Vika is a plant from the legume family. Description, properties, cultivation

Vika is a plant, a representative of a legume. It is included in the diet, used as animal feed. In the second case, it is used in the form of hay, crushed grains.

This culture is also called sowing peas. It can be found in vegetable gardens, as well as in the form of a weed that grows near roads, in gardens, and in littered areas.

The pruning procedure is performed 1-2 times per season. From this, the culture will develop better, which will improve its quality.

Water the plant as needed to keep it from drying out, especially in hot weather.

Useful properties of culture

The plant gives good harvest. In addition, it has such useful properties:

• Concentrates nitrogen in the atmosphere.
• Looses well.
• Protects the soil.
• Improves microflora.
• Does not allow weeds to develop.
• Attracts insects that pollinate plants.

The culture does not require special care, it needs only minor attention.

While watching the video, you will see how a vetch plant is planted.

So, vetch is a plant that can be grown for different purposes. It will be especially valuable for those who keep cattle that eat grass. In addition, the plant still performs a number of useful functions, so it is appreciated by gardeners.

Many legumes have long been favorite plants on the site. They not only give a tasty harvest, but also, as you know, enrich the soil with nitrogen with the help of special ones on the roots. However, few people know their botanical name. They belong to the numerous flowering genus - Vika. The plant (photo, seeds will be considered in the article) is known as mouse peas- sowing vetch, beans - vetch fava. In addition, there are many other representatives widely used as food and

Rod Vika (polka dots)

The genus includes about 140 plant species, which are native to South America, Europe and North Africa. Under natural conditions, peas grow in floodplains, in flood meadows and edges, in the steppes. The bulk are less often annuals. The stem is most often climbing type, sometimes erect. Leaves are paired. Flowers solitary characteristic appearance: the calyx has a short trumpet and teeth, a flag with an indistinct nail, the boat is blunt, wings with a plate.

Botanical description: sowing vetch

A plant whose description is familiar, perhaps, to many. It is also called "sowing peas". This is an annual or biennial plant with a height of 20 to 80 cm. The stem can be erect or ascending, faceted, drooping or bare, with or without branching. The characteristic paired leaves have tendrils at the end, with which the pea clings to the support. The flowers are practically sessile, paired or solitary. The fruit is a bean, cylindrical or slightly flattened, up to 6 cm in length.

However, the plant should not be confused with a very similar, but still different species - peas. This is the most common and well-known representative of the mentioned genus. Numerous varietal forms have been bred that differ palatability and seed size, maturity. All of them are combined into three groups: peeling, sugar and brain peas.

Distribution of seed peas

Vika is a plant whose name in Latin sounds like Vicia sativa. It is widespread in the European part of Russia, Western Siberia, the mountainous zone of the Caucasus and Crimea, on the Kamchatka Peninsula. You can meet as a weed in the fields, less often on the side of roads, in garbage places, deposits. Development and growth proceeds best in the "company" with other herbs that support its creeping stem. The natural species is quite cold-resistant and withstands frosts down to -6 ° C. Vika is a moisture-loving plant, especially during the period of bud formation and flowering, otherwise it is unpretentious and undemanding to environmental conditions.

Use as a fertilizer

Sowing vetch is a wonderful green manure known to mankind since ancient times. The main way to use it in this format is pure sowing and subsequent instillation of the grown green mass into the soil. In terms of the level of action, such a fertilizer is compared with manure, the positive effect lasts for 4-5 years. In about three months, vetch accumulates up to 30 kg of biomass per 10 m 2, in which a high content of nitrogen (160 g), potassium (200 g) and phosphorus (75 g) is observed.

Sowing and care

(vetch) - the plant as a whole is unpretentious, but its cultivation has some features. Peas can vegetate in both light and heavy soils, but prefer neutral pH. If the soil is acidic, then nodule bacteria on the roots are inhibited, they will be small and poorly fixing atmospheric nitrogen, or may be completely absent.

Sowing is carried out in rows, the width between them should be 15-20 cm, between seeds - 5 cm. The sowing depth depends on the structure of the soil: on light ones - 7 cm, on heavy ones - 5 cm. In dry weather, it is recommended to slightly roll the soil after sowing, if If it's wet, then you don't have to. Green manure care is extremely simple and consists in timely weeding and loosening of the crust after rains and watering. Vika is a long daylight plant, moisture-loving, but not tolerant of stagnant water.

Sowing dates

There are two ways to sow peas.

In early spring as a precursor to later crops such as cabbage. After building up the green mass, it is buried in the soil even before flowering.

In early autumn or in the second half of summer, after growing and harvesting early crops. In this case, the plant must be buried in the soil before the onset of frost.

It is necessary to focus on the climatic conditions of the region.

Use as feed

Sowing vetch is a plant whose beneficial properties are not limited to use as green manure. Based on the dried material, its composition includes up to 20% vegetable protein, a small amount of fiber and dietary fiber. Fresh leaves contain lysine, beta-carotene, some fat and water. All these characteristics allow the plant to be used as a complete animal feed. Green mass, hay, haylage, silage, crushed grains and grain flour are used. For these purposes, peas are cultivated, as a rule, with oats or barley, less often with wheat; sunflower, corn, and rye are added for silage.

In addition, vetch is a plant (the photo is presented in the article), which is an excellent honey plant. This fact makes it especially valuable for beekeeping. Abundant flowering continues for a month approximately from the beginning to the middle of June. The indicator of honey productivity is the highest in hairy (winter) vetch - 140-200 kg per hectare of planting, in sowing it is much less - 20 kg / ha, in beans a little more - 20-40 kg / ha. This fact allows you to use plants to attract bees to your site. So, common vetch, having good decorative qualities, may well be planted in the garden or in the garden. It will attract pollinating insects, and pests, on the contrary, will scare away. The plant is an excellent neighbor for nitrogen-loving crops: tomatoes, sweet peppers, lettuce, eggplant, carrots. It goes well with fruit trees and shrubs.

The hydrangea family (lat. Hydrangeáceae) includes 17 genera, including the genus Deutzia (lat. Deutzia). According to decorative features, plants belong to the group of flowering plants, differing long flowering elegant inflorescences of white, pink, lilac-purple flowers, odorless.

Distribution area

Japan and China are considered the homeland of hydrangeas. Actions are widespread in Asia, North America, in certain areas of southeastern Europe. In Russia, they are more common in the southern regions of the Khabarovsk and Primorsky Territories. They grow mainly on forest edges, wet rocky slopes, do not avoid light shady shelter.

Action rough, grade "Candidissima"

The family is under state protection and is listed in the Red Book of Endangered Species. The reason was a weak natural regeneration after damage and predatory destruction during flowering. Deytion grows in the Far East Marine Reserve and many botanical gardens of the Russian Federation. For the beauty of flowering, many species of the genus are recommended for introduction into landscape gardening culture.

Description

Genus includes perennial shrubs and shrubs, creepers and herbaceous plants evergreen and deciduous. Widespread in temperate climate and subtropics of the northern hemisphere.

root system action fibrous rod, consists of one or two powerful roots, going deep into the ground and a large number smaller fibrous roots located in the upper third of the main root. This structure of the root system contributes to drought resistance and easy transfer of injuries during plant transplants.

Rough deutzia (Deutzia scabra)

In the bulk of the representatives of the genus, the leaves are simple with whole, serrated or serrated edges. Less common are plants with a palmately dissected leaf blade, which gives the plants an unusually elegant look of green openwork lace. The leaves are dark green, dull green on both sides, different shades, petiolate, without stipules with alternate or opposite arrangement. In autumn, the foliage takes on shades from green to yellow-brown.

Shoots straight or curving rounded. In other species, slightly pubescent. During the flowering period, under the weight of the inflorescences, they bend to the ground, giving an extraordinary decorative effect to the bush. Young shoots are light brown, gradually darkening. In some types, the bark is gray or reddish-brown. Perennial bark peels off in small crusts or short ribbons. Stem wood becomes woody by autumn and becomes dense, hard, but retains flexibility. A feature is the appearance in the second year of life of a through hollow hole in the center of the stem. The tubular hollow stems break easily, which must be taken into account when sheltering in winter. The growth of bushes, especially when freezing, is resumed by root shoots.

Action flowers are simple or double, small or medium in size (1.0-1.5 cm in diameter). Flowers with double perianth, actinomorphic, rarely slightly zygomorphic forms. By gender, there are same-sex, bisexual. Moreover, according to the combination of flowers of different sexes on one plant of action, there are species with bisexual and female or bisexual and male flowers.

Deutia Strawbury Fields (flowers)

Flower calyx with triangular or rounded linear sepals. Sepals can be 5 or multi-sepal, loosely attached to a bell-shaped calyx of green in different shades, cleavage or folded.

In species with simple flowers in the inflorescence, the corolla consists of 5 petals of white, pinkish or purple-crimson hues. In general, the flower resembles a miniature lily with a wide-open corolla and waxy pointed petals. hallmark double flower forms is pink or crimson color of the outer petals of the corolla with bright white petals of the core.

The flowers are collected in umbellate, oblong-racemose or complex corymbose inflorescences with drooping petiolate flowers. Inflorescences are usually located on lateral shoots. Blooming elegant long, at least 1-2 months (June-July). Inflorescences bloom on the branches of the previous year.

The fruits are represented by spherical or oblong-spherical capsules. When fully ripe, they crack at the top, scattering small seeds. Some cultivated forms do not form fruits.

Photogallery of species

Cultivation and care

The natural distribution of action in recent years is limited, but breeders have bred a huge number of decorative forms and garden varieties mostly low shrubs up to 2 m, intended for use in cultivation in landscaping parks and gardens, summer cottages, etc.

Location

The homeland of the origin of the action predetermined the choice of a place for its location in landscape gardening and house adjoining areas. The environment should be brightly lit, but not very sunny. Therefore, the action shrub must be located in places partially protected from the scorching rays of the midday sun. Deytion does not tolerate drafts, but a warm breeze does not harm its growth and flowering. In addition, she does not tolerate flooding. groundwater. In connection with these requirements, it is best to place the action on elevated places, protected from cold air currents.

Action hybrid, variety "Mont rose"

The soil

The culture develops excellently on neutral, nutrient-rich soils, sufficiently moisture-intensive, but not dense, breathable. For the successful cultivation of action, it is better to prepare a soil mixture of 2 parts of mature humus, 1 part of high-moor peat, 2 parts of sand. In this mixture, you can add (if available) 1-2 parts of leafy soil, 2 cups of ash, a glass of slaked lime. Mix everything with the top layer of soil from the dug hole.

You can do it easier: add a bucket of humus or compost to the drainage layer, add 300 g of slaked lime and 2 cups of wood ash, soil from a dug hole. Mix all. Plant a prepared bush in this mixture. Be sure to add 100 g of nitrophoska to the prepared soil mixture.

Deytion blooms beautifully in the suburbs

Landing

The optimal time for planting the action is the spring period before the buds open on the trees. We buy seedlings on the eve of planting, preferably with an open root system, which will allow us to control the condition of the roots. Before planting, we carefully inspect the seedling, cut off all broken branches and roots. We shorten the roots to 35-40 cm. If they are dry, soak them in a container with a root solution for 2-4 hours.

When planting several bushes in one composition, forming a hedge, we leave the distance between the bushes at least 2.0-2.5 m, which is necessary for the normal development of the root system and habitus of the bush. We dig planting holes according to the size of the root. At the bottom we pour a drainage layer of 15-20 cm from fine gravel or sand, part of the soil mixture (slide). We lower the prepared seedling into landing pit, straighten the roots along an earthen slide and fall asleep with the rest of the mixture.

When planting, make sure that the root neck of the plant is at ground level. Deepening more than 1-2 cm from the surface of the earth is unacceptable. We carefully compact the soil, water it (at least 5 liters of water) and mulch with any mulch with a layer of 5-6 cm.

Action graceful or slender

Watering

Deutsievye are quite resistant to short summer droughts. Therefore, they are watered no more than once a month, and only in a particularly long dry period, watering is carried out after 20 days. The norm of water under a bush is 5-15 liters, depending on the age of the bush. The volume of water can be determined by the time the bucket is filled. The soil should be fairly moist, but not wet. After watering, mulching is a must. We loosen the dried soil, destroying weeds and increasing the supply of oxygen to the upper root layer.

top dressing

Developing a large above-ground mass, action needs an additional supply of nutrients to the soil, especially in organic form. In the spring, after pruning, we add a solution of mullein or bird droppings under each bush of action. For 10 liters of water we dilute 2 liter cans of mullein or 1 bird droppings. We insist for several days and, depending on the age and development of the bush, pour from 3 to 6 liters of working solution under each into the previously loosened soil.

Using liquid fertilizer Pour the soil from above with clean water and mulch. The addition of clean water is necessary to avoid burning the small young roots. If there is no organic matter, then we add 120-150 g of complete mineral fertilizer and a glass of wood ash to the trunk circle of an adult plant for watering or loosening. The next top dressing is carried out in the phase of swelling of the buds (before flowering) with organic matter or complete mineral fertilizer. The last phosphorus-potassium fertilizers during full flowering.

pruning

Pruning action is a very crucial moment in agricultural technology. The splendor of flowering for the next year depends on the quality and correctness of its implementation. Several types of pruning are carried out on the action twice a year - in spring and autumn.

annual sanitation pruning carried out in the spring at the beginning of the growing season. Stems frozen over the winter are cut out, as well as old, shrunken, diseased, crooked (growing inside the bush), old branches. If the bush is thickened, cut out up to 20-25% of the old branches at the very base.

Action pruning scheme

At the end of flowering, cut out the faded shoots of the current year to the first side branch or completely to the base of the stem, if it is old, and the bush needs clarification.

Final autumn pruning combined with the forming. With this pruning, the state of last year's shoots (previous year) is monitored. It is on them that flower inflorescences are laid. And they form a bush by pruning the shoots of the current year, both faded and young.

Anti-aging and thinning pruning carried out as the bush ages. When rejuvenating, all above-ground shoots are cut to a stump. During the summer, young shoots form from the root shoots. Of these, 4-5 of the most developed and strong are selected, the rest are cut off in the fall to the level of the soil. From the left shoots form a young bush. Flowering occurs in 2-3 years, usually on the shoots of the previous year.

Action hybrid near the house

Shelter for the winter

Being heat-loving crops, deytions often freeze in winter, and in cold winters with frosts up to 20-25 * C, the entire above-ground part of the bushes freezes out. Therefore, shrubby forms of plants are subject to shelter for the winter. Young shoots of action up to 1 meter are quite flexible and can simply be bent, spudded with earth by 15-20 cm and pinned to the ground, covered with spruce branches and dry leaves on top.

With a well-established snow cover, it will serve extra cover. Older stems lose their flexibility and often break when bent. Such bushes are spudded, tied, giving the shape of a “sheaf” and wrapped with an integumentary fabric (lutrasil or spandbond) in several layers, covered with spruce branches on top. Open in the spring when the weather is warm. Bushes should not be allowed to get wet.

Preparing action for winter

reproduction

Deytion easily reproduces vegetatively and by seeds. Vegetative propagation can be carried out by cuttings (green and lignified), by dividing the old bush, which forms many root suckers, by layering.

Green cuttings held in June. Cuttings are harvested from large, well-developed annual shoots. Cuttings are cut with a length of 20-25 cm. A couple of leaves are cut off from below and powdered with root or dipped in the prepared solution for 2-3 hours. The container is filled with mixture garden soil, humus and sand. Moisturize with the same root solution.

Cuttings are planted obliquely, deepening into the soil mixture by 0.5-1.0 cm. Containers with cuttings are covered with a film and taken out to a greenhouse or placed in the shade in the garden. Spray systematically. After rooting, the cuttings are transferred to a prepared bed for growing. They need shelter for the winter. Planted permanently next year.

Propagation of action by cuttings

lignified cuttings prepare late autumn. Sliced ​​15-20 cm long (for 3-5 buds), they are tied into bundles of 10 pieces. Store until spring in boxes, falling asleep almost completely with wet sand. The container is placed in the basement. The temperature is maintained around 0*C. In the spring, they are planted on a prepared bed and grown, like green cuttings.

reproduction dividing the bush and layering is carried out by conventional methods of propagation of bushy forms of plants.

It is also possible to grow action from seeds, but this method is rarely used by amateur gardeners. Long-term seed preparation and the inability to obtain maternal qualities in seedlings limit the use of this propagation method.

Action on the background of the lawn

Diseases and pests

Actions are disease resistant. Of the pests, bumblebee proboscis (bumblebee species) sometimes visit the bushes. In July-August, bright green caterpillars appear with a long horn at the end and two stripes on the body. Caterpillars eat young leaves. Control measures: spraying with chemicals (decis, etc.). Bioinsecticides can be offered for protection. During the mass exit of caterpillars (July-August), spray the bushes with bitoxibacillin or better with lepidocide-BTU according to the recommendations.

Flowering hedge from action

Use in landscape design

Large perennial bushes with a white-pink cap of flowering inflorescences are used in solitary plantings of mowed lawns, mixborders, alpine slides, along paths. In summer cottages, areas are ennobled with non-shearing hedges. They look great in single plantings against the background of green conifers. Varieties of varieties and hybrid forms of action with double flowers in large inflorescences are a wonderful decoration for alleys, paths, walking routes in in public places recreation (parks, sanatoriums, rest houses, etc.).

Hybrid Actions (Lemoine, Strawberry Fields, Gorgeous) are an excellent design option for both public and private garden plot. The flowers of the Turbilon Rouge variety are incredibly elegant, repeating the traditions of ancient China in their rich inflorescences. Hereby oriental beauties they call action rough or star-shaped, graceful, pink, purple and other decorating gardens and parks. Garden aristocrats look like varietal and hybrid actions in landings of any type.

Care I Care

for the sick.

Care - a set of measures that provide comprehensive care for the patient, the implementation of medical appointments, the creation optimal conditions and conditions conducive to a favorable course of the disease, the fastest recovery of the patient, alleviating his suffering and preventing complications.

Basic principles of patient care. U. is divided into general and special. General U. includes the hygienic maintenance of the room in which the patient is located, maintaining the proper hygienic condition of the patient himself, taking care of a comfortable bed, cleanliness of the patient’s linen and clothes, organizing the patient’s food, assisting with eating, toileting, physiological functions, etc., clear and timely implementation of all prescribed medical procedures and medicinal prescriptions, as well as continuous monitoring of the dynamics of the patient's well-being and condition. U.'s features, due to the specifics of a particular disease or, are denoted by the term "special care".

Care is not the opposite of cure (Cure) , but organically enters into it as component. Correct U. involves the creation of a favorable domestic and psychological environment at all stages of treatment. It is based on the principles of a protective regime that protects and spares the patient's psyche. Eliminating all kinds of excessive irritants, providing silence, peace, creating comfort contribute to maintaining the patient's optimistic mood, confidence in the successful outcome of the disease. The successful implementation of numerous U. activities requires not only appropriate skills, but also a compassionate attitude towards the patient and sincere generosity. Diseases, physical suffering give rise to an increased feeling of anxiety, dissatisfaction, sometimes even hopelessness, dissatisfaction addressed to medical personnel or loved ones. To oppose this painful worldview, you need sensitivity, tact, the ability to encourage and support the patient. It is also important to protect the patient from negatively influencing factors and from excessive attention to his condition. U. and its implementation in hospital and outpatient settings is an obligatory and very responsible section of the activity of medical personnel. At home, U. is carried out by relatives of the patient, in consultation with a doctor.

The room intended for the patient should be spacious, bright and, if possible, protected from noise, isolated. The abundance of air and light, the optimal temperature in the room have a beneficial effect on any disease. The intensity of light should be reduced in case of diseases and certain diseases of the nervous system. Light bulbs should be covered with frosted lampshades, and at night only low-incandescent lighting devices (night lamps) should be left on.

The temperature in the room should be constant, within 18-20 ° (it is especially important that the room does not cool down in the morning), relative - 30-60% (see Microclimate) . If it is necessary to increase the humidity in the room, they put vessels with water or put moistened rags on the radiators, to reduce the humidity, the room is strongly ventilated. In the city, airflow is preferable at night, because. during the day it is more polluted with dust and gases (especially in areas of high traffic congestion). To protect against cold air flow during ventilation, the patient's room is covered with a blanket, and the head is left open with a towel or scarf. In summer, windows can be open around the clock; in winter, transoms (windows) should be opened 3-5 times a day. It is unacceptable to fumigate the room with various flavoring agents instead of airing.

The cleanliness of the premises must be carefully maintained. Cleaning should be done at least 2 times a day: window frames, doors, furniture are wiped with a damp cloth, washed or wiped with a brush wrapped in a damp cloth. Carpets, curtains and other items where it may accumulate should preferably be removed or shaken or vacuumed frequently. Noise protection measures are always needed: from traffic, street and industrial noise, lowering the volume of TVs, radios, etc., speaking in an undertone.

Very important correct transportation sick. Seriously ill patients are transported carefully, avoiding shocks, on a special chair, wheelchair or carried on a stretcher. with the patient are 2 or 4 people, walking out of step, with short steps. Carrying on the hands and shifting the patient can be carried out by 1, 2 or 3 people. If the patient is carried by 1, then he brings one hand under the shoulder blades, the other under the patient's hips; at the same time, the patient holds the carrier with his hands by the neck. When shifting a seriously ill patient from a stretcher to a bed, they are placed at a right angle to the bed so that the foot end of the stretcher is closer to the head end of the bed. Before shifting a seriously ill patient to bed, check its readiness, the presence of bedside accessories and individual care items. For seriously ill patients, an oilcloth, a urinal, a rubber circle, a bedpan are needed. The patient's bed should be of sufficient length and width, with a flat surface, comfortable and tidy. It is advisable to use a multi-section mattress, on top of which a sheet is placed, if necessary, an oilcloth is placed under the sheet. In some cases, for example, with lesions of the spine, a solid shield is placed under the mattress. It is desirable to place the bed in such a way that it allows you to approach the patient from both sides; the bed should not be placed near sources of heating in the room.

Seriously ill people are helped to undress, take off, in special occasions if necessary, the clothes are carefully cut.

Seriously ill patients need to change bed linen skillfully, without creating an uncomfortable posture for them, forced muscle tension, without causing pain. The patient is carefully pushed to the edge of the bed, the vacated part of the sheet is rolled up, like, up to the patient's body; a fresh sheet is spread on this part of the bed, on which the patient is transferred. The sheet can be rolled up in the direction from the feet to the head (if the patient is forbidden even in bed). First, roll up the foot end of the sheet to the waist. a fresh sheet is laid, then the replaceable sheet is removed from under the upper body, the folds of the fresh sheet are carefully straightened, its edges are attached to the mattress with safety pins. When changing bed linen, shake out the duvet.

When changing a seriously ill shirt, they bring a hand under his back, lift the shirt to the back of the head, remove the sleeve from one hand, then from the other (if one is damaged, the healthy one is released first). They put on a shirt, starting with a sore arm, then lower it over the head along the back to the sacrum and carefully straighten the folds. If the patient cannot move at all, put on a vest. Linen contaminated with secretions or blood is soaked in a clarified bleach solution and dried before being sent to the laundry.

Depending on the severity and nature of the disease, the patient is prescribed a different regimen: strict bed (it is not allowed to sit), bed (you can move in bed without leaving it), half-bed (you can walk around the room) and the so-called general regimen, in which the patient's motor not limited.

With bed rest, physiological administration is carried out in bed. Patients are given a cleanly washed and disinfected bedpan (a special device for collecting feces), into which a little water is poured to absorb odors. The vessel is brought under so that it turns out to be a large hole, and the tube is between the thighs: at the same time, the free hand is placed under and lifted the patient. Having freed the vessel from feces, it is thoroughly washed with hot water and disinfected with a 3% solution of lysol or chloramine. A urinal (special for collecting urine) is also served well washed and warm. After each urination, the urine is poured out, the urinal is washed with solutions of potassium permanganate and sodium bicarbonate, a weak solution of hydrochloric (hydrochloric) acid.

All care items, necessary tools and equipment must be stored in a certain place and be ready for use. Bedpans, urinals, ice packs, rubber circles after washing with hot water and rinsing with a 3% solution of chloramine are stored in special cabinets. Gas outlet tubes, probes, catheters and enema tips are washed with hot water and soap and boiled for 15 min. Enema tips are stored in a separate labeled container. Beakers, drinkers, boil. If possible, it is recommended to use care items and disposable tools. Medical equipment (beds, stretchers, chairs, wheelchairs, cabinets, etc.) is periodically disinfected with a 3% solution of lysol and chloramine, wiped daily wet rag or wash with soap.

The patient is essential. Patients entering, with the exception of those in extremely serious condition, are subjected to sanitization(, shower or wet rubdown, if necessary - a short haircut with disinsection treatment of the scalp). Patients who need outside help are lowered into the bath on a sheet or put on a stool placed in the bath and washed with a hand shower. Seriously ill patients are wiped with a swab moistened with warm water and soap, then with water without soap, and wiped dry. on the arms and legs of the patient should be cut short. If there are no contraindications, you should take a bath or shower at least once a week. If a bath and shower are contraindicated, then the patient's body should be wiped daily with a cotton swab moistened with boiled or toilet water.

Hair is washed with warm water and soap and gently combed, seriously ill people wash their heads in bed. , neck and upper part the torso is supposed to be washed daily, hands - before each meal, legs - daily before bedtime, with strict bed rest - 2-3 times a week. The skin of the genitals and anus must be washed daily, in seriously ill patients - at least 2 times a day. When washing under the buttocks of the patient, a vessel is placed: the patient during this procedure is in a supine position with legs bent at the knees. For washing it is convenient to use Esmarch's mug, equipped with a rubber tube with a tip having a tap or (see Enemas) . A stream of water or a weak solution of potassium permanganate is directed to the perineum, while a cotton swab is carried out in the direction from the genitals to the anus. Dry the skin of the perineum with another cotton swab, leading it in the same direction. This procedure can also be performed using a jug into which a warm disinfectant solution is poured.

Underarms, inguinal folds, skin folds under the breasts, especially in obese patients and those with excessive sweating, should be washed frequently to avoid diaper rash (Diaper Rash) .

Severely ill patients who are emaciated and have been in bed for a long time need especially careful skin care in order to prevent bedsores (Decubituses) . To do this, it is necessary to keep the bed in strict order (eliminate irregularities, smooth out the folds of the sheet); constantly monitor the cleanliness of the skin, wipe it 1-2 times a day with camphor alcohol, powder with talcum powder; put rubber circles wrapped in pillowcases under places subject to pressure (for example, under the sacrum), often change the position of the patient in bed (turn him). In patients on prolonged bed rest, with insufficient hygienic care of the feet, thick horny layers are sometimes formed on the soles as a manifestation of the scaly form of athlete's foot (Athlete's foot) . In such cases, mechanical removal of the horny masses and subsequent treatment of the skin with antifungal agents (Antifungal agents) is recommended.

Ears should be washed regularly with warm water and soap. Sulfur plugs from the external auditory canal are carefully removed with a stream of water released from a rubber balloon (a few drops of a 3% hydrogen peroxide solution are first poured into the external auditory canal).

Eye care is necessary in the presence of secretions that stick together and eyelids, which is more common in children. In these cases, gently soften and remove the crusts with a damp swab. Usually, in the morning and in the evening, the eyes are washed with a swab moistened with boiled water.

Oral care consists in brushing your teeth (at least 2 times a day), rinsing your mouth after each meal. Seriously ill patients are wiped with a cotton ball moistened with a 0.5% solution of sodium bicarbonate, a weak solution of potassium permanganate or furacilin. The mouth is washed with a syringe or a rubber balloon. In order to prevent the liquid from getting into, the patient is given a position with the head slightly tilted forward, for a better outflow of the liquid, the corner of the mouth is pulled. To wash the mouth, use a 0.5% sodium bicarbonate solution, 0.9% sodium chloride solution or a 1:10,000 potassium permanganate solution.

Nasal care is carried out in the presence of secretions and the formation of crusts. The crusts are removed after softening them with vaseline oil or glycerin.

An important element of U. is the feeding of seriously ill patients in accordance with the prescribed diet and diet (see Medical nutrition) . Lying patients during meals should be given a position to avoid fatigue. As a rule, they give an elevated or semi-sitting position. and the patient's neck is covered with a napkin. Weakened and febrile patients should be fed during periods of improvement, during a decrease in temperature. Such patients are fed from a spoon, food (mashed or chopped) is given in small portions. It should not be interrupted for feeding during the day if the patient suffers from insomnia. Seriously ill people are given drink from a sippy cup. Patients who cannot swallow food are transferred to artificial (see Tube feeding) .

Monitoring the patient's condition is an indispensable condition for successful treatment. Persons who carry out U. must inform the attending physician about all changes that occur in the patient's condition. At the same time, one should pay attention to the position of the patient’s body, mental state, sleep, facial expression, skin color, the appearance of rashes on it, respiratory rate, the presence of cough, changes in the color and nature of urine, feces, sputum, to perform thermometry (Thermometry) of the body on the instructions of the doctor , weighing, measure the ratio of the allocated and drunk liquid and carry out other special observations.

It is necessary to ensure that the intake of medicines by patients strictly complies with the recommendations of the doctor. For taking medicines inside, a decanter with boiled water and clean beakers should be prepared.

Seriously ill patients suffering from respiratory diseases should be regularly turned over in bed, with shortness of breath (Shortness of breath) they are helped to take a comfortable position for breathing (put an extra pillow, roller, use chairs, etc.). For a better discharge of sputum, the patient is given a position in which a freer and fuller bronchi is carried out. Sputum is collected in an individual spittoon with a screw cap, pre-filled 1/3 with chloramine. The patient is helped to master the recommended set of breathing exercises.

When U. for patients with cardiovascular diseases, much attention is paid to providing the recommended regimen (bed, restricted active or training), which is especially important in the acute stage of the disease, when it is necessary to reduce the load on, which is achieved with complete physical and mental rest. For most patients, the most comfortable and physiological position is with a raised upper half of the body. If a patient has a fear of death - one of the frequent and very painful sensations in heart disease - a certain psychological impact on the part of others is necessary. Their lack of fright and fussiness, correct when referring to the patient (the ability to dispel, cheer up and not be intrusive) creates the most favorable psycho-emotional environment.

Features In patients with diseases of the gastrointestinal tract, they largely depend on the presence of abdominal pain, colic (Colic) , nausea (nausea) , vomit (vomit) , stool disorders (see Constipation , diarrhea) . At the same time, caregivers should provide the patient with the required assistance: bring the tray in time or when vomiting, help to take a comfortable position, prepare a solution for rinsing the mouth or for washing the stomach (Gastric lavage) , for an enema, prepare a heating pad or with ice, strengthen them over the desired area of ​​\u200b\u200bthe abdomen, replace them in a timely manner.

Vomit must be examined by a medical doctor for diagnostic purposes: blood admixture, as well as vomit in the form of coffee grounds, should be of particular concern (see Gastrointestinal bleeding) . When observing a patient, it is necessary to monitor his activity, the adequacy of behavior (with liver failure), the size of the abdomen, the protective reaction of the anterior abdominal wall (see Acute abdomen) , skin, urine, and stool color (see Jaundice) .

Caring for a sick child. The specificity of U. for sick children of different ages lies in the features of direct observation of a sick child, communication with him, methods of collecting material for laboratory research, and conducting medical procedures.

The creation of a hygienic environment for a sick child consists of general hygienic attitudes, hygiene features of a newborn (Newborn) and baby(Infant) .

For kids early age small wards or boxes (closed and open) are equipped in hospitals; if an infectious disease is suspected, the child should be placed in with special equipment (see Isolation of infectious patients) . For mothers hospitalized with their children, they allocate a bedroom and a dining room. For walks of sick children use a veranda or special rooms with constantly open windows. Beds for infants should have high sloping or folding walls. A hard mattress made of horsehair, bast, sea grass is placed in the crib. Do not use mattresses made of fluff or feathers. A small flat pillow is placed under the head.

Room temperature for a premature baby (see Premature babies) should be 22-26° depending on body weight, for full-term - 20°. Daily systematic airing is necessary at any time of the year. should be light, warm and not hamper the movements of the child. For swaddling premature babies, it is convenient to use envelopes. Free swaddling is indicated for children with normal thermoregulatory function.

The basis of U. for newborns (full-term and premature) is the observance of the strictest cleanliness, in some cases - sterility. Persons with acute and chronic infectious diseases are not allowed to U. for newborns. Wearing woolen clothes and rings is unacceptable. must strictly observe the rules of personal hygiene, work in a gauze mask, replaced every 3 h. Every month, all employees of the department should conduct a study of mucus from the nose and throat for the carriage of diphtheria bacilli (see Diphtheria) , hemolytic streptococcus (see Scarlet fever) , hemolytic staphylococcus aureus (see Staphylococcal infection) . With the same frequency, hand washings are examined for the carriage of staphylococcus aureus.

Special attention is required to care for the umbilical wound (see Umbilical region) , which must be carried out under strictly aseptic conditions. The toilet of the newborn is carried out daily: the eyes are washed with sterile cotton wool soaked in a solution of potassium permanganate (1:10,000) or furacilin (1:5000), in the direction from the outer edge to the inner; clean with cotton wicks dipped in boiled vegetable oil; the child is washed, the skin folds are lubricated; washed away after each act of defecation.

A daily examination of the pharynx of a sick child is necessary. Every day they measure the temperature, determine the quantity and quality of bowel movements, the presence of regurgitation, vomiting, coughing fits, asphyxia, convulsions. Children are weighed in the morning, before the first feeding.

When appointing a walk, take into account body weight, child, season and local climatic conditions. Premature babies can be taken out for a walk over the age of 3-4 weeks. in the spring-summer period when they reach a weight of 2100-2500 G, in autumn-winter - upon reaching a weight of 2500-3000 G. The first walk of these children in winter should not exceed 5-10 min, and in summer - 20-30 min. Full-term children from 2-3 weeks of age are allowed to walk in winter at an air temperature of at least -10 ° in the absence of wind. If the child has an intensified cough, pallor, anxiety appear, the walk is stopped.

The organization of feeding a sick child requires special clarity, consistency and skill from the staff. Difficulties in feeding may be due to underdevelopment of the sucking reflex, the presence of congenital deformities, the child's refusal to eat, unconsciousness, etc. In such cases, feeding is done through the stomach, through a pipette, from a spoon; use Parenteral nutrition , rectal.

Collecting material from children for laboratory research requires special skills. Children under 5-6 years of age do not cough up sputum. Therefore, at the moment when the child coughs, holding the spatula, remove the sputum with a sterile swab, which is then inserted into a sterile test tube. In infants, sputum is removed from the stomach using a probe inserted into the fasting stomach. Blood sampling for serological, biochemical and other studies is performed by venipuncture (venopuncture) . Feces for bacteriological examination are collected with a glass tube, melted at both ends, which is sterilized and inserted into. The tube filled with feces is closed at both ends with sterile cotton wool, lowered into a test tube and sent to the laboratory. Faeces for research on worm eggs are collected in a cleanly washed glassware small size. A cleanly planed stick is taken from 5-6 different places, then the dishes are tightly covered with clean paper (see Helminthological research methods (Helminthological research methods)).

Care of elderly and senile patients are carried out taking into account the characteristics of an aging organism, a decrease in its adaptive capabilities, the peculiarity of the course of diseases in the elderly and age-related changes in the psyche. A feature of many diseases in the elderly is an atypical sluggish course without a pronounced temperature reaction, local changes and a relatively rapid addition of severe complications.

Exposure of older people to infectious diseases, inflammatory processes (see Old age , aging (Old age. Aging)) obliges to especially careful hygienic care. Older people often show increased resistance to changes in the microclimate, diet and diet, lighting, and noise. Features of the psyche and behavior of an old person (emotional instability, slight vulnerability, and in case of vascular diseases of the brain - a sharp decrease in memory, intelligence, criticism, and sometimes untidiness) require special attention and patient sympathetic attitude of the attendants.

The period of strict bed rest for elderly patients should be reduced, if possible, by prescribing as early as possible Massage and therapeutic physical culture (Therapeutic physical culture) in order to return to the usual motor) mode as soon as possible (to avoid hypokinesia (Hypokinesia)) , as well as breathing exercises to prevent congestive pneumonia.

Care of infectious patients. Of great importance in U. for infectious patients are measures aimed at preventing nosocomial infections (nosocomial infections) . Particular attention is paid to the epidemic regime in the department and the ongoing disinfection (Disinfection) (disinfection of dishes, linen, cleaning of premises, vomit, feces and urine).

A patient with tuberculosis must be taught the proper handling of personal items, utensils, as well as the rules for coughing up and disinfecting sputum, which he must collect in a closed court, usually filled with 1/3 of the volume with a 5% chloramine solution.

It is advisable for the personnel of the infectious diseases hospital to have a special hospital gown or suit, over which a gown is put on. Hair is covered with a cap or scarf. At U. for sick intestinal infections it is necessary to wash hands with warm water and soap after each procedure. Processing of the vessel and dirty linen is carried out in rubber gloves, which are disinfected after each procedure. In the departments of respiratory infections, the staff works in a four-layer gauze mask that covers the nose, which is changed every 3-4 h.

Care of neurological patients. In diseases of the nervous system, severe movement disorders, disturbances of sensitivity, speech, disorders of the function of the pelvic organs often occur, and convulsive seizures are possible. This determines the specificity of U. for neurological patients.

From the operating table, the patient is transferred to a gurney and taken to the ward, making sure that during transportation it does not cause additional trauma, does not displace the applied bandage, and does not disturb the condition of the transfusion systems.

The patient after the operation remains under the supervision of experienced staff. the patient before his awakening should be located low, without a pillow. When postanesthetic vomiting occurs, the head is turned to one side. As a result of retraction of the tongue or aspiration of mucus, the patient may experience asphyxia . In these cases, it is necessary to push the lower jaw forward and stretch it out, remove it with a swab from the throat, and cause a cough. After awakening, the patient is given a position that spares the wound. Elevated (semi-sitting) position, facilitating, is recommended after laparotomy and after chest operations; position on the abdomen - after operations on the spine. It is necessary to strive to start motor activation of the patient as early as possible in order to prevent pneumonia, thromboembolism and the development of other complications.

After the patient is discharged from the hospital, his follow-up is to follow the recommendations of the attending physician to provide the patient with the necessary diet, diet and methods of cooking (after abdominal operations), hygiene measures, and a program to expand physical activity.

Features of patient care after urological operations. On the first day after nephrectomy (see Kidneys), patients are continuously monitored, carefully monitor the state of the functions of the cardiovascular system, respiration, acid-base balance, electrolyte balance in order to timely use, if necessary, extrarenal methods of blood purification (Extrarenal methods of purification blood) . Control and ensure the effectiveness of drainage in the surgical wound. From the first day, breathing exercises and gymnastic exercises in bed are used.

After the operation of removal of the bladder and transplantation of the ureters into the sigmoid colon, in the first hours and days, attention is paid to the patency of the tubes intubating the ureters, brought out through. If necessary, the tubes are washed with sterile isotonic sodium chloride solution.

Organ-preserving operations on the kidney are often accompanied by pelvis or ureter (separately or simultaneously) for a period of 2-4 weeks. At U. for the patient during this period it is necessary to monitor the smooth functioning of the drainage tube. To remove possible clots, the tube is flushed with sterile isotonic sodium chloride solution (5 ml). Sometimes the patency of the drainage is maintained by constant drip irrigation its solution of furacilin 1:5000. Do not allow urine to flow past the drainage tube - this can cause wounds. the development of phlegmon, maceration of the skin around the wound, the formation of bedsores and other complications.

At home, with U. for patients who have long terms drains are installed in the kidney (nephrostomy), in the bladder (cystostomy) or ureters brought to the skin (ureterocutaneostomy), great attention is paid to the hygienic treatment of the skin around the drainage hole. Patients are under the constant supervision of a urologist, who must determine the frequency of washing and changing the drainage tube in each individual case.

Features of patient care after gynecological operations are largely due to the anatomical proximity of the female genital organs to the organs of urination, the rectum and anus.

The toilet of the external genital organs, both before and after surgery, is carried out 2 times a day with the use of disinfectant solutions (potassium permanganate 1:10,000, furacilin 1:5000, etc.). A vessel is placed under the buttocks of the patient and with a cotton swab captured by a forceps, the external genitalia are washed from top to bottom, and then dried with a dry swab. Patients who are allowed to walk carry out the toilet of the external genitalia themselves in the hygiene room. According to the indications (the presence of sutures in or pathological secretions), vaginas are produced or medicinal vaginal baths are used. The sutures in the vagina and perineum are inspected as necessary and treated with solutions of hydrogen peroxide, dioxidine, an alcohol solution of iodine, brilliant green, or other disinfectants.

Forced stay in bed exacerbates postoperative difficulty urinating. Therefore, in the preoperative period, it is recommended to teach the patient to urinate in the supine position. After the operation, in order to facilitate urination, a warmed vessel is placed under the buttocks of the patient, in the absence of contraindications, a heating pad is placed on the lower abdomen, if necessary, bladder catheterization is performed in compliance with asepsis rules. The number of catheterizations depends on the daily diuresis (usually 3 times a day is enough). In order to prevent cystitis and ascending infection, 10 ml 2% solution of collargol 1 time per day.

To accelerate the recovery of urination and prevent the adverse effects of physical inactivity, it is necessary for patients to get up early - after 48 h after vaginal surgery. It is necessary to teach patients to get out of bed correctly (first turning on).

Features of the restoration of bowel function depend on the type of operation. In most cases, they are released on the 4th day with a cleansing enema. However, after the sphincterolevatoroplasty operation (for example, a third-degree perineal rupture), defecation is delayed until the 8-9th day. For this purpose, for 3-4 days. before the operation, patients are transferred to tube feeding, and on the eve of the operation, they give a laxative and put cleansing enemas. The first 3 days are allowed only to drink, and then they give liquid food. On the 7th day, vaseline oil is prescribed inside (30 ml 3 times a day) to facilitate bowel movements.

Patients who underwent surgery for purulent inflammatory processes in the uterine appendages, pelvioperitonitis, bartholinitis, it is necessary to provide wound care and functioning of the drainage. It is better to use double-lumen drainage tubes, the ends of which are lowered into a jar of disinfectant solution.

Cancer Care is inextricably linked with the solution of deontological problems, the need to respect medical secrecy, which puts the attendants and relatives in difficult conditions. A careless statement or a medical document that has fallen into the hands of the patient, especially if they are misinterpreted by the patient, can cause severe mental illness for the patient, which makes it much more difficult.

Most patients admitted to the hospital are not aware of the severity of their disease and respond inadequately to the amount of treatment offered to them. At the same time, operations for malignant tumors are often crippling and lead to permanent disability, and in the case of a rapid progression of the process, the patient often develops respiratory, digestive, and excruciating pain. All this, as well as the peculiarities of the psyche and behavior of an oncological patient (emotional instability, vulnerability,), and sometimes mental disorders due to brain damage, require a particularly sympathetic attitude towards the patient, patient treatment by relatives and attendants.

Care for malnourished patients with tumors of the digestive system is primarily aimed at organizing nutrition. Feeding is recommended up to 6 times a day in small portions, using the most high-calorie foods (daily food should be at least 2000 kcal): added to food mixtures or administered parenterally; taking into account the degree of dehydration of the patient, fluids are replenished (on average, up to 3-3.5 G). Patients who cannot eat, throughout the entire period of their preparation for surgery, are given parenteral nutrition using protein hydrolysates, amino acid mixtures and high-energy fat emulsions.

In the preoperative period, patients are taught breathing exercises, the use of a vessel, a urinal, which they will need in the postoperative period. The last at oncological patients often proceeds with purulent complications which is one of important tasks of U. in the postoperative period. Careful treatment of contaminated areas around wounds, an effective toilet of the perineum, genitals, buttocks after physiological administration, strict adherence to hygiene rules in all medical procedures are necessary. Particular attention in the postoperative period is paid to the restoration of bowel function, using cleansing enemas, if necessary. During operations on the hollow organs of the gastrointestinal tract, intestinal stimulation is carried out using hypertonic enemas, and vaseline oil is administered to the patient before the first feeding. The timing of the start of enteral nutrition is determined by the type of operation performed and the onset of active intestinal motility. After operations on the larynx, pharynx, and the initial sections of the digestive tract, tube nutrition, nutritional enemas, and nutrition through the formed stoma are prescribed. normal diet in this case can lead to infection of wounds or ingestion of food into the respiratory tract. through the probe can be carried out for 2-3 weeks, introducing food into the stomach, duodenum or further into the intestine. A thin gastric tube in such cases is passed through and fixed to the wings of the nose; a funnel is attached to the outer end of the probe and food is poured into it in small portions (for 1 sip each). Nutrient enemas are carried out by drip injection into the rectum of saline solutions, 5% glucose solutions and ethyl alcohol, protein preparations (total volume up to 2 l per day). To improve absorption, it is administered warm, and the rectum is freed from the contents with a cleansing enema an hour before the nutrient enema. When feeding through a stoma, food is introduced through a rubber or plastic tube in small portions using a special syringe or a rubber bulb. In just a day, the patient is administered up to 2.5-3 l liquid or pureed food, the calorie content of which should be about 3000 kcal. When choosing a nutritional formula, preference should be given to preparations adapted for enteral nutrition such as Enpit, Enpitan or preparations for breastfeeding. After each meal of the patient, hygienic treatment of the stoma is performed.

Formed during operations, esophago-, gastro- and enterostomy require repeated changes during the day with vaseline oil, a thorough dressing of the skin around the stoma using a solution and a tanning solution of potassium permanganate. With severe maceration of the skin, it is indicated topical application various indifferent pastes. After improving the general condition of the patient, they are taught the rules of self-feeding through a tube and caring for the stoma.

The skin around the formed external intestinal fistula is treated with gauze wipes with antiseptic solutions, and after stopping the inflammatory process around the colostomy, it is possible to use specially fitted colostomy bags, the dimensions of which are selected individually depending on the size of the external lumen of the formed stoma. After 2-3 months. after surgery, the external opening of the colostomy requires periodic bougienage (at least once a week), which the patient can perform independently with a finger after appropriate training. replacement plastic bag a colostomy bag should be made after each act of defecation, after washing the skin around the stoma with running water or a weak antiseptic solution and treating it with ointment creams. During operations on the colon with the formation of a colostomy and preservation of the distal parts of the intestine, the area excluded from the passage of feces requires periodic douching using a weak hypertonic solution.

Cancer patients with advanced disease often need only symptomatic therapy and care, because radical treatment is impossible. Often they are sharply emaciated and weakened, suffer from excruciating pain that is not relieved by non-narcotic analgesics. U. for such patients should be as sparing and precautionary as possible. To reduce pain, the patient is given the most comfortable position in bed; monitor the absence of folds on the bed linen that disturb him; actively help the patient to drink, eat. Narcotic analgesics are used not at the request of the patient, but strictly according to the hours indicated by the oncologist. In order to prevent and treat bedsores, daily treatment of the back and lumbosacral region with camphor alcohol and potassium permanganate solution, massage is necessary. In case of involuntary urination, a permanent catheter is sometimes inserted into the bladder, which should be washed 2-3 times a day with a solution of furacilin 1: 5000. With persistent violations of bowel function, laxatives and cleansing enemas are prescribed every 2-3 days.

Care of resuscitated patients, as well as for patients in intensive care units, includes all elements of general, as well as special care in relation to surgical, neurological, traumatological and other patients, especially those who are in an unconscious state. Much attention is paid to continuous monitoring, including monitoring surveillance , for the most important physiological functions (blood circulation, respiration, urination), for the composition of catheters, perfusion tubes, conductors from devices and systems connected to the patient. Special care is needed for patients who are artificial lungs (Artificial ventilation of the lungs) through an endotracheal tube or through a tracheostomy. At the same time, a thorough and systematic toilet of the tracheobronchial tree is produced (sometimes every 15-20 min for several days), without which a violation of bronchial patency and the development of asphyxia are possible. The procedure for removing secretions from the trachea and bronchi is carried out with sterile gloves or after treating the hands with a disinfectant solution. Apply (preferably disposable) a special angled or straight catheter connected through a tee with vacuum suction, with one tee left open. Turning the patient's head to the left or right, while inhaling the patient with a quick movement, insert the catheter into the endotracheal or tracheostomy tube and advance it through the trachea and, accordingly, into the right or left lung until it stops. After that, you should close the hole of the tee with your finger, thus ensuring. action of vacuum suction, and, rotating the catheter with your fingers, slowly remove it. washed with a sterile isotonic sodium chloride solution or replace it, the procedure is repeated as many times as necessary for a sufficiently complete removal of the secret and restoration of airway patency. The effectiveness of the procedure is increased if at the same time the second registry performs a vibrational massage of the patient's chest.

To prevent bedsores, as well as the development of stagnation in the lungs and other organs, medical personnel approximately every 2 h should change the position of the patient's body, wipe the skin with antiseptic solutions, put gauze ring pads under the bone protrusions. It is better if the patient constantly lies on a special anti-decubitus mattress. Patients who are in an unconscious state are shown parenteral nutrition and parenteral fluid administration. before their introduction into the vascular bed or into the body cavity, they are heated to the patient's body temperature.

Dental care in the postoperative period and with jaw injuries (Jaws) has its own characteristics due to difficulties in eating and drinking in the usual way, impaired chewing, swallowing, speech, and breathing functions. Patients should be given a semi-sitting position, which helps to reduce bleeding and improve respiratory function, prevents aspiration of mucus, blood, and pus. The neck and the patient are covered with oilcloth to protect against secretions from the oral cavity and from bandages.

In the first days after the operation, patients should be prohibited from speaking and taught to communicate in writing. After 6-7 days, on the contrary, it is necessary in every possible way to encourage the patient to arrange speech, because. promotes self-cleaning of the oral cavity.

Oral hygiene is an important part of U. Many patients, and especially those who have various splints and splinting devices in their mouths, cannot clean themselves, so this procedure is carried out by caregivers. Washing the mouth is best done from Esmarch's mug with an individual tip for each patient, you can also use a rubber balloon. Washing is carried out with a warm solution of potassium permanganate at a dilution of 1:3000. Before washing, it is useful to treat the oral cavity with a solution of sodium bicarbonate at the rate of 1 tablespoon per 1 l water. The patient during washing is in a sitting or reclining position. The patient's chest is covered with a waterproof apron. The cheek is held with a dental mirror or spatula and the tip is advanced into the posterior sections of the vestibule of the oral cavity, directing a jet of fluid into the upper and lower sections of the fornix. Then the jet is directed through the interdental spaces into the oral cavity. Rinse your mouth at least 5-6 times a day and always after each meal. After washing the oral cavity, they begin to clean the splints and orthopedic splinting devices. A swab moistened with a solution of hydrogen peroxide wipes all the spaces between the tires and the dentition. After this treatment, the oral cavity is washed again. Removable splints and brushed with soap and water after each meal and at bedtime.

Much attention is paid to feeding the sick, because. It is difficult for them to eat independently. Patients are fed with the help of a drinker, to the outlet of which a rubber tube 20-25 cm long is attached. cm. The end of the rubber tube is harmed in the back of the mouth. Feeding should be carried out 4-5 times a day in small portions. Liquid food is introduced through the tube, adjusting the portions by clamping the tube. Solid requires special machining. After heat treatment, the products are crushed as much as possible, passed through a meat grinder, a sieve, and then diluted with broth, milk, fruit juice to a creamy consistency. should not be hot and spicy. During feeding, the patient takes a sitting position, and in severe cases, bedridden patients raise their heads. Before feeding, the patient is covered with an oilcloth apron so as not to stain bandages, clothes and bedding. In case of impossibility of feeding with the help of a drinker, they resort to tube feeding (using a nasopharyngeal tube).

Rinse mouth after feeding large quantity sodium bicarbonate solution, and then potassium permanganate (1: 5000) or another disinfectant solution.

Care of otorhinolaryngological patients. For various diseases of the external ear, the auricle and external auditory canal are hygienically treated with sterile cotton wool, if necessary moistened with an isotonic solution of sodium chloride, vaseline or other oil (when removing crusts), alcohol (with a boil). Cleaning the ear canal with cotton wool wrapped around a threaded ear probe should be done with caution, because. ear canal is very sensitive and easily hurt. In the presence of abundant purulent discharge, hygienic treatment begins with washing the external auditory canal (see Washing the ear) with a disinfectant solution (furatsilina, rivanol, etc.), necessarily heated to body temperature. Typically, this treatment is repeated depending on the rate of accumulation of pathological content.

Immediately after the operation on the ear, the patient is placed on the healthy side. After hearing-improving operations, the movements of the patient's head are limited for 5 days. For this purpose, his head is fixed with a strip of bandage to the edges of the bed. Bed rest after radical ear surgery (see Otitis) 2 days should be observed, after a hearing-improving operation - 5 days. With intracranial complications, the duration of bed rest is due to the severity of the course of neurological and septic complications.

The main goal of treatment after various operations on the middle ear is to achieve complete epidermization of the walls of the postoperative cavity. This requires systematic care for the auricle, behind the ear area and for the wound cavity (release it from pathological contents, suppress microflora in it, contain excessive granulation, and if it is not enough, stimulate the growth of granulations).

Care of a patient with acute or chronic rhinitis after operations in the nasal cavity consists in removing discharge and crusts from the nasal passages with suction, nasal tweezers and a nasal probe, on the end of which is wound. According to the indications, the nasal cavity is washed with various solutions (isotonic sodium chloride solution, Ringer-Locke, etc.) through their instillation and suction.

In the presence of an anterior or posterior nasal tamponade, performed due to nosebleeds (nosebleeds) or after surgery in the nasal cavity, the management of the patient consists in monitoring the condition of the tampons, stopping possible bleeding, especially back wall throats. The sling-like bandage after soaking it with ichor is changed in a timely manner. In the first days after surgery on the paranasal sinuses, tear flow may be disturbed. In these cases, the eyes are washed 1-2 times a day and a solution of sodium sulfacyl (albucid) is instilled.

After a tonsillectomy, the patient is taken to the ward on a wheelchair, put to bed, usually on the right side, a towel or sheet is placed under the cheek, on which saliva, often stained with blood, should flow through the corner of the mouth. As the discharge accumulates, the litter is changed. Within an hour after the operation, cold is applied to the neck in the region of the lower angle (alternately on both sides). The patient is advised to lie with his mouth half open so that saliva drains on its own. Abundant blood indicates from tonsillar niches requiring immediate surgical revision. It is necessary to ensure that the patient does not swallow (this causes vomiting). After removal of the tonsils, the patient is allowed to eat in a day, at first semi-liquid or in the form of jelly; spicy foods are excluded for several weeks.

In diseases of the larynx, narrowing its lumen (edematous inflammation, tumor processes, paralysis), the patient is given a position in bed with a raised upper half of the body. The most important part of U. is to control the state of external respiration, so as not to miss signs of increased stenosis of the larynx, often requiring immediate surgical care. After operations on the larynx, careful care of the bandage, tracheostomy tube and tracheostomy is necessary (see Tracheostomy) . Usually, 10 drops of isotonic sodium chloride solution are infused into the tracheostomy tube 1-5 times a day to prevent crusting. In the first days after the operation, the tracheotomy tube is changed daily, if necessary, the contents are aspirated from the trachea. After extirpation of the larynx, care includes feeding the patient through a nasoesophageal tube.

Ophthalmic care with diseases and injuries of the eyeball includes assisting them in self-care, in carrying out hygiene procedures, as well as performing a number of specific appointments (instilling drops, laying ointment, applying a bandage over the eye, etc.). All manipulations are performed carefully, without undue pressure on. Dressings and medicines used in ophthalmology must be sterile.

Washing the eyes is carried out in order to disinfect the conjunctival cavity, remove the discharge, superficial foreign objects. After wiping the eyelids with a damp cotton swab, they are pushed apart with the index and thumbs left hand and irrigate with a stream of solution from an undine or a rubber can, without touching the eyelashes. During the procedure, the patient tilts his head, and the liquid flows into the tray, which he holds under his chin. When instilling drops, the lower eyelid is pulled back with a wet swab, pressed against the edge of the orbit and 1-2 liquids are released with a pipette onto the mucous membrane of the lower eyelid, when the eyelids are closed, excess fluid flows out through the edge of the eyelid and is removed with a cotton swab. No more than 1 drop remains in the conjunctival sac, so instillation of more than 2 drops is impractical. Eye drops should be at room temperature. When instilling drops, it is necessary to avoid touching the eyelashes of the patient with the end of the booty, which can lead to infection of the entire solution in the vial. Necessary condition is the use of individual pipettes for each patient, followed by their sterilization. To avoid errors when instilling drops, they should be placed on the tray in a certain order, each bottle should have a label with the exact designation of the contents and its concentration. To achieve a longer contact with the anterior segment of the eyeball solutions of some drugs, an eye bath is used, the configuration of the thickened edges of which corresponds to the edges of the orbit. With the eyelids open and the patient's head tilted, the eye is irrigated with the liquid in the bath.

For the purpose of long-term exposure to some drugs, thin (2 mm) cotton turundas, which are placed with a glass rod in the lower conjunctival 20-30 min. For lotions, a cold or heated (depending on the indication) solution of the drug is used, in which sterile cotton wool is moistened, then it is applied to closed eyelids and replaced every 5 min. Solutions of drugs, often alcohol, are used to lubricate the ciliary edge of the eyelids after their preliminary degreasing. For this purpose, use a cotton swab moistened with a solution and wrung out, tightly wound around a probe or the thin end of a glass rod. To prevent the solution from getting on the conjunctiva and cornea, the lower eyelid is pulled down, and the upper eyelid is moved away from the eyeball with light pressure near the edge of the eyelid.

In ophthalmic practice, ointments, emulsions and gels are widely used, which prolong the action of the medicinal substance and reduce the friction of the eyelids on the anterior surface of the eyeball. When laying these dosage forms the patient should look up. The lower eyelid is pulled with the left hand, a small amount of ointment is applied to the wide end of a sterile glass rod. inner surface century, holding the stick parallel to its edge, after closing the eyelids, the stick is pulled out. When using drugs in the form of powders, they are shaken from the wide end of the glass rod onto the inner surface of the lower eyelid after pulling it down. Soluble ophthalmic medicinal films are injected once a day with tweezers into the conjunctival sac.

Eye care includes the use of heat treatments, cold, and distractions. Apply warming - overlay on the closed eyelids of a gauze napkin moistened with warm boiled water. The top of the napkin is covered with compress paper or thin oilcloth. Alcohol and semi-alcohol compresses are not used in eye practice. Dry heat is used in the form of eye warmers or bottles with a capacity of approximately 15-20 ml filled with hot water, having a temperature not higher than 80 °. Lying on his side, the patient touches the heating pad with a sore eye, covered with a napkin, for 30 min. Cold is prescribed after blunt trauma and in the postoperative period. Pieces of ice or cold water are placed in a rubber bladder wrapped in a napkin and applied to the brow bone, avoiding pressure on the eye.

On the eve of the operation with the opening of the eyeball, the patient's eyelashes are trimmed. Immediately before the operation, it is necessary to remove dentures. After the end of the operation, the patient is bandaged on both eyes (binocular) or on one eye (monocular), depending on the nature of the surgical intervention. First, the eyelids are closed with a cotton-gauze pad, which is then fixed with a bandage bandage or strips of an adhesive plaster 0.5 wide cm arranged parallel, at an angle to each other or crosswise. If there is a need for a pressure bandage, then a dense cotton roll is placed under the cotton-gauze pad, according to the place where compression should be made, and then a bandage is applied. Sometimes special metal eye grids are used.

The patient, delivered from the operating room to the ward on a gurney, must comply with strict bed rest, the timing of which is determined by the nature of the surgical intervention. Postoperative U. includes immobilization of the patient's head, prevention of coughing and vomiting. After 6-8 h after surgery, the patient can be fed liquid or mushy food. After the bandage or sticker is canceled, special curtains are used to protect the operated eye. They are prepared from bandages or pieces of gauze 7-8 wide cm and length 14-16 cm, folded in half and thrown through a bandage bandage in one round around the head or fixed on the forehead with a sticky plaster.

Care of patients with skin and venereal diseases. Patients suffering from skin diseases require special U., the features of which depend on the nature and stage of the disease. water procedures in the period of acute inflammation of the skin, you should refrain, because. moisturizing the skin (bath, shower, rubbing with a damp towel) can be harmful, contributing to increased inflammation and exudation. For some skin diseases (for example, eczema, dermatitis), accompanied by acute inflammatory phenomena and subjective sensations (burning,), to reduce them, as prescribed by a doctor, astringent disinfectant solutions are applied to the weeping skin surfaces, which should be stored in the refrigerator (they should only be removed before starting procedures). After the inflammation subsides in the absence of weeping, local hygienic washing of the skin and local ones can be started. To clean the skin, remove crusts and scales from its surface, the secret of the sebaceous and sweat glands, you can use warm water, tanning and disinfecting solutions. In diseases accompanied by itching, especially in the genital area and anus, washing with a hot solution of chamomile (or local baths) has a beneficial effect. If the patient has a stop, apply daily foot baths with cool water. In addition to local (sitting, foot), general baths are also recommended. The latter, like a warm shower, are indicated for common, chronically occurring dermatoses (psoriasis, diffuse neurodermatitis, etc.). Warm baths, causing active hyperemia, contribute to the resolution of skin infiltration. Various ointments, creams, pastes are used to treat skin diseases. Lubrication of the skin is carried out with a cotton-gauze swab or spatula. Remains of pastes and ointments are removed from the surface of the skin with a swab moistened with warm vegetable oil (peach, sunflower, etc.). All activities for U. for the skin should be carried out only on the recommendations of a dermatologist.

When treating patients with contagious skin diseases, precautions are necessary. To avoid the spread of pustular pyoderma patients should not be washed in a bath or shower. The skin around the lesions should be thoroughly wiped daily with 2% salicylic or camphor alcohol. Underwear and bed linen, as well as a towel for patients with pyoderma, should be changed daily. The linen which was in the use is subject to boiling, the top - disinfection in a dezkamera. You should also deal with the clothes of patients with scabies and fungal skin diseases. A blanket, mattress, pillow and all household items used by patients with scabies, mycosis are subject to disinfection.

When U. for patients with venereal diseases, it is necessary to carefully observe measures that exclude the possibility of transmission of infection. For patients with syphilis, an insulator or a special department, labeled dishes are allocated. Used burn. Dirty linen is subject to mandatory boiling, outerwear - disinfection. In the venereological department, a thorough wet cleaning of all wards and offices should be carried out daily, door handles and other common items should be wiped with soapy water or a solution of chloramine. Particular attention is paid to the special cleaning of rooms where patients undergo hygienic procedures.

Care for the mentally ill. Mentally ill people in certain states are not able to control their actions, to be aware of them, in their behavior they are guided by painful experiences, they cannot evaluate their condition. Such patients may be dangerous to others, to themselves, or become helpless, suffer from an accident. Therefore, management of the mentally ill is associated with supervision of their behavior and monitoring of their condition. Monitoring carried out by staff is also necessary to identify symptoms of mental disorders, assess the mental state, and the effects of the treatment methods used. In psychiatric hospitals, supervision and monitoring of patients (depending on their condition), incl. general supervision, enhanced supervision, strict supervision.

Strict supervision is carried out for patients with clouded consciousness or with severe painful experiences (some forms of delusions and hallucinations), under the influence of which the patient himself may suffer (suicide attempts, self-mutilation, stubborn refusal of food, etc.), harm others or strive for I'll run. With strict supervision, patients are kept in a special ward under round-the-clock supervision of staff and can leave this ward (for toilets, procedures, etc.) only when accompanied by staff.

Enhanced monitoring can be carried out in ordinary wards for patients who require close attention of the staff due to the need to note the manifestations of mental disorders, the possibility of complications caused both by the course of the disease itself and associated with the methods of treatment used. Enhanced monitoring is also prescribed for somatic indications, helpless and weak patients. The rest of the patients in ordinary wards are under the general supervision of the staff.

With the development of the system of rehabilitation of the mentally ill, a stepped differential observation regimen has been developed. The most strict (restrictive) regime differs from strict supervision in that the patient is given freedom of movement within the department, but under the continuous supervision of staff. In addition, there is a regime of differentiated observation, an open door regime and partial hospitalization (day or night hospital, home holidays, etc.). The observation regimen is combined with therapeutic regimens: protective (including bed), sparing and activating (with extensive use of occupational therapy, etc.).

Work in psychiatric institutions (hospitals, semi-hospitals, dispensaries) places high demands on the staff and is associated with constant and significant stress. In all situations, the staff must maintain restraint and calmness, never raise their voices, never respond to the attacks of patients, patiently listen to complaints and painful statements, not refute them, but also not agree with the patients. Supervision and care of patients must be carried out in such a way as not to offend their dignity, while maintaining constant vigilance, especially during meals, procedures, going around doctors, walking, going to the toilet, and visiting relatives.

Bibliography: Bisyarina V.P. Childhood diseases with child care and anatomical and physiological features childhood, M., 1981; Bulkina I.G. and Pokrovsky V.I. with nursing care and the basics of epidemiology, M., 1979; Zalikina L.S. General nursing, M., 1979; Ivanova O.I., Kuzavova N.I. and Mosharev V.A. Care of gynecological patients. L., 1979; Kabanov M.M. mentally ill, L., 1978; Krasnov M.L. and Margolis M.G. outpatient doctor, M., 1969; Milich M.V., Lanchenko S.N. and Pozdnyakov V.I. Textbook on special care for patients, M., 1978; Muratov S.N. Surgical diseases with nursing care, M., 1981; Mukhin M.V. in maxillofacial patients, L., 1965; Nurse's Handbook for Nursing, ed. N.R. Paleeva, M., 1980; Khazanov A.I. Nursing of premature babies, L., 1978; Shabad A.L. The work of a nurse in the urological department, M., 1973.