Place used equipment in a disinfectant solution.
32. Wash and dry your hands.
33. After an hour, ask the patient how he feels.
34. Make a record of the procedure and the patient's response.

Preparation for the procedure
14. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
15. Wash and dry your hands.
16. Prepare the equipment (the probe must be in the freezer 1.5 hours before the start of the procedure).
17. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last opening of the probe is below the xiphoid process).
18. Help the patient to accept the high position of Fowler.
19. Cover the patient's chest with a towel.
20. Wash and dry your hands. Put on gloves.

Performing a procedure
21. Copiously treat the blind end of the probe with glycerin.
22. Ask the patient to tilt his head back slightly.
23. Insert the probe through the lower nasal passage at a distance of 15–18 cm.
24. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add ice cubes to the water.
25. Help the patient to swallow the probe, moving it into the throat during each swallowing movement.
26. Make sure the patient can speak clearly and breathe freely.
27. Gently advance the probe to the desired mark.
28. Make sure the probe is in the correct location in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) must enter the syringe.
29. If necessary, leave the probe for a long time, fix it with a patch to the nose. Remove towel.
30. Close the probe with a plug and attach with a safety pin to the patient's chest clothing.

Completion of the procedure
31. Remove gloves.
32. Help the patient to take a comfortable position.
33. Place the used material in a disinfectant solution for subsequent disposal.
34. Wash and dry your hands.
35. Make a record of the procedure and the patient's response.

Preparation for the procedure
16. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
17. Wash and dry your hands.
18. Prepare the equipment (the probe must be in the freezer 1.5 hours before the start of the procedure).
19. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last opening of the probe is below the xiphoid process).
20. Help the patient to assume the high position of Fowler.
21. Cover the patient's chest with a towel.
22. Wash and dry your hands. Put on gloves.

Performing a procedure
23. Copiously treat the blind end of the probe with glycerin.
24. Ask the patient to tilt his head back slightly.
25. Insert the probe through the lower nasal passage at a distance of 15 - 18 cm.
26. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add ice cubes to the water.
27. Help the patient to swallow the probe, moving it into the throat during each swallowing movement.
28. Make sure the patient can speak clearly and breathe freely.
29. Gently advance the probe to the desired mark.
30. Make sure the probe is in the correct location in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) should enter the syringe or inject air with a syringe into the stomach under the control of a phonendoscope (characteristic sounds are heard).
31. Disconnect the syringe from the probe and apply a clip. Place the free end of the probe into the tray.
32. Remove the clamp from the probe, connect Janet's syringe without a piston and lower it to the level of the stomach. Tilt Janet's syringe slightly and pour in food heated to 37–38 °C. Gradually raise until the food reaches the cannula of the syringe.
33. Lower Janet's syringe to the initial level and introduce the next portion of food. The introduction of the required volume of the mixture should be carried out fractionally, in small portions of 30-50 ml, at intervals of 1-3 minutes. After the introduction of each portion, pinch the distal portion of the probe.
34. Rinse the probe with boiled water or saline at the end of feeding. Place a clamp on the end of the probe, disconnect Janet's syringe and close with a plug.
35. If it is necessary to leave the probe for a long time, fix it with a plaster to the nose and attach it with a safety pin to the patient's clothes on the chest.
36. Remove the towel. Help the patient to assume a comfortable position.

Completion of the procedure
37. Place used equipment in a disinfectant solution for subsequent disposal.
38. Remove gloves and place in a disinfectant solution for subsequent disposal.
39. Wash and dry your hands.
40. Make a record of the procedure and the patient's response.

Gastric lavage with a thick gastric tube

Equipment
1. Sterile system of 2 thick gastric tubes connected by a transparent tube.
2. Sterile funnel 0.5 - 1 liter.
3. Gloves.
4. Towel, napkins are medium.
5. Container with disinfectant solution.
b. Tank for washing water analysis.
7. Container with water 10 liters (T - 20 - 25 * C).
8. Capacity (basin) for draining wash water for 10 - 12 liters.
9. Vaseline oil or glycerin.
10. Two waterproof aprons and an absorbent diaper if washing is done lying down.
11. Mug or jug for 0.5 - 1 liter.
12. Mouth expander (if necessary).
13. Language holder (if necessary).
14. Phonendoscope.

Preparation for the procedure
15. Explain the purpose and course of the upcoming procedure. Explain that when the probe is inserted, nausea and vomiting are possible, which can be suppressed by deep breathing. Obtain consent for the procedure. Measure blood pressure, count the pulse, if the patient's condition allows it.
16. Prepare equipment.

Performing a procedure
17. Help the patient to take the position necessary for the procedure: sitting, leaning against the back of the seat and slightly tilting his head forward (or lay on the couch in the side position). Remove the patient's dentures, if any.
18. Put on a waterproof apron for yourself and the patient.
19. Wash your hands, put on gloves.
20. Place the pelvis at the patient's feet or at the head end of the couch or bed if the procedure is performed in the supine position.
21. Determine the depth to which the probe should be inserted: height minus 100 cm or measure the distance from the lower incisors to the earlobe and to the xiphoid process. Put a mark on the probe.
22. Remove the system from the packaging, moisten the blind end with Vaseline.
23. Put the blind end of the probe on the root of the tongue and ask the patient to swallow.
24. Insert the probe to the desired mark. Assess the patient's condition after swallowing the probe (if the patient coughs, then remove the probe and repeat the insertion of the probe after the patient rests).
25. Make sure that the probe is in the stomach: draw 50 ml of air into Janet's syringe and attach it to the probe. Introduce air into the stomach under the control of a phonendoscope (characteristic sounds are heard).
26. Attach the funnel to the probe and lower it below the level of the patient's stomach. Fill the funnel completely with water, holding it at an angle.
27. Slowly raise the funnel up to 1 m and control the passage of water.
28. As soon as the water reaches the mouth of the funnel, slowly lower the funnel to the level of the patient's knees, drain the rinsing water into the basin for rinsing water. Note: The first wash water may be collected in a test container.
29. Repeat rinsing several times until clean rinsing water appears, using the entire amount of water, collecting rinsing water in a basin. Make sure that the amount of the injected portion of the liquid corresponds to the amount of the allocated wash water.

End of procedure
30. Remove the funnel, remove the probe, passing it through a napkin.
31. Place the used instrumentation in a container with a disinfectant solution. Drain the wash water into the sewer, pre-disinfect them in case of poisoning.
32. Remove the aprons from yourself and the patient and place them in a container for disposal.
33. Remove gloves. Place them in a disinfectant solution.
34. Wash and dry your hands.
35. Give the patient the opportunity to rinse his mouth and accompany (deliver) to the ward. Cover warmly, observe the condition.
36. Make a note about the procedure.

Dilution of the antibiotic in a vial and intramuscular injection

Equipment
1. Disposable syringe with a volume of 5.0 to 10.0, an additional sterile needle.
2. Vial with benzylpenicillin sodium salt 500,000 units, sterile water for injection.

5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Non-sterile tweezers for opening the vial.
9. Containers with disinfectant solution for disinfection of used equipment

Preparation for the procedure
10. Clarify the patient's awareness of the drug and his consent to the injection.
11. Help the patient to take a comfortable lying position.
12. Wash and dry your hands.
13. Put on gloves.
14. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the vial and ampoule; - packaging with tweezers - expiration date; - packaging with soft material - expiration date.
15. Remove the sterile tray from the package.
16. Collect a disposable syringe, check the patency of the needle.
17. Open the aluminum cap on the vial with non-sterile tweezers and file the ampoule with the solvent.
18. Prepare cotton balls, moisten them with a skin antiseptic.
19. Treat the bottle cap with a cotton ball moistened with alcohol and an ampoule with a solvent, open the ampoule.
20. Draw the required amount of solvent into the syringe to dilute the antibiotic (in 1 ml of the dissolved antibiotic - 200,000 units).
21. Pierce the bottle cap with the needle of the solvent syringe, | add solvent to the vial.
22. Shaking the vial, achieve complete dissolution of the powder, dial the desired dose into the syringe.
23. Change the needle, expel the air from the syringe.
24. Put the syringe in a sterile tray.

Performing a procedure
25. Determine the site of the proposed injection, palpate it.
26. Treat the injection site twice with a napkin or cotton ball with a skin antiseptic.
27. Stretch the skin at the injection site with two fingers or make a fold.
28. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two thirds of the length, holding the cannula with your little finger.
29. Release the skin fold and use the fingers of this hand to pull the plunger of the syringe towards you.
30. Press on the piston, slowly insert medicinal product.

End of procedure
31. Remove the needle by pressing the injection site with a tissue or cotton ball with a skin antiseptic.
32. Make a light massage without removing the napkin or cotton ball from the injection site (depending on the drug) and help to get up.
33. Disinfection of used material and equipment with subsequent disposal.
34. Remove gloves, throw into a container with disinfectant.
35. Wash and dry your hands.
36. Ask the patient how he feels after the injection.
37. Make a record of the procedure performed in the patient's medical record.

intradermal injection

Equipment
1. Disposable syringe 1.0 ml, additional sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) 3 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.

Preparation for the procedure

10. Help the patient to take a comfortable position (sitting).
11. Wash and dry your hands.
12. Put on gloves.

16. Prepare 3 cotton balls, moisten 2 balls with skin antiseptic, leave one dry.

Performing a procedure
21. Determine the site of the proposed injection (middle inner part of the forearm).
22. Treat the injection site with a napkin or cotton ball with a skin antiseptic, then with a dry ball.
23. Stretch the skin at the injection site.
24. Take a syringe, insert a needle into the needle section, holding the cannula with your index finger.
25. Press on the plunger, slowly inject the drug with the hand that was used to stretch the skin.

End of procedure
26. Remove the needle without treating the injection site.

29. Wash and dry your hands.

subcutaneous injection

Equipment
1. Disposable 2.0 syringe, extra sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Containers with disinfectant solution for disinfection of used equipment

Preparation for the procedure
9. Clarify the patient's awareness of the drug and obtain his consent to the injection.

11. Wash and dry your hands.
12. Put on gloves.
13. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the package and ampoule; - packaging with tweezers - expiration date; - packaging with soft material - expiration date.
14. Remove the sterile tray from the package.
15. Collect a disposable syringe, check the patency of the needle.

17. Open the ampoule with the drug.
18. Dial the drug.
19. Change the needle, expel the air from the syringe.
20. Put the syringe in a sterile tray.

Performing a procedure

23. Take the skin at the injection site in the fold.
24. Take a syringe, insert the needle under the skin (at an angle of 45 degrees) two thirds of the length of the needle.
25. Release the skin fold and press the piston with the fingers of this hand, slowly inject the drug.

End of procedure
26. Remove the needle by pressing the injection site with a tissue or cotton ball with a skin antiseptic.
27. Disinfection of used material and equipment with subsequent disposal.
28. Remove gloves, discard into a container with disinfectant.
29. Wash and dry your hands.
30. Ask the patient how he feels after the injection.
31. Record the procedure performed in the patient's medical record.

Intramuscular injection

Equipment
1. Disposable syringe with a volume of 2.0 to 5.0, an additional sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
b. Gloves.
7. Sterile tweezers.
8. Containers with disinfectant solution for disinfection of used equipment

Preparation for the procedure
9. Clarify the patient's awareness of the drug and obtain his consent to the injection.
10. Help the patient to take a comfortable lying position.
11. Wash and dry your hands.
12. Put on gloves.
13. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the package and ampoule; - packaging with tweezers - expiration date; - packaging with soft material - expiration date.
14. Remove the sterile tray from the package.
15. Collect a disposable syringe, check the patency of the needle.
16. Prepare cotton balls, moisten them with a skin antiseptic.
17. Open the ampoule with the drug.
18. Dial the drug.
19. Change the needle, expel the air from the syringe.
20. Put the syringe in a sterile tray.

Performing a procedure
21. Determine the site of the proposed injection, palpate it.
22. Treat the injection site twice with a napkin or cotton ball with a skin antiseptic.
23. Stretch the skin at the injection site with two fingers.
24. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two thirds of the length, holding the cannula with the little finger.
25. Pull the plunger of the syringe towards you.
26. Press on the plunger, slowly inject the drug.

End of procedure
27. Remove the needle; pressing the injection site with a napkin or cotton ball with a skin antiseptic.
28. Make a light massage without removing the napkin or cotton ball from the injection site (depending on the drug) and help to get up.
29. Used material, equipment subjected to disinfection with subsequent disposal.
30. Remove gloves, discard into a container with disinfectant.
31. Wash and dry your hands.
32. Ask the patient how he feels after the injection.
33. Make a record of the procedure performed in the patient's medical record.

DEPARTMENT OF HEALTH OF THE CITY OF MOSCOW State budgetary professional educational institution of the Department of Health of the city of Moscow "MEDICAL COLLEGE No. 2" Group 374 Specialty 34.02.01. Nursing PM 02 Participation in medical diagnostic and rehabilitation processes. The work was defended with an assessment (signature of the head) "" 20g.

Course work

Subject: Nursing activity in fractures of limb bones in the post-traumatic period

Completed by: Antonov A.G.

"___" _________ 20

signature________________

Head: Kazakov A.A.,

teacher GBPOU DZM "MK No. 2"

______________________________

"___" _________ 20

Moscow 2016

LIST OF ABBREVIATIONS

BP - Blood pressure

ASh - Anaphylactic shock

AU (ME) - Units of action

(International Units) ICU - Intensive Care Unit

CPR - Cardiopulmonary resuscitation

NPV - Frequency respiratory movements

HR - Heart rate

ECG - Electrocardiogram

INTRODUCTION

Among the main causes of death of the population, diseases of the circulatory system occupy a leading place. With such diseases, pathologies are observed both in the vessels and in the very heart of the patient. Cardiovascular diseases - diseases of the circulatory system at the beginning of the 20th century occupied no more than a few percent in the structure of the pathology of the population. Back in the 50s. according to a mass survey in more than 50 cities and rural areas Russian Federation they occupied 10th - 11th place in the ranking of diseases. Approximately the same situation was abroad. In the future, the changing lifestyle of the population, industrialization, urbanization with psycho-emotional stress and other risk factors of a civilized society, as well as improving the diagnosis of coronary artery disease, hypertension and other lesions have dramatically increased the proportion of circulatory diseases. Today, cardiovascular diseases are in the first place for the causes of disability and mortality of the population of the Russian Federation.

Currently, there are more than 380 million people in the world whose age exceeds 65 years. In Russia, a fifth of the total population is made up of elderly and senile people. In the next 10 years, they expect an increase in the number of older citizens by about 2 times, i.e. already 40% of the population will be in the category of elderly and senile age. The incidence rate in older people is 2 times higher than in younger people. old age- 6 times.

The aging process is a continuous gradual transition from stage to stage: the optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - disability - death.

The rate of aging can be quantified using indicators that reflect a decrease in viability and an increase in damage to the body. One of these parameters is age.

Currently, 1-2% of the population of developed countries suffer from diseases of the circulatory system. Every year, chronic heart failure develops in 1% of people over 60 years of age and in 10% of people over the age of 75 years.

The elderly make up the majority of CAD patients. Almost 3/4 of deaths from coronary artery disease occur among people over 65 years of age, and almost 80% of people who die from myocardial infarction belong to this group. age group. At the same time, in more than 50% of cases, the death of people over 65 years of age occurs from complications of coronary artery disease.

The prevalence of coronary artery disease (and, in particular, angina pectoris) in young and middle age is higher among men than among women, however, by the age of 70–75, the incidence of coronary artery disease among men and women is comparable (25–33%). Annual mortality among patients in this category is 2-3%, in addition, another 2-3% of patients may develop myocardial infarction.

Objective:

Analysis of the features of the course of diseases of the circulatory organs in elderly patients, and the development of a set of measures for their prevention in the geriatric department.

The set goal defines the following range of tasks:

Analysis of the literature on the topic under study;

Carrying out a comparative assessment of the level of knowledge of risk factors for the occurrence of circulatory diseases among patients of the geriatric department.

Object of study: the work of nurses in the geriatric department.

Chapter 1. Literature Review.

1.1. Chronic heart failure as a consequence hypertension.Chronic heart failure (CHF, synonym: cardiovascular failure) is a condition in which the heart is not able to provide sufficient blood supply to the body to ensure metabolism (metabolism) in tissues. It can develop in hypertension due to overload of the left heart. Circulatory failure is a syndrome in cardiac and non-cardiac diseases. Circulatory failure is associated with:

1. deterioration in myocardial contractility,

2. decrease in stroke (minute) volume of the heart (low cardiac output syndrome)

3. overload heart pressure,

4. overload of the heart with volume.

Main part

1.2. Etiopathogenesis of heart failure. Classification. Risk factors. Clinic. Complications. Prognosis. Circulatory failure can be acute and chronic (congestive), as well as right ventricular, left ventricular and total (biventricular).

Chronic total (congestive) circulatory failure (CNK, ZNK) begins with the left ventricular, which leads to stagnation of blood in the small circle, and then right ventricular (stagnation in big circle). Stagnation of blood develops above the weakened part of the heart.

Chronic heart failure is observed in hypertension, ischemic heart disease, cardiomyopathies, myocardial dystrophy, carditis, heart defects, symptomatic hypertension, arrhythmias, chronic bronchitis, COPD, chronic renal failure, hepatargia.

Clinic of chronic (congestive) circulatory insufficiency (CNC).

Symptoms: 1. nocturia (the very first symptom is an increase in renal blood flow at rest),

2. shortness of breath (decrease in partial pressure of oxygen, cardiac output), first during exercise, and then at rest (in the supine position orthopnea. The degree of orthopnea can be assessed by the number of pillows under the patient’s head), first dry rales in the lungs due to swelling of the bronchial mucosa, for

the wet due to stagnation of fluid in the lumen of the bronchi - stagnation in a small circle,

3. edema begins with sloping places - legs, fingers, lower back in the recumbent - a sign of right ventricular failure (in a large circle).

Right ventricular failure leads to stagnation of blood and enlargement of the liver with portal hypertension, ascites; then hydrothorax develops - a sign of blood stagnation in both the small and large circle, since the visceral sheet is supplied with blood from the small circle, and the parietal - from the large one; anasarca - swelling of the whole body,

4. cold acrocyanosis due to an increase in the concentration of reduced hemoglobin (it has blue color) in the distal parts due to stagnation of blood and slowing down the rate of hemoglobin binding to carbon dioxide,

5. weakness, fatigue - low tolerance to physical activity due to hypoxia,

6. anorexia - lack of appetite - edema and atrophy of the mucosa of the gastrointestinal tract,

7. bulging of the veins of the neck due to an increase in pressure in the right atrium and a positive symptom of Plesh (when pressing on the liver, the veins of the neck swell),

8. cough - swelling of the bronchial mucosa and hemoptysis, sweating (diapedesis) of erythrocytes into the lumen of the bronchi due to venous plethora of pulmonary vessels and increased pressure in the small circle,

9. dilatation of the heart chambers due to volume overload and myocardial hypertrophy due to pressure overload,

10. tachycardia, followed by bradycardia,

11. liver enlargement,

12. "Corvisar's face": yellowish-pale, acrocyanosis, half-open mouth, dull eyes.

radiograph chest with CHF. All parts of the heart are enlarged. Such a heart is called "bull".

Stages of congestive circulatory failure (CNC): I - latent - fatigue, shortness of breath, palpitations with little physical exertion, myocardial hypertrophy and dilatation of the heart chambers are detected,

II - shortness of breath and tachycardia are constant, stagnation in the small circle, amenable to therapy,

III - shortness of breath at rest, signs of stagnation in the small and large circle, therapy does not give the full effect,

IV - dystrophic, irreversible, therapy is not effective.

Factors provoking decompensation (compensation - compensation, decompensation - loss of function, lack of balance) of chronic (congestive) circulatory failure: pregnancy, psycho-emotional overstrain, inadequate physical activity, excess salt in food, cancellation of cardiotonics, b-blockers, alcohol intake, corticosteroids, anti-inflammatory non-steroids, sex hormones.

Complications:one. cordial cirrhosis of the liver,

2. chronic kidney failure,

3. arrhythmias.

The course is progressive. The prognosis is unfavorable.

Treatment of chronic heart failure . For the treatment of chronic circulatory failure, the following are used: cardiac glycosides, digitalis, strophanthus, non-glycoside cardiotonic drugs.

Surgical treatment: heart transplant.

Prevention is the treatment of diseases that cause CHF. Rehabilitation. Diet therapy (In case of circulatory failure of II-III degree). In case of circulatory insufficiency of II-III degree, table No. 10A is prescribed. The purpose and characteristics of the diet are the same as diet No. 10. All dishes are prepared without salt, food is given in a pureed form. Chemical composition: proteins - 60 g, fats - 50 g, carbohydrates - 30 g, content of vitamins and minerals the same as in diet number 10; energy value - 1900 kcal. The liquid is limited to 1/2 of the norm (500-600 ml). The number of meals - 6 times. To improve the taste of food, you can use cumin, parsley, bay leaf, vanilla, lemon. High-protein salt-free bread is used. Recommended: cottage cheese-apple or cottage cheese-apple-potato fasting days; potassium diet (milk, rosehip broth, fruit and vegetable juice, rice porridge, salt-free bread, potatoes). With pronounced changes in the heart in acute phase diseases for 1.5-2 weeks, an anti-inflammatory diet is prescribed with a restriction of carbohydrates due to bread and sweets, as well as table salt (up to 1/3 of the norm). Extractive substances are completely excluded. The food is steamed. Diet in the first hours and days of acute myocardial infarction, when the patient's appetite is sharply reduced, is limited to fruit juices, mineral water, easily digestible and high-calorie foods. Starting from 3-4 days, the diet is gradually expanded with products from mashed meat, cottage cheese and other lactic acid products, so that by the 7-10th day of the disease the patient is transferred to diet No. 10. 4-5 meals a day are optimal. Eating at large intervals contributes to an increase in fat formation and the progression of associated changes in the vessels - atherosclerosis. After all, with many hours of intervals between meals, the body begins to store fat in case of possible starvation, moreover a large number of eaten fills and stretches the stomach, complicates the work of the heart and the entire cardiovascular system.

One of the reasons for the increase in the number of diseases of the cardiovascular system is the decrease in motor activity of a modern person. That is why regular physical education, the inclusion of various muscle activities in the daily routine are necessary for their prevention. In the presence of a disease, exercise therapy exercises provide healing effect and stop further development. Strictly dosed, gradually increasing physical activity increases functionality cardiovascular system, are an important means of rehabilitation. In chronic diseases, after achieving a steady improvement in the patient's condition and in the absence of an opportunity to achieve further improvement in the functions of the cardiovascular system, physiotherapy exercises are used as a method of maintenance therapy.

Mechanisms of therapeutic and rehabilitation action exercise

The use of physical exercise cardiovascular diseases allows you to use all 4 mechanisms of their therapeutic action: tonic effect, trophic effect, formation of compensation and normalization of functions. For many diseases of cardio-vascular system the patient's range of motion is limited. The patient is depressed, "immersed in the disease", in the central nervous system inhibitory processes predominate. In this case, physical exercises become important for providing a general tonic effect. Improving the functions of all organs and systems under the influence of physical exercises prevents complications, activates the body's defenses and speeds up recovery. Improves psycho emotional condition the patient, which, of course, also has a positive effect on the processes of sanogenesis.

Physical exercise improves trophic processes in the heart and throughout the body. They increase the blood supply to the heart by increasing coronary blood flow, opening reserve capillaries and developing

collaterals, activate metabolism. All this stimulates the recovery processes in the myocardium, increases its contractility. Physical exercise also improves the overall metabolism in the body, lowers cholesterol in the blood, delaying the development of atherosclerosis. A very important mechanism is the formation of compensation. In many diseases of the cardiovascular system, especially in a serious condition of the patient, physical exercises are used that have an effect through extra-cardiac (extracardiac) circulatory factors. So, exercises for small muscle groups promote the movement of blood through the veins, acting as a muscle pump and causing the expansion of arterioles, reduce peripheral resistance to arterial blood flow. Breathing exercises promote inflow venous blood to the heart due to rhythmic changes in intra-abdominal and intrathoracic pressure. During inhalation, the negative pressure in the chest cavity has a suction effect, and the rising intra-abdominal pressure, as it were, squeezes blood from the abdominal cavity into the chest cavity. During expiration, the movement of venous blood from the lower extremities is facilitated, since intra-abdominal pressure is reduced. Normalization of functions is achieved by gradual and careful training, which strengthens the myocardium and improves its contractility, restores vascular responses to muscle work and changes in body position. Physical exercise normalizes the function of regulatory systems, their ability to coordinate the work of the cardiovascular, respiratory and other body systems during physical exertion. This increases the ability to do more work. Systematic exercise has an impact on blood pressure through many parts of the long-term regulatory systems. So, under the influence of a gradual dosed training, the tone of the vagus nerve and the production of hormones increase.

(for example, prostaglandins), which lower blood pressure. As a result, resting heart rate slows down and blood pressure drops. Special attention should be paid to special exercises, which, having an effect mainly through neuro-reflex mechanisms, reduce blood pressure. So, breathing exercises with lengthening the exhalation and slowing down the breath reduce the heart rate. Exercises in muscle relaxation and for small muscle groups lower the tone of arterioles and reduce peripheral resistance to blood flow. In diseases of the heart and blood vessels, physical exercises improve (normalize) the adaptive processes of the cardiovascular system, which consist in strengthening the energy and regenerative mechanisms that restore functions and disturbed structures. Physical culture is of great importance for the prevention of diseases of the cardiovascular system, as it compensates for the lack of physical activity of a modern person. Physical exercises increase the general adaptive (adaptive) capabilities of the body, its resistance to various stressful influences, giving mental relaxation and improving the emotional state. Physical training develops physiological functions and motor qualities, increasing mental and physical performance. Activation of the motor mode by various physical exercises improves the functions of systems that regulate blood circulation, improves myocardial contractility and blood circulation, reduces the content of lipids and cholesterol in the blood, increases the activity of the anticoagulant blood system, promotes the development of collateral vessels, reduces hypoxia, i.e., prevents and eliminates manifestations most risk factors for major cardiovascular diseases. Thus, physical culture is shown to all healthy people not only as a health-improving, but also as a prophylactic. Especially she

necessary for those individuals who are currently healthy, but have any risk factors for cardiovascular disease. For people with cardiovascular disease, exercise is the most important rehabilitation tool and secondary prevention.

Fundamentals of methods of physical exercises in the treatment and rehabilitation of patients with cardiovascular diseases. In these classes, it is very important to strictly observe the basic didactic principles: accessibility and individualization, systematic and gradual increase in requirements. It is necessary to widely use the methodical method of dissipating and alternating loads, when an exercise for one muscle group is replaced by an exercise for another group, and exercises with a large muscle load alternate with exercises that require little muscle effort, and breathing. The method of physical exercise depends on the disease and the nature of the pathological changes caused by it, the stage of the disease, the degree of circulatory insufficiency, the state of the coronary blood supply.

In severe manifestations of the disease, severe heart failure or coronary circulation, classes are structured in such a way as to primarily have a therapeutic effect: prevent complications by improving peripheral circulation and respiration, help compensate for weakened heart function due to the activation of non-cardiac circulatory factors, improve trophic processes by stimulating myocardial blood supply. For this, low-intensity physical exercises are used, at a slow pace for small muscle groups, breathing exercises and muscle relaxation exercises.

loads. Therapeutic exercises include exercises for medium and large muscle groups, exercises with objects (gymnastic sticks, balls), light weights (dumbbells, stuffed balls 1-1.5 kg) and resistance, sedentary games, game tasks, various walking, short running at a slow pace. Movements that are complex in coordination are performed with full amplitude. The number of repetitions is 8-12 times. These exercises alternate with exercises for small muscle groups of the arms and legs and breathing exercises. All basic starting positions are applied: standing, sitting and lying down. In addition to therapeutic exercises, morning hygienic exercises and dosed walking are used. The walking distance increases from several hundred meters to 1-1.5 km, the pace of walking is up to 70-80 steps / min (speed 50-60 m / min). With a compensated state of blood circulation (NC 0), the task is to train the cardiovascular system and the whole body with gradually increasing physical activity. Numerous observations of patients with atherosclerosis and the elderly also indicate the beneficial effect of various muscle activities. So, with an increase in cholesterol in the blood, the course of exercise therapy often lowers it to normal values. The use of physical exercises that provide special therapeutic effect, for example, improves peripheral blood circulation, helps to restore motor-visceral connections, impaired due to the disease. As a result, the responses of the cardiovascular system become adequate, the number of perverted reactions decreases. Special physical exercises improve blood circulation in that area or vessels. Systematic exercises develop collateral (roundabout) blood circulation. Under the influence of physical activity normalizes overweight. With the initial signs of atherosclerosis and the presence of risk factors for the prevention of further development of the disease

Chapter 2 Practical part

2.1Indications and contraindications for the use of physiotherapy exercises

Physical exercises as a means of treatment and rehabilitation are indicated for all diseases of the cardiovascular system. Contraindications are only temporary. Physiotherapy contraindicated in acute stage diseases (myocarditis, endocarditis, angina pectoris and myocardial infarction during the period of frequent and intense attacks of pain in the heart area, severe disorders heart rate), with an increase in heart failure, the addition of severe complications from other organs.

With the removal of acute phenomena and the cessation of the increase in heart failure, improvement general condition you should start exercising.

Fundamentals of methods of physical exercises in the treatment and rehabilitation of patients with cardiovascular diseases. In these classes, it is very important to strictly observe the basic didactic principles: accessibility and individualization, systematic and gradual increase in requirements. It is necessary to widely use the methodical method of dissipation and alternation of loads, when an exercise for one muscle group is replaced by an exercise for another group, and exercises with a large muscle load alternate with exercises that require little muscle effort and breathing. The method of physical exercises depends on the disease and the nature of the pathological changes caused by it, the stage

diseases, the degree of circulatory failure, the state of the coronary blood supply. In severe manifestations of the disease, severe heart failure or coronary circulation, classes are structured in such a way as to primarily have a therapeutic effect: prevent complications by improving peripheral circulation and respiration, help compensate for weakened heart function due to the activation of non-cardiac circulatory factors, improve trophic processes by stimulating myocardial blood supply. For this, low-intensity physical exercises are used, at a slow pace for small muscle groups, breathing exercises and muscle relaxation exercises.

When the patient's condition improves, physical exercises are used in combination rehabilitation measures to restore functionality. Although physical exercises continue to be used for the implementation of therapeutic tasks, systematic training is becoming the main direction, i.e. in the classroom, the physical load gradually increases. First, due to a large number of repetitions, then - the amplitude and pace of movements, the inclusion of more difficult physical exercises and starting positions. From exercises of low intensity, they move on to exercises of medium and high intensity, and from the initial positions of lying and sitting to the initial position of standing. In the future, dynamic cyclic loads are used: walking, working on a bicycle ergometer, running.

After the end of rehabilitation treatment and in chronic diseases, physical exercises are used to maintain the results achieved to improve blood circulation and stimulate the functions of other organs and systems. Exercise and Dosage physical activity are selected depending on the residual manifestations of the disease and functional state sick. Are used

a variety of physical exercises (gymnastics, elements of sports, games), which are periodically replaced, physical activity is familiar, but from time to time it either increases or decreases. For effective treatment and rehabilitation of patients, the use of physical activity dosages adequate to the patient's condition is of great importance. To determine it, many factors have to be taken into account: the manifestations of the underlying disease and the degree of coronary insufficiency, the level of physical performance, the state of hemodynamics, the ability to perform household physical activity. Given these factors, patients ischemic disease hearts are divided into 4 functional classes, for each of which is regulated physical activity and study programs. This regulation also applies to patients with other diseases of the cardiovascular system.

The method of exercise therapy for diseases of the cardiovascular system also depends on the degree of circulatory failure. In chronic heart failure III degree, therapeutic exercises are used only when stabilizing circulatory failure during the period of intensive treatment with an improvement in the patient's condition. Therapeutic gymnastics is aimed at preventing complications, stimulating compensation and improving mental state sick. Properly selected exercises do not complicate, but, on the contrary, facilitate the work of the heart, as they activate non-cardiac factors of blood circulation. These exercises include active movements for small and medium muscle groups. Movements in large joints limbs are performed with incomplete amplitude, with a shortened lever, sometimes with the help or passively. Exercises for the body are used only in the form of a turn to the right side and a low elevation of the pelvis. Static breathing exercises are performed without deepening breathing, at a slow pace, in the initial position lying on your back with a raised headboard. Quantity

repetitions in large joints 3-4 times, in small ones - 4-6 times. In chronic heart failure of II degree, exercise therapy is carried out to prevent complications, improve peripheral circulation and fight congestion, improve metabolic processes in the myocardium, provide a slight general tonic effect that increases the functions of all body systems, including the central nervous and endocrine systems. In case of insufficiency of H-II B degree, the method of practicing therapeutic exercises basically resembles the method for H-III, but the number of repetitions of movements in small joints increases (up to 8-10 times), breathing exercises are performed with lengthening and a slight increase in exhalation to improve venous outflow and peripheral circulation. For the muscles of the body, exercises in incomplete amplitude begin to be applied with the number of repetitions 3-4 times. Starting positions lying and sitting. With H-II A deficiency in therapeutic exercises, the number of exercises for medium and large muscle groups of the limbs and trunk increases. Gradually increases, but remains incomplete, the range of motion of the body. All movements are in harmony with the breath. Special breathing exercises, static and dynamic, are carried out with intensification and lengthening of the exhalation. Movements in large joints are performed at a slow pace 4-6 times, and in small ones - an average of 8-12 times lying, sitting and standing. When the condition improves, the task is to gradually adapt the patient to moderately increasing physical activity. Dosed walking begins to be applied, which is gradually brought to several hundred meters. Walking pace is slow. Gymnastic exercises become more difficult, the range of motion and pace increase. The number of repetitions of exercises for large muscle groups increases to 6-12 times. In chronic heart failure of the 1st degree, the main task of physical exercises is the adaptation of the cardiovascular system and the whole organism to household and industrial physical activity.

loads. Therapeutic exercises include exercises for medium and large muscle groups, exercises with objects (gymnastic sticks, balls), light weights (dumbbells, stuffed balls 1-1.5 kg) and resistance, sedentary games, game tasks, various walking, short running at a slow pace. Movements that are complex in coordination are performed with full amplitude. The number of repetitions is 8-12 times. These exercises alternate with exercises for small muscle groups of the arms and legs and breathing exercises. All basic starting positions are applied: standing, sitting and lying down. In addition to therapeutic exercises, morning hygienic exercises and dosed walking are used. The walking distance increases from several hundred meters to 1-1.5 km, the pace of walking is up to 70-80 steps / min (speed 50-60 m / min). With a compensated state of blood circulation (NC 0), the task is to train the cardiovascular system and the whole body with gradually increasing physical activity. Numerous observations of patients with atherosclerosis and the elderly also indicate the beneficial effect of various muscle activities. So, with an increase in cholesterol in the blood, the course of exercise therapy often lowers it to normal values. The use of physical exercises that have a special therapeutic effect, for example, improving peripheral circulation, helps to restore motor-visceral connections that have been disturbed due to the disease. As a result, the responses of the cardiovascular system become adequate, the number of perverted reactions decreases. Special physical exercises improve blood circulation in that area or organ, the nutrition of which is impaired due to vascular damage. Systematic exercises develop collateral (roundabout) blood circulation. Under the influence of physical activity, excess weight is normalized. With the initial signs of atherosclerosis and the presence of risk factors for the prevention of further development of the disease

it is necessary to eliminate those that can be affected. Therefore, exercise, a diet that reduces cholesterol and fat rich foods, and smoking cessation are all effective.

Most physical exercises are suitable for classes: long walks, gymnastic exercises, swimming, skiing, running, rowing, sports games. Especially useful are physical exercises that are performed in an aerobic mode, when the need of working muscles for oxygen is fully satisfied. Physical activity is dosed depending on the functional state of the patient. Usually they initially correspond to the physical loads used for patients assigned to functional class I. Then classes should be continued in a health group, in a jogging club or on your own. Such classes are held 3-4 times a week for 1-2 hours. They must continue constantly, since atherosclerosis proceeds as chronic illness, and exercise warns him further development for all muscle groups. Exercises of a general tonic nature alternate with breathing exercises for small muscle groups. With insufficient blood supply to the brain, rapid tilts and sharp turns of the torso and head are limited.

2.2 Extracardiac (non-cardiac) factors for promoting blood flow through the vessels.

1. Blood moves towards the heart due to the suction force of the chest cavity during inspiration.

2. When exhaling, the diaphragm relaxes and rises, initiating the reverse processes of increasing the volume of the abdominal cavity, the pressure drops and the blood moves from the lower extremities to the inferior vena cava.

3. "Muscle pump" that is, the compression of the veins by the muscles of the body during passive and active physical exercises, which causes the valves of the veins to move blood towards the heart.

2.3 Nursing process in circulatory failure.

The nursing process consists of 5 successive stages:

First stage- examination of the patient, consists of a survey, which includes complaints, anamnesis of the disease and life, what drugs the patient takes and how, examination and additional examination methods (laboratory and instrumental). The nurse is interested in how the patient feels, what he complains about, how long he has been sick and how he is being treated, in what conditions he lives, with whom?

Examination of the patient involves measuring temperature, blood pressure, pulse, heart rate, respiratory rate, skin examination, detection of edema, and so on. These are objective data, as opposed to complaints, which are called subjective. The examination data are entered into the nursing assessment sheet of the patient's condition. The source of information at this stage is the patient himself, his relatives, the attending physician, medical history or outpatient card. When examining patients with CHF, the following are visible: edema, acrocyanosis. Patients complain of weakness, shortness of breath, and possibly frequent nighttime urination. When prescribed by a doctor additional methods examination, the nurse explains to the patient the purpose of the examination, how to prepare for them and behave after them.

Blood test (KLA). It is necessary to warn the patient that the analysis is taken in the morning on an empty stomach. Complete the course of taking medications in 14 days (exception: cases when the concentration of drugs in the blood is being examined). For 1-2 days, give up fatty, fried foods and alcohol. For 1 hour - refrain from smoking. For 30 minutes, exclude physical activity and psychological stress.

General analysis urine (OAM). It is collected in the morning, on an empty stomach, the average portion, having made the morning toilet of the inguinal region. alcohol 24 hours before the analysis is contraindicated categorically. Do not use beets, vitamins and medicines in the evening.

Electrocardiogram (ECG). For 2 hours you can not drink coffee, alcohol, medicinal stimulants, do not be subjected to physical and emotional stress. carry out no earlier than 2 hours after eating, smoking, staying in the cold. Immediately before the ECG, you need to rest for 10-15 minutes, lie down on the couch. It is also important to know that electrocardiography is performed before X-ray examination and physiotherapy procedures, not after them!

Chest X-ray. Does not require special preparation.

Daily analysis for diuresis. For laboratory research in the morning before collecting urine, it is necessary to carry out a toilet of the external genital organs. The first morning portion of urine is not collected, but the time of urination is noted. In the future, collect all the urine excreted in 24 hours from the marked time of the first urination to the same hour a day later. All urine from 8 o'clock. until 8 o'clock the next day is collected in one container.

Second phase- Identification of the violated needs and problems of the patient. In CHF, patients have impaired needs:

Breathing: cough, shortness of breath, choking,

Drinking and eating: exhaustion, poor appetite, hand tremor, need for diet, blurred vision, obesity

Distinguish: constipation, flatulence, urinary and fecal incontinence, nocturia,

Sleep: insomnia, night terrors, palpitations,

Move: weakness, hand tremor, poor exercise tolerance, fatigue, apathy, lethargy, dizziness, shortness of breath, suffocation, exhaustion,

Dressing, undressing: weakness, hand tremor, poor exercise tolerance, fatigue, apathy, lethargy, dizziness, shortness of breath, suffocation,

Observe hygiene: weakness, hand tremor, poor exercise tolerance, fatigue, apathy,

Avoid danger: weakness, edema, crises, visual impairment, memory impairment, deterioration of adaptation to adverse effects, meteorological sensitivity, inadequate behavior, dizziness, shortness of breath, suffocation, exhaustion, obesity, diarrhea, dyspepsia,

Communication: loss of interest, apathy, lethargy, decreased mood, irritability, anxiety, suspiciousness, belching, bad breath, decreased libido, memory impairment, irritability, anger, fussiness, verbosity, mood swings, difficulty concentrating, fear, inappropriate behavior, skin rashes,

Work and rest: weakness, swelling, loss of interest, apathy, decreased performance, memory impairment, irritability, anger, fussiness, verbosity, mood swings, difficulty concentrating, anxiety, fear, sleep disturbances.

The need to be healthy: patients are not able to independently, correctly and regularly follow the doctor's prescriptions, take medications according to the regimen.

Due to the violation of needs, patients have problems:

shortness of breath, weakness, swelling, pain, memory impairment, problems in self-care. The priority of the problem depends on the stage of CHF.

Third stage- nursing intervention planning

Independent nursing interventions - a set of activities aimed at resolving the patient's problems. Includes: nursing supervision, care, control, training and manipulation (procedures).

In patients with CHF, it is necessary: to monitor daily diuresis, it should be at least 70-80% of the total fluid consumed by the patient per day. If the patient excretes less urine during the day than he consumes fluids (negative diuresis), then part of the fluid is retained in the body, swelling increases and fluid accumulates in the cavities (dropsy). If urine is excreted per day more than the total volume of fluid drunk, they speak of positive diuresis. It is observed in patients with circulatory failure during the period of convergence of edema, while taking diuretics. . The state of the body's water balance can also be controlled by weighing the patient: an increase in body weight indicates fluid retention. In connection with bed rest, patients should be provided with urinals. In patients with chronic circulatory insufficiency, as a rule, there are pronounced trophic changes in the skin, especially in the places where edema develops: on the legs, in the lumbar region, sacrum, shoulder blades - bedsores occur (prevention of bedsores).

Nutrition of patients with chronic circulatory failure should be sufficiently high-calorie, easily digestible, with the inclusion of plant fiber, with a high content of vitamins and a significant restriction of salt and liquid. Food must contain

foods rich in potassium salts (potatoes, cabbage, dried apricots, figs) and calcium (milk and dairy products), which have a diuretic effect. Fractional meals 5-6 times a day. Diet number 10. Diet and drink. Monitor the work of the intestines: for constipation, a patient with edema should be given a hypertonic or oil enema.

The nurse should talk with patients about what drugs are prescribed by the doctor, how to take them correctly (before meals, during meals or after it, what to drink, sublingually, what food should be). Explain and help to create a diary of taking medications and fulfilling prescriptions, where patients or their relatives will record the regularity of taking them.

Algorithm of actions of a nurse when measuring blood pressure.

Target: determine blood pressure indicators and evaluate the results of the study.

Indications: as prescribed by a doctor to assess the functional state of the body, for self-monitoring of blood pressure.

Equipment: tonometer, phonendoscope, pen, 70% alcohol, cotton balls or napkins, medical documentation for data recording.

I. Preparation for the procedure

1. Make sure that the membrane of the phonendoscope and tubes are intact.

2. 15 minutes to warn the patient about the upcoming study.

3. Clarify the patient's understanding of the purpose and course of the study and obtain his consent.

4. Select the correct cuff size.

5. Ask the patient to lie down or sit down.

II. Performing a procedure

6. Lay the patient's arm in an extended position (you can put a clenched fist of the free hand or a roller under the elbow). Free your hand from clothing.

7. Place a cuff on the patient's bare shoulder 2-3 cm above the elbow (clothes should not squeeze the shoulder above the cuff). There should be 1 finger between the shoulder and the cuff.

8. Insert the phonendoscope into the ears and with one hand place the membrane of the phonendoscope on the area of the elbow bend (the location of the pleural artery).

9. Check the position of the pressure gauge arrow relative to the “0” mark of the scale and close the “pear” valve with the other hand, turn it to the right, with the same hand inflate the cuff until the pulsation on the radial artery disappears + 20-30 mm Hg. (i.e. slightly higher than the expected blood pressure).

10. Release air from the cuff at a speed of 2-3 mm Hg. in 1 second, turn the valve to the left.

11. Mark the number of the appearance of the first impact of the pulse wave on the pressure gauge scale corresponding to the systolic blood pressure.

12. Continue to deflate the cuff and note the diastolic pressure corresponding to the weakening or complete disappearance of the Korotkoff sounds.

13. Release all the air from the cuff and repeat the procedure after 1 - 2 minutes.

14. Inform the patient of the measurement result.

III. Completion of the procedure

15. Round off the measurement data and write down blood pressure as a fraction, in the numeral - systolic pressure, in the denominator - diastolic pressure (BP 120/80 mm Hg).

16. Wipe the membrane of the phonendoscope with a cloth moistened with alcohol.

17. Wash your hands.

18. Record the data in the accepted medical documentation.

Multiplicity of measurements. Repeated measurements are taken at intervals of at least 2 minutes, to measure blood pressure on both arms.