Hair, oral, eye, ear, nose care
Hair care. A person should comb the hair of those patients who cannot do it themselves in the morning and evening. Each patient should have an individual comb. Women's hair is combed and braided. You cannot comb your hair with a comb with sharp teeth, because they irritate and damage the skin. It is better to use a brush, which also improves blood circulation in the scalp. Short hair is combed, moving the comb from the roots of the hair to its ends. Long hair is better to comb in several steps. First, the ends of the hair are combed, and then gradually move closer to the skin. In diseases that require a long stay in bed, it is better to cut the hair short.
The head is washed once every 7-10 days during a hygienic bath. If the hair is oily, you can use hard water, which contains a lot of salts. When it is dry, you should use soft water. Hard water can be softened by prolonged boiling or by adding drinking water or borax to it (1/4 teaspoon of soda or 1 teaspoon of borax per 1 liter of water). To wash the hair well, use baby soap or shampoos.
Seriously ill people are washed in bed (Fig. 25). Slightly raising the head end, place the basin on the bed net. The head is tilted back and, pouring water from a jug, washed. After lathering the head, the scalp is rubbed, then rinsed, wiped dry and combed. Then the head is tied with a scarf to prevent hypothermia.
Oral care. It should be remembered that food residues left in the oral cavity decompose and can lead to inflammation of its mucous membrane. To prevent this, the patient should brush his teeth with toothpaste or powder in the morning before eating and in the evening before going to bed, and rinse his mouth with boiled water after each meal. The toothbrush should move from top to bottom on the teeth of the upper jaw, and from bottom to top on the teeth of the lower jaw, this is the best way to remove food particles stuck between the teeth. To rinse his mouth, patients can use disinfectant solutions: salted water (!/4 teaspoon of salt per glass of water); potassium permanganate solution (1 crystal per glass of water), 2% solution of boric acid or sodium bicarbonate.
For seriously ill patients, oral hygiene is carried out by medical workers 2 times a day. To do this, use a small rubber bulb filled with a weak antiseptic solution, tweezers or forceps, a spatula, cotton balls, gauze napkins, warm boiled water or one of the antiseptic solutions (5% boric acid solution, 2% sodium bicarbonate solution, weak potassium permanganate solution). First, the oral cavity is rinsed with the solution, and then the tongue, teeth, gums and lips are carefully wiped. To wipe the tongue, its end is covered with a sterile gauze napkin and plaque is removed from the tongue with a cotton swab moistened with an antiseptic solution, clamping it with tweezers or forceps. After that, the inner and outer surfaces of the teeth are wiped with another swab, while pulling the cheeks apart with a spatula. Each tooth is wiped separately from all sides, especially near the neck. The inner surface of the cheeks is not wiped, and the upper molars are wiped especially carefully, pulling the cheek with a spatula. After this procedure, the patient rinses his mouth with warm water.
If the patient cannot rinse his mouth on his own, the nurse performs irrigation (rinsing) of the oral cavity. Rinsing of the oral cavity is carried out with a Janet syringe, a rubber balloon or using an Esmarch mug. In addition, it is necessary to prepare an oilcloth apron, a tray, a spatula and one of the antiseptic solutions (2% boric acid solution - 1 teaspoon per glass of water, hydrogen peroxide solution - 1 teaspoon per glass of water, furatsilin solution 1-5000, etc.).
The patient is given a semi-sitting position with his head slightly tilted forward so that the liquid does not enter the respiratory tract. The neck and chest are covered with an oilcloth apron, and a tray is placed under the chin, which the patient holds. The nurse pulls the right and left cheeks alternately with a spatula and irrigates the oral cavity with a stream of liquid. Under the pressure of the liquid, mechanical washing out of food particles occurs. The Esmarch mug should be 1 m above the patient’s head – this ensures sufficient force of the liquid jet.
In seriously ill patients, especially after operations on the abdominal organs in the presence of a permanent nasogastric tube, the process of self-cleaning of the oral cavity is disrupted. In the absence of daily care for the oral cavity, patients quickly develop catarrhal stomatitis – inflammation of the oral mucosa, which is manifested by drooling, pain, especially during meals, sometimes bleeding. For the treatment of stomatitis, oral irrigation and applications are performed.
Application – application of sterile gauze napkins soaked in a disinfectant solution (0.1% furatsilin solution, 2% chloramine solution) or a medicinal solution (chamomile decoction) for 3-5 minutes. The procedure is repeated several times a day.
In inflammatory processes of the oral mucosa, it is advisable to periodically rinse the mouth with a 0.5% solution of chloramine, a % solution of sodium bicarbonate or a 1% solution of sodium chloride. To prevent inflammation around the parotid gland, it is also recommended to chew dry lemon peel or chewing gum.
To prevent cracks on the lips, they are lubricated with petroleum jelly or glycerin, the patient should take out dentures, wash them with water using a toothbrush and store them until the morning wrapped in gauze or in a glass of water. In the morning, before placing them in the mouth, they should be washed with fresh water.
Eye care. Every time you wash your face, you usually wash your ears and eyelids. If there is discharge on the eyelid mucosa, they dry out and form crusts that stick the eyelids and eyelashes together. The crusts should be moistened with a warm antiseptic solution (2% boric acid solution, rivanol solution 1:5000, 0.02% furatsilin solution), isotonic sodium chloride solution or strong tea infusion. To do this, apply clean gauze moistened with these solutions and folded several times to the eye slit or irrigate the eye with an eye dropper. After softening, the crusts are easily removed.
Eye washing with pus reduction is carried out using a special glass - undine, and in its absence, sterile gauze napkins are used.
Before the procedure, the nurse should wash her hands with soap and wipe her fingertips with alcohol. To wash her eyes with undine, a warm antiseptic solution is poured into it. The patient takes the glass by the stem, leans over it so that the eyelids are in the glass and, pressing it to the skin, raises his head, holding the glass with his hand (Fig. 26). The liquid should not flow out of the undine. The nurse asks the patient to blink frequently for 1 minute, and then, leaning forward, put the glass on the table. Changing the solution in the glass to fresh, repeat the procedure 8-10 times.
Therapeutic eye baths are performed similarly.
In the absence of undine for washing the eyes, the nurse prepares a sterile tray, 8-10 sterile gauze napkins, one of the antiseptic solutions or a strong brew of tea. The eyes are washed in the direction from the outer corner of the eye to the inner corner, along the tear. Do not rub your eyes with your fingers, as this can easily introduce an infection.
Ear care. Earwax is a modified product of the sweat glands of the skin of the external auditory canal. Ambulatory patients wash their ears independently during their daily morning toilet. For seriously ill patients, a nurse performs a toilet of the external auditory canal 2-3 times a week using cotton turundas (small balls of cotton wool wound around the end of a match). It is better to moisten the turunda in a 2% solution of boric acid, soda or in fresh boiled water. To clean the ear, pull the auricle back and up with the left hand, and with the right hand carefully insert the turunda into the external auditory canal and clean it with light rotational movements. If the wax does not come out, you can drip 2-3 drops of 3% hydrogen peroxide into the external auditory canal using a regular eye dropper. After the wax softens, it can be easily removed with a cotton swab. This procedure should be carried out carefully so as not to injure the skin of the external auditory canal, and especially the eardrum. In case of failure, you should not forcibly continue to remove the wax with a swab, but you should contact an otolaryngologist to remove dried wax by rinsing the ear canal.
Nose care. Ambulatory patients clean their nasal passages themselves during their morning toilet. For seriously ill patients, a nurse does this every morning using a cotton swab. If crusts form in the nose, they should not be peeled off, as this can cause bleeding. In addition, after peeling off, new crusts form, even thicker, and they hold even stronger. To soften the crusts. you need to put a little boric petroleum jelly or glycerin into each nostril. After 2-3 minutes. with a cotton turunda, the crusts are removed with rotational movements.
With a runny nose, wipe the nose with a soft handkerchief or towel. You do not need to rub the skin at the entrance to the nasal cavity, you should only apply a soft cloth to the skin, drying it. To prevent skin irritation from secretions flowing from the nose. it should be lubricated with petroleum jelly.