Fig. 37. Urinary catheterization in men.

Preparation of the patient for roentgen examination of kidneys and urinary tracts

Plan radiography of kidneys and urinary tracts and excretory urography are often used during roentgen examination of kidneys. For this kind of examination contrast medium is introduced intravenously and then is excreted by kidneys.

Preparation consists in the patient’s keeping to a low-residue diet, excluding foodstuff rich in fiber, for three days before the examination. Overnight and in the morning on the day of examination the patient is given a cleansing enema. The examination is carried out on an empty stomach.

Attending serious and agonizing
patients Terminal diseases

Peculiarities of attending serious patients

Diseases of various organs and systems can result in grave condition of patients. In satisfactory condition most often patients are in active position when they can easily and freely make voluntary movement. The patient takes the forced position to relieve the condition. A striking example of it is the position with the legs lowered down in patients with circulatory inefficiency (orthopnea). In such position redistribution of blood takes place, so that it stays in the lower extremities and stagnation of lesser circulation decreases; due to it dyspnea abates. In unconscious state or sudden weakness when active movements are impossible,the patient’s position is passive.

Preparation of the bed and control over its condition is of great importance. Mattresses of serious patients with rectal and urinary incontinence are sewn with an oilcloth. The bedsheet should be thoroughly straightened, the edges are tucked up under the mattress. Bed linen and clothes are changed once in 10 days or much more often if necessary. When changing bedsheet, the patient is moved to the side of the bed, the freed part of the dirty bedsheet is rolled longways and a clean one is spread over this place. Then the patient is put on the clean bedsheet, the dirty one is rolled completely and the clean one is straightened. When changing the shirt, the nurse puts her hand under the back of the serious patient, pulls the shirt up to the nape holding it by the edge and removes the shirt over the head freeing the hands. The shirt is put on in reverse order – first the hands, then the head is let through the shirt. Serious patients perform vital functions in bed. In such cases patients are given bedpans or urinals. After emptying the bedpan it is carefully washed with hot water and disinfected by 1-2 % solution of bleaching powder or 3 % solution of chloramine.

Skin care and bedsore prevention

Thorough care of skin is of great importance, especially for patients confined to bed. Dirtying of skin integuments leads to itching, scratching, reinfection of skin, development of fungous diseases, bedsores. Bedsores are deep skin lesions, sometimes resulting in its necrosis, caused by long compression of soft tissues. Very often bedsores appear in areas where muscular tissue is poorly developed or totally absent – in the area of sacrum, coccyx, anklebones, condyles and hip trochanters. Bedsores also develop as a result of negligent care of skin integuments, untimely remade beds, insufficient activation of the patient, etc. First there appears blanching and then reddening of skin integuments, puffiness, blistering, exfoliation of epidermis. There develops necrosis of skin, hypoderm, fascia and tendons up to damage of periosteum. Complication of bedsores is possible through purulent or putrid reinfection.

Bedsore prevention consists in regular control over the condition of bed and underclothes of the serious patient – in duly elimination of irregularities, smoothing of folds. As a preventive measure special bed air-pillows which are placed under the areas exposed to long-term pressure (for example, under the sacrum) are used. The air-pillow must be poorly inflated, so that it can change its form when the patient moves. It is necessary to change the patient’s position regularly by turning him in bed 8-10 times a day. For treating bedsores at initial stages it is recommended to wet the damaged areas with 5-10 % solution of iodine, 1 % solution of brilliant green. The surface of bedsores is covered with an aseptic bandage. Salve and stimulating dressings, as well as surgical treatment in some cases, are also applied.

If there are no contra-indications, hygienic bath or shower is taken by patients not rarer than once a week. It is recommended to wash oily hair once a week, dry and normal hair – once in 10 days. Skin integuments of serious patients are wiped daily with cotton wool balls wetted in boiled water with alcohol or cologne added to it. Hands are washed before each meal, and feet – 2-3 times a week. It is necessary to wash skin integuments of genitals and perineum daily with warm water or weak solution of potassium permanganate using cotton wool balls. It is also necessary to cut the nails short removing the dirt that has accumulated under them not rarer than once a week. Care of eyes is carried out if there is egestion sticking together eyelashes and eyelids. With the help of a cotton wool ball wetted in a 2 % solution of boric acid first the crusting is softened and removed and then the conjunctival cavity is washed out with boiled water or physiological solution of sodium chloride. Patients must clean teeth at least 2 times a day and rinse the mouth after each meal. Oral cavity of serious patients is washed out by means of Janet’s syringe or rubber can with a 0,5 % solution of sodium bicarbonate, isotonic solution of sodium chloride or a weak solution of potassium permanganate. To prevent the liquid from going to respiratory tracts the patient stays in a semi-sitting position with the head bent forward or if the patient lies, his head is turned to one side. For the best outflow of liquid the corner of the mouth is pulled aside with a spatula.

Notion of resuscitation and work of the resuscitation department

The section of clinical medicine studying different aspects of revivescence and elaborating methods of treatment and prevention of terminal diseases is resuscitation. Resuscitationactions are carried out in cases of various diseases and states: sudden arrest of cardiac performance (acute myocardial infarction, electric injury, etc.), sudden respiratory standstill (a foreign body in trachea, drowning, etc.), poisoning by different poisons, permanent injuries, blood loss, acute renal and hepatic failure, etc.

Borderline states (between life and death) are called terminal diseases. Process of dying includes several stages:

Preagonal state results from severe anoxia of the internals and is characterized by gradual suppression of consciousness, respiratory distress and circulatory disturbance. Preagonalperiod ends by a terminal pause (short-term apnea) from 5-10 seconds to 3-4 minutes.

Agony is characterized by a short-term rise of AP and acceleration of respiration rate, sometimes a brief recovery is possible. Then a sudden fall of AP, heart rate fall, respiratory distress and loss of consciousness are observed. Algesthesia disappears, reflexes become lost, pupils become mydriatic, unconscious urination and defecation take place, body temperature falls.

Clinical death is a reversible stage of dying that lasts 5-6 minutes. During this period external signs of vital functions of the organism disappear, but yet there are no irreversible changes in the organs and tissues. It is possible to reanimate the organism completely with the help of resuscitationactions. If the death is biological, it is no longer possible to recover the functions of various organs (first of all of cerebral cortex).

Resuscitationactions are most effective, if they are performed in specialized departments. General resuscitationdepartments are organized in large hospitals and are intended for carrying out resuscitationactions in patients with various diseases and states; postoperative departments of reanimation – for observing and treating patients who have undergone an operation under anaesthetic; specialized departments of reanimation are created for patients with certain diseases (toxicology, cardoiresuscitation, etc.). In each ward individual posts of nurses are equipped with necessary facilities for rendering first aid.

First aid

Resuscitationhelp is rendered immediately. It is carried out in case of clinical death, the patient is quickly put on a hard surface.

Artificial respiration is the change of air in the patient’s lungs which is carried out artificially with the purpose of maintaining gas exchange when natural respiration is impossible or insufficient. On beforehand it is necessary to provide patency of airways by throwing back the patient’s head with the maximal drawing out of the lower jaw to the front. The patient is put down horizontally on the back and the patients neck, thorax, stomach are freed from clothes. When using “mouth-to-nose” methodthe person whorenders help closes the patient’s mouth and after a deep breath makes an energetic exhalation enfolding the patient’s nose with the lips. When using “mouth-to-mouth” method, the patient’s nose is closed and the exhalation goes into the patient’s mouth preliminary covered with gauze or a handkerchief (Fig.38). Then the patient’s mouth and nose are slightly opened which causes a passive exhalation. During this time the person whorenders help makes 1-2 normal breaths. The criterion of correct performance of artificial respiration is respiratory excursions of the thorax at the time of artificial inhalation and passive exhalation. Artificial respiration can be also carried out with the help of Ambu’s bag. Artificial respiration is carried out with the frequency of 12-18 a minute.