Preparing a patient for surgery algorithm point by point. Preparing the patient for planned and emergency operations

Preoperative

Preoperative- a room adjacent to the operating room, where personnel are prepared for surgery, used instruments are processed, instruments and sterile dressings are stored.

Preoperative period

Preoperative period - I

the period of time from the moment of diagnosis and indications for surgery to the start of its implementation.

The main task of P. p. is to minimize the risk of developing various complications associated with anesthesia and surgical intervention both during surgery and in the immediate postoperative period. P. p. is necessary for a comprehensive examination of the patient, a deep assessment of the function of the main organs and systems, as well as a possible complete corrective therapy of the identified disorders in order to increase the reserve capacity of the body.

Each surgical intervention can be complicated by bleeding, infection of the surgical wound and body cavities, damage to important anatomical structures. The risk of complications is due not only to the quality of the surgical technique of the surgeon, the conditions of asepsis and antisepsis, but also to the individual characteristics of the patient, anatomical variability, the nature of the underlying and concomitant diseases. So, life-threatening bleeding can occur in people with hemorrhagic diathesis caused by disorders in the blood coagulation system or in the vascular wall. A real threat of infection of the surgical wound or the spread of the inflammatory process exists during operations for purulent-inflammatory diseases of soft tissues or internal organs, in patients with obesity, diabetes mellitus, reduced immunoresistance. The risk of damage to anatomically important formations is highest during operations on the neck, in the mediastinum, in the area of the hepatoduodenal ligament, on the organs of the small pelvis and retroperitoneal space. In addition, any surgical intervention is accompanied by a chain of regular general reactions. Their severity depends on the duration, extent and trauma of the surgical intervention, and often on the anatomical region in which it is performed. Stress activation of hormonal homeostasis regulation systems is manifested by disorders of central and peripheral hemodynamics, impaired function of parenchymal organs and metabolism, which can sometimes become critical and become a priority in the outcome of surgery.

The duration and content of P. items differ significantly in the practice of emergency and elective surgery, in a hospital and outpatient clinic. Improving outpatient and inpatient surgical care, introducing the outpatient method (full outpatient examination, hospitalization on the day of surgery and 2-4-day stay of patients in the hospital), one-day surgical hospital (stay of patients in the hospital only on the day of surgery) and the outpatient method (operation and postoperative period are performed on an outpatient basis) has transformed the very concept of P. p. Since planned outpatient surgery mainly concerns young and middle-aged patients without concomitant diseases with small superficial benign tumors, dropsy of the testicles and spermatic cord, phimosis, Dupuytren's contracture, external hemorrhoids, anal fissure, in they do not need special in-depth examination. Patients undergo a clinical blood test, a general urinalysis, determine the time of blood clotting and the duration of bleeding. With the same diseases, patients over 60 years of age, with severe obesity, diabetes mellitus, diseases of the cardiovascular system, lungs, liver and kidneys, pregnant women and mentally ill patients should be hospitalized, because. they have an increased risk of unforeseen complications. Thus, elective outpatient surgery is predominantly possible in a limited number of individuals with minimal operative risk. Preparation for planned outpatient operations consists in taking a hygienic bath, shaving the surgical field, taking weak sedatives on the eve of the operation, mechanical cleaning of the intestine during interventions on the anterior abdominal wall and perineum.

The nature and scope of activities in the preparation of patients for planned operation in the surgical department is determined by the severity of the disease, the complexity of the upcoming surgical intervention and the initial state of the patient, which together determine the concept of operational risk.

According to the modified classification of V.A. Gologorsky, 5 groups of the physical condition of patients and 4 groups of severity of surgical intervention are taken as the basis for assessing the operational risk. Depending on the initial physical condition of patients, the following groups are distinguished: 1 - patients who do not have organic diseases or the pathological process is localized and does not cause systemic disorders; 2 - patients with mild or moderate systemic disorders associated or not associated with a surgical disease and only moderately disrupting normal life and general physical condition; 3 - patients with severe systemic disorders that are associated or not associated with a surgical disease, but seriously disrupt normal life; 4 - patients with an extreme degree of systemic disorders that severely disrupt normal life and pose a threat to life; 5 - patients whose preoperative condition is so severe that they can be expected to die within 24 hours even without surgical intervention. Surgical interventions of the same severity are accompanied by different operational risks in accordance with the different somatic condition of the patients.

According to the severity of surgical interventions, there are: A - minor operations (for example, opening small abscesses, removal of superficial benign tumors, uncomplicated appendectomy and hernia repair, removal of varicose veins of the extremities, hemorrhoidectomy); B - operations of moderate severity on abdominal organs, main vessels (opening of abscesses located in cavities, appendectomy and herniotomy in complicated forms of appendicitis and hernia, cholecystectomy, trial laparotomy, embolothrombectomy from the main arteries and other operations); B - extensive surgical interventions on the organs of the chest and abdominal cavities, main vessels (for example, gastric resection and gastrectomy, resection of the colon and rectum, extirpation of the uterus with appendages); D - radical operations on the esophagus, lungs and heart, extended operations on the abdominal organs. Taking into account the complexity of predicting the outcome of an emergency surgical intervention, each category of severity of an emergency operation is supplemented by the designation E.

Allocate general and specific measures of preoperative preparation, providing for a reduction in operational risk. The general ones include improving the patient's condition by identifying and eliminating as much as possible violations of the function of the main organs and systems. Specific are the activities aimed at preparing those organs on which the operation is to be performed.

Activities in the preparation of the patient for a planned operation, carried out in the clinic and hospital, are closely interconnected. After the disease requiring surgical treatment is recognized on the basis of anamnesis data, physical, instrumental and laboratory examinations, the functional state of the cardiovascular and respiratory systems, liver and kidneys, endocrine organs is assessed and corrective therapy of existing disorders is started before hospitalization. In diseases of the thyroid gland with thyrotoxicosis, acquired heart defects without circulatory decompensation, uncomplicated peptic ulcer, etc., the main stages of examination and preoperative therapy can be performed on an outpatient basis and in specialized non-surgical departments. Long-term in-depth examination and symptomatic treatment in the clinic of patients with malignant tumors are unacceptable.

The most important element of P. p. is the psychological preparation of the patient. As a rule, patients want to receive comprehensive answers to questions related to the nature of the disease, the validity of the operation and its features, the danger to health or disability, etc. The patient must be confident in the high professional competence of the surgeon and in the successful outcome of the operation. Special attention and special psychological preparation are required for patients who are about to undergo a mastectomy, amputation of a limb, gastrointestinal fistula, or palliative surgery. The doctor must find arguments not only in favor of the need for surgery, but also to convince of the possibility of medical and social rehabilitation. The question of how fully a patient suffering from an oncological or other incurable disease should be informed about his condition remains open and is decided individually. But if the essence and prognosis of the disease are hidden from the patient, they should be known to his relatives. Consideration should be given to the great psychological stress in P. p., especially in elderly people suffering from cardiovascular diseases, patients with thyrotoxicosis, and diabetes mellitus. The sparing, careful attitude to the patient's psyche on the part of medical personnel, the correct organization of the work of the surgical hospital retain their exceptional importance in the complex of preoperative preparation. Patients with a labile psyche, sleep disorders need to take light tranquilizers or sedatives. For 2-3 days before surgery, sleeping pills can also be prescribed for sleep disorders.

Preparation of the respiratory organs in P. p. reduces the likelihood of developing respiratory disorders and postoperative pleuropulmonary complications. Patients suffering from chronic bronchitis, pneumosclerosis or pulmonary emphysema require the appointment of expectorants, bronchodilators, inhalation of alkaline solutions, aerosols with proteolytic enzymes and bronchodilators. Before operations for chronic purulent lung diseases, postural drainage and sanitation bronchoscopy are used. Preventive antibiotic therapy may also be given if indicated. Patients with bronchial asthma are also prescribed antihistamines, and in some cases glucocorticosteroids. Respiratory gymnastics plays an important role in complex training.

The preparation of the cardiovascular system is determined by the nature of the existing disorders and is aimed at improving myocardial contractility, normalizing peripheral circulation and preventing thromboembolic complications. With normal volemic parameters and signs of cardiovascular insufficiency, cardiac glycosides, diuretics, coronary lytics and agents that improve myocardial trophism are used. Patients suffering from hypertension and cardiac arrhythmias deserve special attention. Individual selection of antihypertensive and antiarrhythmic drugs and their use up to the normalization of blood pressure and stabilization of the heart rate are one of the prerequisites for a complete preoperative preparation. Prevention of thromboembolic complications is necessary first of all in patients with chronic venous insufficiency. lower extremities and with occlusive lesions of the main arteries. For this purpose, elastic bandaging and massage of the lower extremities are effective, the appointment of antiplatelet drugs a few days before the operation ( acetylsalicylic acid, chimes, rheopolyglucin), small doses of anticoagulants of direct or indirect action.

Elimination of hypovolemia, which often develops in chronic intoxication, recurrent bleeding, dehydration, oncological and gastrointestinal diseases, is the most important task of preoperative preparation. Restoration of normal circulating blood volume and selection of transfusion therapy components should be carried out taking into account the predominant changes in the globular or plasma volume, osmotic and oncotic pressure of the plasma. Depending on this, canned donor blood, erythrocyte mass, plasma, albumin or protein are used. Colloidal crystalloid solutions are used as basic media. With the normalization of volemic parameters, rheopolyglucin is recommended in order to improve microcirculation and blood rheology.

Measures to restore the volume of circulating blood are inextricably linked with the normalization of water and electrolyte balance and acid-base state by infusion of isotonic sodium chloride solution, Ringer-Locke solution, 5% glucose solution, and in the presence of metabolic acidosis - lactasol or sodium bicarbonate. Depending on the concentration of electrolytes in blood plasma, erythrocytes, urine and indicators of acids of the main state, infusion media also include 7.49% potassium chloride solution, hypertonic sodium chloride solution.

Most patients with diseases of the gastrointestinal tract, oncological processes and chronic intoxication need to provide full enteral or parenteral nutrition, create an adequate balance of carbohydrates, fats, proteins and other ingredients of energy metabolism. The main components for enteral or parenteral nutrition should be fluids, amino acids, sugars, polyhydric alcohols, fats, mineral salts, trace elements, vitamins.

In the process of preoperative preparation, it is necessary to pay attention to the state of carbohydrate metabolism, the disorders of which are often detected only at the time of admission of patients to the hospital. In diabetes mellitus, in addition to dietary nutrition, corrective drug therapy should be carried out for patients who are to undergo extensive surgical interventions; in case of violations of natural nutrition, it should be timely transferred from oral antidiabetic drugs to insulin.

Preparation of the gastrointestinal tract for surgery for its diseases consists in prescribing a high-calorie diet with mechanically crushed products, normalizing intestinal motility. According to indications, laxatives are prescribed. In case of pyloric stenosis, daily gastric lavage with water or 0.1% hydrochloric acid solution (with achilia) is performed daily before bedtime for 5-7 days before the operation, followed by aspiration of the contents. The day before surgery on the stomach or small intestine, cleansing enemas are done. 3-4 days before surgery on the colon or rectum, a slag-free diet is prescribed with the last meal 12-18 hours before surgery. In the afternoon on the eve of the operation, the patient is given 30 ml of castor oil or saline laxative. Cleansing enemas are done in the evening and in the morning before the operation. Usage antibacterial agents in the preparation of the colon for surgery does not affect the frequency of postoperative purulent complications.

Normalization of liver function in P. p. occurs under the influence of diet therapy, in the process of improving organ hemodynamics and basal metabolism. With a decrease in the level of prothrombin, vikasol, fresh frozen plasma is prescribed to prevent hemorrhagic complications. For the prevention of liver failure in patients with prolonged jaundice, lymphosorption, hemosorption, and plasmapheresis give a good effect. Important in P. p. belongs to the improvement of renal blood flow and urodynamics, the suppression of infection in the urinary tract.

Preparation for operations for emergency indications has a number of features due to the time limit for a detailed examination of the patient's condition and correction of existing acute disorders and chronic pathology. This predetermines an increased operational risk, which is also associated with various, sometimes unfavorable, conditions in which emergency surgical interventions have to be performed. The main task of P. of the item at the emergency surgical diseases is reduced to the maximum decrease in operational risk. The priority here is the earliest possible elimination of the acute surgical process in parallel with the normalization of general pathophysiological disorders.

Patients belonging to operational risk groups 1A-2A usually do not need special preparation for emergency surgery. They are limited to shaving the surgical field, emptying the bladder and premedication. According to indications, antihypertensive drugs, coronary and bronchodilators, antihistamines, etc. are used.

Patients with a higher operational risk most often need intensive preoperative preparation, the duration of which very rarely exceeds 1-2 hours. The optimal amount of preoperative preparation is determined by the surgeon together with the anesthesiologist-resuscitator. Preoperative therapy should be in the nature of resuscitation measures aimed at the fastest and possibly complete restoration of all vital body functions.

It should be borne in mind that in the vast majority of cases (especially with peritonitis, intestinal obstruction, or impaired mesenteric circulation), delay in the operation aggravates the condition of patients and cannot be drastically improved by full-fledged infusion therapy. In a serious condition of patients and a high operational risk, short-term training is preferably carried out in the department intensive care or directly in the operating room. In patients with signs of external or internal bleeding, asphyxia, pneumothorax, etc. intensive care is carried out in parallel with surgical intervention.

Intensive preoperative preparation should eliminate or reduce water and electrolyte imbalance (acute dehydration, hypovolemic shock), eliminate metabolic acidosis, improve the state of central and peripheral hemodynamics, and restore diuresis. With severe dehydration, infusion therapy should be carried out with polyionic crystalloid solutions (Ringer's solution) in combination with colloidal solutions (medium molecular solutions - polyglucin, macrodex, dextran) or blood products (albumin, protein) until stabilization of hemodynamics and diuresis. The presence of metabolic acidosis requires the inclusion of a solution of sodium bicarbonate, lactasol or trisamine in the composition of the infusion media. Stabilization of hemodynamic parameters, restoration of the acid-base state and diuresis make it possible to start surgery simultaneously with infusion therapy.

In order to reduce the anesthetic risk, nasogastric aspiration without gastric lavage is necessary before surgery. In case of interventions on the pelvic organs and the genitourinary system or a large amount of the planned intervention, bladder catheterization is performed.

In some cases, for the purpose of preoperative preparation, palliative interventions are performed (for example, gastrostomy for cicatricial stricture of the esophagus, colostomy for intestinal obstruction), which provide more favorable conditions for performing a radical operation.

The question of choosing the method of anesthesia in critically ill patients, in most cases, is preferable to decide in favor of general anesthesia with artificial lung ventilation, which allows not only to perform the necessary amount of surgical intervention, but also to most effectively control and maintain the main functions of the body.

Contraindications to surgical interventions depend on the nature of the disease and its complications, as well as the patient's condition. In most acute surgical diseases and injuries that pose a real threat to the life of patients and require surgical intervention, there are practically no contraindications. However, in persons belonging to the 5th group of operational risk, surgical interventions are usually futile and inappropriate. At the 4th degree of operational risk, if it is due to the senile age of the patient and severe concomitant diseases, they more often seek to perform surgical interventions that are minimal in terms of volume and trauma.

Temporary contraindications to surgery occur with purulent skin diseases, hypertensive and thyrotoxic crises, decompensation of diabetes mellitus, menstruation, disorders in the hemostasis system. In a number of diseases there are specific contraindications for surgery.

The preoperative period in the elderly has a number of features due to obvious or hidden violations of basic vital functions due to age-related changes in the body, surgical and concomitant diseases. In addition, in elderly and senile patients, there is a decrease in the reserve capacity for adaptation of the main organs and systems to surgical aggression. Therefore, in ensuring the safety of surgical interventions, preoperative examination and targeted preparation of the patient for surgery and anesthesia, carried out by the surgeon and anesthetist, with the involvement, if necessary, of doctors of other specialties, most often a cardiologist, therapist, etc., are of great importance. These patients need the most thorough, versatile and, as a rule, long-term preparation up to the normalization or stabilization at a level close to the norm, all identified violations. Based on the most typical complications of the operational and immediate postoperative periods in elderly and senile patients, the main attention in preoperative preparation is given to the cardiovascular, respiratory, urinary and endocrine systems.

Features of the preoperative period in children are mainly due to immaturity and functional inferiority of a number of systems and organs. Children under three years of age usually have a tendency to form atelectasis and develop pneumonia; slow blood clotting (due to deficiency of vitamin K and prothrombin) and increased sensitivity to blood loss; imperfection of thermoregulation processes, often leading to a hypo- or hyperthermic state; increased susceptibility to infectious agents, etc. In order to reduce the risk of nosocomial infection, the time spent in the hospital before surgery is reduced as much as possible, for which many preoperative studies and therapeutic measures are performed on the basis of a children's consultation or polyclinic. With simple elective operations, children are admitted to the surgical department, as a rule, on the eve of the operation itself. Preparation for surgery of newborns with severe malformations often begins already in the maternity hospital.

When preparing children for planned operations, they are taught the elements therapeutic gymnastics, postural drainage and other measures that contribute to the favorable course of the postoperative period.

During the examination, special attention is paid to the state of the blood coagulation system, the bacillus carrier of diphtheria bacillus, hemolytic streptococcus, enteropathogenic Escherichia coli (see Carriage of pathogens of infectious diseases) is excluded, blood tests are performed, signs of malnutrition, rickets are detected.

When preparing for emergency operations, the reason for which in children is usually diseases (especially of the abdominal organs) that occur with dehydration, hemoconcentration and intoxication, the main task is to combat intoxication and disturbance of water and electrolyte balance, the degree of which is judged according to laboratory tests. (hematocrit, acid-base state of the blood, plasma osmolarity and the amount of total protein, potassium, sodium, etc.).

The volume of solutions administered intravenously before surgery is determined individually (see Infusion Therapy). In a compensated state of hemodynamics, a calculated amount of infusion media of a rheological or detoxifying effect is administered with the inclusion of a 10% glucose solution and insulin. In case of decompensation, in addition to concentrated glucose solutions, medium-molecular blood substitutes or albumin preparations are prescribed, and at the same time sodium bicarbonate solutions are added to compensate for metabolic acidosis; be sure to introduce vitamins E, group B. Such preparation is continued for 2-3 hours. A shorter preparation with the inclusion of blood transfusion is possible if internal bleeding or perforation of the genital organ of the abdominal cavity is suspected. An obligatory element of preoperative preparation in emergency surgery in children is Gastric probing, which allows to avoid regurgitation (Regurgitation) during general anesthesia due to poor development of the early age cardiac sphincter.

Preoperative preparation of newborns includes the prevention (or treatment) of respiratory failure, hemorrhagic syndrome and infusion therapy according to indications. In incubators for premature babies, the relative humidity of the air should be in the range of 90-95%, the oxygen concentration should be 40-80% (depending on the degree of respiratory failure). In the treatment of respiratory failure in congenital intestinal obstruction, regular suction of gastric contents, tracheal intubation, followed by sanitation are important. respiratory tract. To prevent increased bleeding before surgery, vikasol is used for prophylactic purposes.

Indications for infusion therapy in newborns are peritonitis, large hernias, congenital intestinal eventration, body weight deficit exceeding 10% at birth. The composition of the infusion medium depends on the nature of the disease. Intravenous load should correspond to 100-125% of the daily volume of age-related water needs, and in conditions accompanied by respiratory and heart failure - no more than 75%.

Premedication is carried out according to general anesthetic principles with the obligatory consideration of the characteristics of the neuropsychic development of the child. For children from 1 to 7 years old, sedatives are included in premedication 2-3 hours before surgery, starting from 8 years old they are prescribed on the eve of surgery. Emotionally labile or re-operated children are anesthetized while still in the ward with sodium hydroxybutyrate or ketamine (see Non-Inhalation Anesthesia).

Subject: Introduction. Stages of development and formation of surgery

Lecture plan The concept of surgery and surgical diseases The main stages in the history of the development of the world ... The group of haloids ... The principle of action free halogens chlorine iodine denature coagulate the protoplasm of cells by interacting with ...

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All topics in this section:

Lecture plan
1. The concept of surgery and surgical diseases. 2. The main stages in the history of the development of world and domestic surgery. 3. The role of N. I. Pirogov in the development of the Russian surgeon

A BRIEF HISTORY OF THE DEVELOPMENT OF SURGERY.
In the centuries-old history of the development of surgery, four main periods can be distinguished. until the second half of the 19th century In ancient times, surgery

ORGANIZATION OF SURGICAL CARE.
The basic principle of organizing surgical care in our country is the maximum proximity to the population. First aid is provided at health centers of enterprises, and in rural areas.

Lecture plan
1. The concept of nosocomial infection and the role of microbial flora in the development of purulent infection. 2. Entrance gates and ways of penetration of surgical infection into the wound. 3. Antiseptics and its

Types of antiseptics
Antisepsis is a complex of therapeutic and preventive measures aimed at the elimination of microorganisms in the wound and the body as a whole. Mechanical antiseptic

The main groups of chemical antiseptics.
Antiseptic substances belong to the group antimicrobial agents and have bacteriostatic (associated with the ability of substances to inhibit the growth of microbes) and bactericidal (the ability to cause

Synonym: sublimate is a heavy white powder. Is active antiseptic and is highly toxic. Great care must be taken when working with it. Should not be allowed

Ethanol
It belongs to narcotic substances, but is not used as an anesthetic agent due to the extremely small breadth of narcotic action. Possesses: - analgesic activity d

Sulfanilamide preparations
These include a large group of chemotherapeutic agents characterized by bacteriostatic action: streptocid, sulfadimesin, etazol, norsulfazol, etc. All drugs can be taken

Lecture plan
1. The concept of asepsis and its purpose. 2. Prevention of air infection. 3. Prevention of drip infection. 4. Prevention of contact infection - types of sterilization

PREVENTION OF AIR INFECTION.
Airborne infection refers to microorganisms that are suspended in the air. Their number in the air increases in direct proportion to the number of dust particles. Pro

PREVENTION OF DRIP INFECTION
Infection in the air can be in liquid droplets that are in suspension. It is formed from human saliva, which plays a huge role in infection of the wound and the human body.

PREVENTION OF CONTACT INFECTION
It is one of the most common sources of wound infection. The infection can be introduced into the wound through any objects in contact with it (gloves, instruments, surgical linen, etc.).

Types of bix laying
1. Universal - everything that is needed for one trading day is placed in one bix. Applied operating rooms. 2. Purposeful - laying in one bix

Sterility control methods
1. Physical - based on the use of substances whose melting point is less than the minimum operating temperature of the autoclave. 1 mode - 1 atm - 120 C - benzoic acid; 2 mode

Sterilization of endoscopic instruments
It is carried out in gas sterilizers with a mixture of ethylene oxide and methylene bromide from 3 to 24 hours in a package made of polyethylene film or in kraft bags. Also in paraformalin chambers for 3

Treatment of the surgical field
1. The Filonchikov-Grossich method consists of four stages: - the skin of the intended incision is widely processed before applying the surgical linen 2 times with 96 about alcohol and 2 times

Suture sterilization
1. Sterilization of synthetic threads. - wash the threads in soapy water; - wind the threads on glass or metal spools; - boil for 30 minutes from the moment

Questions for consolidation
1. Define asepsis and name the author of this method. 2. What is the prevention of air infection. 3. What is the prevention of droplet infection. 4. Name

Bleeding - the outflow of blood from the bloodstream into the external or internal environment.
Causes of bleeding: 1. Direct mechanical trauma blood vessel(incision, injection, crush, blow, stretching) 2. Pathological changes in the vessel wall (atherosclerosis)

Clinical manifestations of bleeding and blood loss.
Any bleeding manifests itself with a specific clinical picture, due to a combination of general and local symptoms. General symptoms: increasing weakness, dizziness, shu

Complications of bleeding
1. Acute anemia: pale skin and mucous membranes; haggard face, sunken eyes; tachycardia, weak pulse; tachypnea, drop in blood pressure; dizzy, weak

Methods of final hemostasis.
The final stop of bleeding is carried out in a hospital. Almost all patients with wounds are subject to surgical treatment, only small wounds with stopped bleeding do not require

First aid for external and internal bleeding.
Any bleeding is a threat to the life of the patient. Therefore, its immediate stop is the main task of first aid. With external bleeding, the sequence of actions

The concept of blood groups, Rh factor. Methods of blood transfusion.
A person's blood type is constant throughout life, it does not change with age, under the influence of diseases, blood transfusions and other causes. Blood transfusion can be carried out in those with

Rules for the preparation, storage and conservation of blood.
A blood transfusion is a transfusion of donated blood. Autohemotransfusion - transfusion of human blood, his own during a planned operation.

Post-transfusion hemolytic shock.
Causes: transfusion of incompatible blood by group, Rh factor, transfusion of unsuitable blood, individual intolerance. Clinic: with the development of agglutination, a person develops

Post-transfusion citrate shock.
Occurs during the transfusion of blood preserved in a glucose-citrate solution. When transfusing large doses of blood of 500 liters or more, an excess amount of sodium citrate enters the patient's body.

Blood components.
erythrocyte mass. The erythrocyte mass is conventionally called a suspension of whole blood erythrocytes, from which 60-65% of the plasma has been removed. It is obtained by settling the blood in the refrigerator while

Blood products.
Human albumin in the form of a 5-10% solution is used for hypoproteinemia of various origins (for burns, liver cirrhosis, renal failure, dystrophy). It is effective against

Antishock agents.
Anti-shock blood substitutes should have the following properties: have an osmotic pressure and viscosity close to those of blood; do not have anaphylactogenic, toxic and pyrogenic

Detoxifying agents.
1) synthetic colloid Hemodez - 6% solution of low molecular weight polyvinylpyrrolidone. It is rapidly excreted by the kidneys. Hemodez binds, neutralizes and removes

Means for parenteral nutrition.
This group of blood substitutes is used in violation of protein balance and an increased need for protein in the body, with general exhaustion, after blood loss, an infectious disease.

Care of patients after blood transfusion.
1. After blood transfusion, the patient is monitored daily with an assessment of all objective indicators: pulse, blood pressure, respiratory rate. 2. Three hours are held

Evaluation of the results of the reaction.
0 (I) A (II) B (W) AB (IV) Blood type - - - 0 (I)

Topic: "General anesthesia".
Lecture plan: 1. The concept of pain and anesthesia. 2. Brief history of pain relief. 3. General anesthesia (narcosis). Types of anesthesia. Show

A Brief History of Pain Management
Defeating pain has been the dream of surgeons for many centuries. And for this they used decoctions, infusions, alcohol, cold - snow, ice - everything that could relieve and eliminate pain during and after the operation.

General anesthesia (narcosis).
Types of anesthesia. Depending on the route of administration of narcotic drugs, pharmacological anesthesia is usually divided into: Inhalation, when the drug is injected

Local anesthesia.
Local anesthesia is a local loss of tissue sensitivity, created artificially using chemical, physical or mechanical means in order to painlessly perform operations.

Soft bandages.
Soft bandages are very diverse. According to the purpose of application, soft dressings are divided into: 1. Protective - protect wounds, areas of damage and skin diseases from drying out, contamination,

Headbands.
Since the condition of patients with head injuries can be very serious, medical worker dressing person must clearly know the technique of applying a bandage and apply a bandage quickly and carefully

Bandages on the body.
1. The spiral bandage is used for chest wounds, rib fractures, and inflammatory processes. Apply at the moment of exhalation. 2. A cruciform bandage is applied to the anterior and

Bandages on limbs.
Bandages on the upper limb. 1. Returning bandage on the finger in case of damage to the distal or middle phalanx. 2. Retractable hand bandage applied when needed

Desmurgy. Soft bandages.
1. What is desmurgy? 2. What kind of soft dressing do you know? 3. List the main types of soft bandages. 4. What kind of soft bandages are used on the head?

Plaster bandages.
Of the hard bandages, plaster bandages, which were introduced into practice by N.I. Pirogov. The high plastic properties of gypsum make it possible to apply a fixing bandage on

Rules for applying and removing a plaster cast.
Types of HP 1) Circular (solid) HP covers the limb or torso around the circumference; 2) Fenestrated GP - bandage with a "window" over the wound - for the possibility of treating wounds;

Tire bandages. Rules for imposing transport tires.
Special devices that provide immobility (immobilization) of bones and joints in case of their injuries and diseases are called splints. For transport immobilization, there are various

Diagnosis of surgical diseases.
The effectiveness of treatment, and, consequently, the recovery of the patient, primarily depends on the accuracy of the diagnosis of the disease. In many surgical diseases, early recognition is very important.

Types of operations.
A surgical operation is a mechanical effect on the tissues and organs of a patient with a therapeutic or diagnostic purpose. Surgical operations are divided by purpose into: 1. Treatment

Features of preoperative preparation of children and persons of elderly and senile age.
Peculiarities of preparation of children: Last meal 4-5 hours before the operation, because. prolonged fasting leads to severe acidosis; Enema the day before and in the morning; Washing

Transportation of the patient to the operating room, taking into account the condition.
Transportation of patients to the operating room is an important step in the treatment. Any movement of patients should be done as carefully as possible, avoiding sudden movements and shocks, bearing in mind the presence of

Treatment of the patient in the intensive care unit, postoperative ward.
Intensive care is a complex of therapeutic measures aimed at normalizing homeostasis, preventing and treating acute disorders of vital functions. Resuscitation - restored

Postoperative complications, their prevention and treatment.
Not always the postoperative period proceeds smoothly. Postoperative complications are divided into: a) Early, which occur on the first day after surgery; b) Late ones that fuss

Patient care in the postoperative period.
Observation of the bandage and timing of suture removal: In adults: - face, neck, fingers - 5-6 days, - torso, limbs - 7-8 days, in children: 5-6 days, in the elderly

Management of patients in the postoperative period.
1. Define the concept of the postoperative period. 2. Tell about the treatment of the patient in the intensive care unit, postoperative ward. 3. What complications occur

sepsis clinic. Septic shock.
Septicemia is characterized by a sudden onset, a sharp deterioration in the patient's condition. There is a tremendous chill and a critical increase in body temperature up to 40-41 degrees. Noting

Treatment of sepsis.
Patients with sepsis should be treated in specialized intensive care units. Modern treatment of sepsis consists of two interrelated components: 1. Active

Nursing.
The ICU nurse monitors the general condition of the patient: skin, pulse, respiration, consciousness and immediately reports all deviations to the doctor. The nurse must own everything

Local surgical infection.
Lecture plan: 1. Local and general symptoms of purulent inflammation. 2. Principles of treatment of patients with purulent surgical infection. 3. Types of local purulent diseases

Principles of treatment of patients with purulent surgical infection.
In the stage of infiltration in an acute process, wet-drying dressings with antiseptic solutions(20% dimexide solution, 10% sodium chloride solution, 25% magnesium solution

Types of local purulent diseases.
Furuncle. Furuncle is an acute purulent-necrotic inflammation of the hair follicle and surrounding tissue. Localization in places of hair growth and permanent trauma:

inflammation syndrome. Local surgical infection.
3. List the local symptoms of inflammation. 4. What are the principles of local treatment festering wounds you know? 5. Name the places of the most frequent localization

Anaerobic surgical infection.
Lecture plan: 1. The concept of anaerobic infection. 2. Gas gangrene: 3. Tetanus: Anaerobes are a large group of pathogens inf

Gas gangrene.
Causes of occurrence. Gas gangrene usually develops with extensive crushing of tissues (gunshot, torn, torn-bruised), often contaminated with earth, scraps of clothing.

inflammation syndrome. Anaerobic surgical infection.
1. Give the concept of anaerobic infection. 2. What is gas gangrene? 3. What clinical forms of gas gangrene do you know? 4. How to carry out gas gang prevention

Topic: “Syndrome of circulatory disorders. Deadness".
Lecture plan: 1. The concept of necrosis. 2. Types of necrosis: Heart attack; Dry and wet gangrene; · Bedsores. trophic yaz

Types of dead.
A heart attack is a section of an organ or tissue that has undergone necrosis due to a sudden cessation of its blood supply. More often this term is used to refer to the necrosis of a part of the internal

Obliterating diseases of the artery.
Obliterating endarteritis. The development of endarteritis is promoted by prolonged hypothermia, frostbite, injuries of the lower extremities, smoking, beriberi, emotions.

Diseases of the veins, varicose veins.
Varicose veins are a disease accompanied by an increase in length and the appearance of a serpentine tortuosity of the saphenous veins, a saccular expansion of their lumen. Women get sick 3 times more often

Topic: "Surgical diseases and injuries of the head, face, mouth."
Lecture plan: 1. Features of the study of a patient with surgical pathology of the face, head, oral cavity. 2. Malformations of the head. 3. Types of head wounds and d

Malformations of the head.
Among the surgical diseases of the facial skull of children, malformations are the most common. Causing significant cosmetic defects, they interfere with normal physical and ps

Types of head wounds and first aid for them.
bruises. Occurs when hit on the head with a hard object. As a result of injury, vascular rupture occurs, resulting in the formation of subcutaneous and subcutaneous

Wounds of the soft tissues of the head.
A feature of soft tissue wounds of the head is their significant bleeding even with minor damage. If the aponeurosis is dissected, then the wound gapes. Bruised wounds may be accompanied by detachment

Traumatic brain injury.
To craniocerebral injuries include: 1) Closed craniocerebral injury (concussion, bruise and compression of the brain); 2) Fracture of the cranial vault; 3) Fracture of the base of the che

Inflammatory diseases of the head, features of the course and care.
Furuncles and carbuncles. On the face, they are usually located in the area upper lip, at the tip of the nose and may be complicated by thrombophlebitis of the facial veins. At the site of inflammation, there are more

Topic: "Surgical diseases and injuries of the neck, trachea, esophagus."
Lecture plan: 1. Methods of examination of the neck, trachea and esophagus. 2. Types of surgical pathology of the neck, trachea and esophagus and methods of its correction. 3. Food burns

Types of surgical pathology of the neck, trachea and esophagus and methods of its correction.
Neck cysts. There are median and lateral cysts of the neck. Median cysts of the neck are located in the midline outside the thyroid cartilage. Clinically, cysts do not cause complaints, they grow slowly. In sl

Burns of the esophagus.
Rarely can be thermal (hot liquid ingestion), more common chemical burns resulting from accidental or deliberate ingestion of acids or alkalis that cause severe injury with

Foreign bodies of the trachea and esophagus.
Foreign bodies of the respiratory tract. It can be caused by pieces of food, a variety of objects, dentures, bones. After aspiration of a foreign body, an asthma attack occurs

Neck injury.
Neck wounds. There are stab, cut, gunshot wounds of the neck. Incised wounds are usually inflicted when attempting suicide. They have a transverse direction, are located below the hyoid

Care of patients with surgical diseases of the neck, trachea and esophagus.
Patients with neck injuries need careful care and observation in the postoperative period. They are placed on a functional bed in a semi-sitting position. The nurse monitors the condition of the bandage

Topic: "Surgical diseases and injuries of the organs of the chest cavity."
Lecture plan: 1. Methods for examining the chest and its organs. 2. Malformations of the lungs and esophagus. 3. Damage to the chest. 4. Inflamed

Malformations of the lungs and esophagus.
Lung agenesis is the absence of all structural units of the lung. Children with such a defect are not viable. Lung hypoplasia - underdevelopment of all structural units l

Chest injury.
Chest injuries can be closed or open. Closed injuries include: contusion, closed fractures of the ribs, and clavicle. These injuries can be with damage to internal organs and b

Inflammatory diseases of the lungs.
Lung abscess is a limited focal purulent-destructive inflammation of the lung tissue. An abscess develops with acute inflammation of the lung tissue, impaired bronchial patency

Diseases of the mammary gland.
Breast hyperplasia and gynecomastia. Breast hyperplasia is a dishormonal disease of the breast in girls and women. Gynecomastia is a

Care of patients with surgical diseases of the chest.
Care of a patient with damage to the chest and its organs. A patient with a chest injury is placed in a semi-sitting position in bed. great attention given to the prevention of pulmonary

Topic: "Surgical diseases and injuries of the abdominal wall and abdominal organs."
Lecture plan: 1. Methods of examination of a patient with surgical diseases and injuries of the abdomen. 2. Closed and open injuries of the abdominal wall and

Closed and open injuries of the abdominal wall and abdominal organs.
Closed and open injuries of the abdominal wall. Closed injuries of the anterior abdominal wall occur with direct trauma - a blow to the anterior abdominal wall. Distinguish

Sharp belly.
Acute abdomen is a term for severe pain in the abdomen lasting several hours or more. The terms "acute abdomen" include diseases such as acute appendicitis, acute

Acute appendicitis.

Peritonitis.
Peritonitis is an inflammation of the peritoneum. It can be limited and diffuse if the infection spreads throughout the abdominal cavity. The course of diffuse purulent peritonitis can be divided into 3 phases:

Care of patients with diseases and injuries of the abdomen.
Care of the patient with abdominal trauma. In case of damage to the abdomen, the patient is on strict bed rest. Before surgery during the follow-up period

Topic: "Hernia of the abdomen."
Lecture plan: 1. The concept of abdominal hernias. 2. The main symptoms of hernias. 3. Types of hernias. 4. General treatment of hernias. 5. Patty care

The main symptoms of hernias.
The first sign of a hernia is pain that occurs when walking, coughing, working, physical effort. The pain is stronger in the initial period of the disease; as the hernia increases, the pain decreases. Simultaneously

Types of hernias.
Inguinal hernia. Inguinal hernias are called, which are formed in the inguinal region. They can be straight, oblique and inguinal-scrotal. Direct inguinal hernias have a spherical f

General treatment of hernias.
A radical cure for a hernia is possible only with the help of an operation during which the viscera are reduced into the abdominal cavity, the hernia sac is excised and a ligature is applied to its neck,

Care of patients with hernia.
Before a planned operation, the patient undergoes an outpatient examination. In the hospital on the eve of the operation, a cleansing enema is done in the evening and in the morning. The operation is performed under local anesthesia. At

Topic: "Complications of peptic ulcer of the stomach and 12 duodenal ulcer."
Lecture plan: 1. The main manifestations of cicatricial deformities and stenosis, ulcer penetration. 2. Perforated ulcer of the stomach and duodenum. 3.

Perforated ulcer of the stomach and duodenum.
A perforated gastric ulcer or perforation is the formation of a through defect in the wall of the stomach. Gastric and duodenal ulcers are complicated by perforation in approximately 15% of patients. It's a complication

Gastrointestinal bleeding.
Gastroduodenal bleeding occurs suddenly in the midst of full health. The onset of bleeding may be preceded by weakness, palpitations. The severity of the patient's condition depends on the massiveness and rapid

Therapeutic tactics for gastrointestinal bleeding.
With profuse bleeding, emergency surgical interventions are performed, because. the source can only be established during laparotomy. In other cases, treatment begins with a complex

Care of the patient after gastric resection.
Treatment outcomes and the provision of good care for the sick. The first 2 days the patient is in the intensive care unit, then he is transferred to the intensive care unit

Topic: "Acute cholecystitis, pancreatitis, appendicitis."
Lecture plan: 1. Acute cholecystitis: causes, clinic, complications, treatment. 2. Acute pancreatitis: causes, clinic, complications, treatment. 3.

Acute pancreatitis.
Acute pancreatitis is a peculiar pathological process that includes edema, inflammation, hemorrhagic impregnation and necrosis of the pancreatic tissue. Acute pancreatitis occurs in the form of

Acute appendicitis.
Acute appendicitis is an inflammation of the appendix. Sick with the same frequency and men and women at any age. clinical picture. The main symptom of acute

Features of the course of acute appendicitis in children, the elderly, pregnant women.
Acute appendicitis occurs atypically in children, the elderly and pregnant women. In elderly patients, weak muscle tension is observed, symptoms of peritoneal irritation may not be expressed. So

Features of care for patients with acute cholecystitis, pancreatitis, appendicitis.
Care of the patient after cholecystectomy. 4-5 hours after removal from general anesthesia, the patient is placed in bed in the Fowlerian position. Paren is carried out in the first two days

Topic: "Intestinal obstruction".
Lecture plan: 1. The concept of intestinal obstruction, causes and types of intestinal obstruction. 2. Clinical forms of intestinal obstruction

Clinical forms of intestinal obstruction.
Dynamic obstruction has a neuro-reflex character. Spasmodic intestinal obstruction. Clinically manifested by colicky pain in the intestines, in

Treatment of patients with various types of intestinal obstruction.
Treatment of patients with spastic intestinal obstruction is conservative. A good effect is observed from pararenal blockades, the introduction of antispasmodics (no-shpa). In the treatment of Spanish

Topic: "Surgical diseases and injuries of the rectum."
Lecture plan: 1. Methods of research of patients with diseases of the rectum. 2. Damage to the rectum, first aid and treatment. 3. Vices

Injuries of the rectum, first aid and treatment.
Damage to the rectum occurs with fractures of the pelvic bones, medical manipulations, the introduction of a foreign body. Clinically, the patient notes pain in the lower abdomen and in the anus, tenesmus (according to

Malformations of the rectum.
Among the malformations, atresia is the most common - the complete absence of the lumen of the rectum. Distinguish the infection of the anus, the pelvic part of the rectum or the infection of both departments.

Diseases of the rectum.
Fissure of the anus The cause of the fissure of the anus may be excessive stretching of the anus with stool, frequent constipation or loose stools, hemorrhoids, complications

Features of postoperative care for patients with diseases and trauma of the rectum.
Postoperative care for patients with anal fissures. In the postoperative period, jelly, broth, tea, juices are prescribed. To delay stool for 4-5 days, give 8 drops

Topic: "Surgical diseases and injuries of the spine, spinal cord and pelvis".
Lecture plan: 1. Malformations of the spine. 2. Injuries of the spine and spinal cord: Bruises of the spine; Dislocations and perforations

Injuries to the spine and spinal cord.
Spinal injuries can be closed as a result of blunt trauma and open with gunshot and stab wounds. Depending on the nature of the injury, bruises, sprains of the ligamentous apparatus are possible.

Tuberculosis of the spine.
Tuberculous spondylitis is the main form of bone tuberculosis. Mostly children get sick, more often under the age of 5 years. The source of infection is the pulmonary focus, from which mycobacteria spread.

Pelvic injury.
Pelvic fractures are the result of a severe transport or work injury, so they are more common in men under the age of 40. Pelvic fractures occur when it is compressed in the anteroposterior

Nursing care of patients with diseases and injuries of the spine, spinal cord and pelvis.
Care of patients with injuries of the spine and spinal cord. The nurse closely monitors compliance with bed rest, the correct position of the patient in bed. Huge

Topic: "Surgical diseases and injuries of the genitourinary organs."
Lecture plan: 1. Methods of research of patients with diseases of the genitourinary organs. 2. Surgical pathologies urinary system. 3.

Surgical pathologies of the urinary system.
Agenesis is the absence of one or two kidneys. In the absence of 2 kidneys, the child dies. Accessory kidney - located near the main kidney, has a small size and its own ureter

Injuries of the genitourinary organs and first aid for them.
Kidney damage. It is customary to distinguish between closed and open kidney injuries. Open injuries are observed with gunshot and stab wounds with extensive destruction of the renal

Urolithiasis and first aid for renal colic.
Urolithiasis is one of the most common kidney diseases. It occurs with equal frequency in men and women. The causes of urolithiasis are: metabolic disorders

First aid for urinary retention.
Acute urinary retention is the involuntary cessation of bladder emptying. The cause may be diseases of the genitourinary system (prostate adenoma, bladder tumor,

Features of care for urological patients in the postoperative period.
Postoperative care of the patient with kidney injury. After the end of the operation on the kidney, regardless of the nature of the intervention, the wound is drained with tubular drains and rubber outlets.

Seam materialPostoperative period

Preoperative preparation

patients consists in a complex of actions. In some cases, they are reduced to a minimum (for emergency and urgent operations), and for elective operations, they should be carried out more carefully.

In case of emergency operations for acute appendicitis, strangulated hernia, non-penetrating wounds of soft tissues, it is enough to inject a solution of morphine or promedol, shave the surgical field and empty the stomach from the contents. In patients with severe injuries, it is necessary to immediately begin anti-shock measures (pain relief, blockades, transfusion of blood and anti-shock fluids). Before surgery for peritonitis, intestinal obstruction, emergency measures should be taken to combat dehydration, detoxification therapy, correction of salt and electrolyte balance. These measures should begin from the moment the patient arrives and should not cause a delay in the operation.

When preparing a patient for a planned operation, the diagnosis should be clarified, comorbidities should be identified that can complicate, and sometimes even make the operation impossible. It is necessary to establish foci of endogenous infection and, if possible, sanitize them. In the preoperative period, the function of the lungs and heart is examined, especially in elderly patients. Debilitated patients require preoperative transfusion of protein drugs and blood, as well as the fight against dehydration. Much attention should be paid to the preparation of the nervous system of the patient before the operation.

Responsibilities of a Nurse. Medical preparation for a surgical operation is directly carried out by a nurse as prescribed by a doctor. The nurse also carries out physical training of the patient, aimed at preventing postoperative complications, prepares the skin, oral cavity, and gastrointestinal tract of the patient for surgery. The medical worker of the surgical department must remember that the unscrupulous performance of even the most insignificant, at first glance, measures for caring for a surgical patient can lead to tragic consequences.

In anticipation of the operation, a person naturally worries, his anxiety is justified. The expectation of pain, and in some cases a premonition of one's own helplessness in the postoperative period, disturb and oppress the patient. The nurse, communicating with the patient, in no case should replace the doctor and try to explain to him the essence of the upcoming operation. But it must support the patient's confidence that, thanks to the high qualification of surgeons and anesthesiologists, with the help of drugs and other special techniques, the operation and the postoperative period will be painless. It is important to convince the patient of the success of the treatment. This is a difficult task, requiring in each case an individual approach to a sick person. Regardless of your own mood, it is necessary to constantly maintain good spirits in a patient who is about to have an operation.

It is very important to strengthen the patient's confidence in those specialists who manage his treatment and directly carry it out. This also applies to those specialists who will treat the patient in the first days after the operation in the intensive care unit.

It is absolutely unacceptable for a nurse to speak critically in the presence of patients about the work of any of the medical staff, even if there are grounds for such criticism.

An important element of the nurse's activity is breathing exercises, especially when preparing elderly patients for surgery. The nurse should not only remind the need for breathing exercises in strict accordance with the doctor's prescription, she must explain to the patients that the postoperative period is much easier for those who clearly followed all the doctor's prescriptions before the operation. Proper implementation of the breathing regimen (coughing up and removing the discharge of the respiratory tract) plays a huge role in the prevention of postoperative pulmonary complications.

The nurse must supervise smokers. It is necessary to convince them of the need to quit smoking, since smoking disrupts the cough reflex and contributes to the retention of sputum in the lungs, which leads to pulmonary complications after surgery.

The human oral cavity contains many microorganisms, among which there are also pathogens. Especially a lot of them with dental caries, inflammation of the gums and chronic tonsillitis (inflammation of the tonsils). In a healthy person, natural cleaning of the mouth occurs. After the operation, the situation is different. Patients have reduced salivation, it is difficult and often impossible for them to brush their teeth. Restriction or cessation of drinking and eating through the mouth creates additional conditions for the development of infection, which can always become sharply activated and cause both local inflammation of the oral cavity, pharynx, parotid gland, and general life-threatening complications (sepsis).

In patients with diseases of the teeth and gums in the preoperative period, it is necessary to sanitize the oral cavity. In the absence of obvious lesions of the oral cavity, preoperative preparation is reduced to observing the rules of hygiene: brushing your teeth 2 times a day (in the morning and before bedtime) and obligatory rinsing your mouth after each meal.

If the patient has not brushed his teeth for a long time, he should not be advised to start brushing his teeth in the preoperative period, as this will cause irritation and inflammation of the gums, which will delay the operation. Such a patient can wipe his teeth and tongue with a sterile gauze cloth moistened with a solution of baking soda (1/2-1 teaspoon per glass of warm water). After that, rinse your mouth with warm water.

Preparation of the gastrointestinal tract. Before any operation, the patient must be cleared of the gastrointestinal tract. Bloating of the stomach and intestines, filled with gases and contents, after surgery impairs the blood supply to these organs, which contributes to the development of infection in the intestines with its penetration beyond the intestinal wall, and due to increased pressure, it can break the sutures on the abdominal organs after surgery. In addition, bloating of the stomach and intestines dramatically worsens the function of the cardiovascular and pulmonary systems, which in turn worsens the blood supply to the abdominal organs. The contents of the hollow organs of the abdomen during operations on these organs can enter the free abdominal cavity, causing inflammation of the peritoneum (peritonitis). The presence of contents in the stomach, which necessarily occurs when a tumor obstructs the exit section of the stomach or with ulcerative narrowing, is dangerous because during induction of anesthesia it can get into the patient's mouth, and from there into the lungs and cause suffocation.

In patients without impaired evacuation from the stomach, the preparation of the upper digestive tract for surgery is limited to complete fasting on the day of surgery. In case of violations of the evacuation from the stomach, the contents of the stomach are pumped out before the operation. To do this, use a thick gastric tube and a syringe for washing the cavities.

With the accumulation of food residues of a thick consistency and mucus, a gastric lavage is performed - instead of a syringe, a large glass funnel is put on the end of the probe.

A large amount of gastric contents accumulates in patients with intestinal obstruction.

A cleansing enema is usually used to cleanse the lower intestines. A single enema or even two enemas (at night and in the morning) cannot effectively cleanse the intestines in a patient with chronic stool retention, so one of the main tasks of the preoperative period is to achieve a daily independent stool in the patient. This is especially necessary for patients with a tendency to accumulate gases (flatulence) and suffering from chronic constipation. Normalization of bowel movements can be ensured by a proper diet.

Skin preparation. Microorganisms accumulate in the pores and folds of the skin, the entry of which into the wound should be excluded. This is the meaning of preparing the patient's skin for surgery. Moreover, contaminated skin after surgery can become a site for the development of purulent-inflammatory diseases, i.e., a source of infection for the whole organism.

On the eve of the operation, the patient is washed and linen is changed. Particular attention should be paid to the places where sweat and dirt accumulate. armpits, perineum, neck, feet, navel and all skin folds, very deep in obese patients).

The hair on the head of the patient should be neatly trimmed, in men the beard and mustache should be shaved off. Fingernails and toenails must be cut short. Nail polish must be washed off.

A more effective sanitization of the patient's body before the operation, of course, is a shower, which is more easily tolerated by many patients.

Bedridden patients are first wiped in bed with warm soapy water, then with alcohol, cologne, etc. An oilcloth should be placed on the bed. When wiping with water, use a sponge. The nurse is obliged to examine the entire body of the patient and, if pustular or other inflammatory skin lesions are found, be sure to inform the doctor about this.

Operating field preparation. The surgical field is the area of the skin that will undergo surgical intervention (dissection) during the operation. Proper preparation operating field significantly reduces the number of microorganisms entering the surgical wound.

The duties of the nurse in the preparation of the surgical field are reduced to shaving the hairline of this area on the day of the operation before the patient takes medicines and injections. (Shave the hair of the surgical field is not performed on the eve of the operation in the evening, because the resulting small scratches may become inflamed by morning, which will make it impossible to perform the operation.)

Before the skin incision on the day of the operation on the operating table, the operating field will be treated at least three times with 5-10% alcohol iodine tincture, which significantly reduces the likelihood of infection not only after microtraumas of the surface layers of the skin with a razor, but also after its dissection to the full depth .

Before use, the razor must be disinfected for 5-10 minutes in a 3% carbolic acid solution or 2% chloramine solution.

It is necessary to shave, slightly pulling the skin in the opposite direction of the razor. Direct movement of the cutting edge of the razor strictly at right angles to the direction of shaving, it is advisable to carry out in relation to the hair "against the grain". Dry shaving is preferred, however, with thick hair, the hair is lathered. The shaved surgical field is washed with boiled water and wiped with alcohol. The boundaries of shaving should exceed the area of the skin that will be exposed after wrapping the surgical field with sterile sheets.

Before most major operations, the entire anatomical area of the surgical intervention is prepared: for head surgery, the entire head is shaved, for abdominal surgery, the entire abdomen, including the pubis, etc. You need to know which areas of the skin are shaved before typical operations. In some cases, you should ask the surgeon about the course of the proposed skin incision, and sometimes the location of a possible additional incision, in order to prepare both surgical fields in advance.

Transporting the patient to the operating room. The patient must spend the day before the operation in an atmosphere of complete mental and physical rest. In the morning, the patient can get out of bed, brush his teeth, wash his face and hands, shave and go to the toilet. In the morning, it is time to shave the hair of the surgical field. Returning to the ward, the patient should lie down in bed and not be active either in conversations or in movements. Later, around 8 o'clock in the morning, injections are usually carried out: the patient is given drugs that prepare him for anesthesia (sedatives, drugs, etc.). This preparation is called premedication. After that, the patient must observe absolute rest and bed rest. The room must be quiet. If the patient is awake, it should be reminded of the need to at least take a nap with your eyes closed.

Before being transported to the operating room, the patient must urinate. When preparing some patients for surgery, it is useful to develop the skill of urinating lying down in their bed, which will then alleviate the forced need to urinate lying down after surgery, and many will save them from inserting a rubber tube into the bladder - an unpleasant and serious event in the sense of possible infectious lesions of the urinary system. The nurse should teach the patient to urinate lying down. Sometimes the patient can urinate while sitting on the bed, after which he lies down on a gurney.

Before transporting the patient, the nurse must make sure that he is properly dressed. If the operation is on the chest, he should not have a shirt. During abdominal surgery, men should not wear underwear. Although underwear can be removed in the preoperative.

Long hair in women should be braided, neatly laid on the head and tied with a gauze scarf. Watches, rings and other jewelry must be removed. Removable dentures are left in the ward.

It is unacceptable to transport a patient without a pillow, with his head in weight. It must be remembered that before the operation the patient experiences a strong emotional stress, so he must constantly feel the care and courtesy of the medical staff. Before transporting the patient to surgery, make sure that the operating room and anesthesia staff are ready to receive him. All instruments on the tables must be closed, traces of previous operations removed, and the operating room must be wet cleaned.

Patients are transported to the operation on a gurney in the supine position. Transportation of a patient lying down is explained by the need to protect him from dangerous reactions of the circulatory organs to a change in body position, which are possible after premedication. The patient is transported smoothly, at a moderate speed, without hitting the gurney against objects in the corridor and the door.

Having delivered the patient to the operating table, the nurse helps him move to it, and lays him on the table in accordance with the instructions of the anesthetist or surgeon, covers the patient with a sterile sheet. A seriously ill patient is transferred by an anesthesiological team and an operating nurse.

Together with the patient, a medical history, a test tube with blood or serum (with the patient's surname and initials) should be delivered to the operating room and transferred to the anesthesiologist to determine individual compatibility during blood transfusion, and in some cases, the medications that the patient needed during the operation that he used before.

If the patient is hearing impaired, a hearing aid should be handed over to the anesthesia team, as it will be needed for contact with the patient.

Preparing for emergency surgery. In conditions that threaten the patient's life (wound, life-threatening blood loss, etc.), no preparation is carried out, the patient is urgently delivered to the operating room, without even taking off his clothes. In such cases, the operation begins simultaneously with anesthesia and resuscitation (resuscitation) without any preparation.

Before other emergency operations, preparation for them is still carried out, although in a significantly reduced volume. After deciding on the need for surgery, preoperative preparation is carried out in parallel with the continuation of the examination of the patient by the surgeon and anesthetist. Thus, the preparation of the oral cavity is limited to rinsing or rubbing. Preparation of the gastrointestinal tract may include evacuation of gastric contents and even leaving a gastric nasal tube (for example, in intestinal obstruction) for the duration of the operation. An enema is rarely given, only a siphon enema is allowed when trying to conservatively treat intestinal obstruction. In all other acute surgical diseases of the abdominal cavity, an enema is contraindicated.

Hygienic water procedure is carried out in an abbreviated form - a shower or washing the patient. However, the preparation of the surgical field is carried out in full. If it is necessary to prepare patients who came from production or from the street, whose skin is heavily contaminated, the preparation of the patient's skin begins with mechanical cleaning of the surgical field, which in these cases should be at least 2 times larger than the intended incision. The skin is cleaned with a sterile gauze swab moistened with one of the following liquids: ethyl ether, 0.5% ammonia solution, pure ethyl alcohol. After cleaning the skin, the hair is shaved and the surgical field is further prepared.

In all cases, the nurse should receive clear instructions from the doctor on how much and by what time she must fulfill her duties.

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Seam materialPostoperative period

patients consists in a complex of actions. In some cases, they are reduced to a minimum (for emergency and urgent operations), and for elective operations, they should be carried out more carefully.
In case of emergency operations for acute appendicitis, strangulated hernia, non-penetrating wounds of soft tissues, it is enough to inject a solution of morphine or promedol, shave the surgical field and empty the stomach from the contents. In patients with severe injuries, it is necessary to immediately begin anti-shock measures (pain relief, blockades, transfusion of blood and anti-shock fluids). Before surgery for peritonitis, intestinal obstruction
emergency measures to combat dehydration, detoxification therapy, correction of salt and electrolyte balance should be carried out. These measures should begin from the moment the patient arrives and should not cause a delay in the operation.
When preparing a patient for a planned operation,
the diagnosis was clarified, concomitant diseases were identified that could complicate, and sometimes even make the operation impossible.
It is necessary to establish foci of endogenous infection and, if possible, sanitize them. In the preoperative period, the function of the lungs and heart is examined, especially in elderly patients. Debilitated patients require preoperative transfusion of protein drugs and blood, as well as the fight against dehydration. Much attention should be paid to the preparation of the nervous system of the patient before the operation. The duties of a nurse. Medical preparation for
surgery is performed directly by a nurse
doctor's prescription. The nurse also performs physical

preparation of the patient, aimed at preventing postoperative complications, prepares the skin, oral cavity, and gastrointestinal tract of the patient for surgery. The medical worker of the surgical department must remember that the unscrupulous performance of even the most insignificant, at first glance, measures for caring for a surgical patient can lead to tragic consequences.
In anticipation of the operation, a person naturally worries, his anxiety is justified. The expectation of pain, and in some cases a premonition of one's own helplessness in the postoperative period, disturb and oppress the patient. The nurse, communicating with the patient, in no case should replace the doctor
and try to explain to him the essence of the upcoming operation. But it must support in the patient the confidence that
thanks to the high qualification of surgeons and anesthesiologists, with the help of medicines and other special techniques, the operation and the postoperative period will be painless. Important
to convince the patient of the success of the treatment. It's a hard task
requiring in each case an individual approach to a sick person. Regardless of your own mood, it is necessary to constantly maintain good spirits in a patient who is about to have an operation.
It is very important to strengthen the patient's confidence in those specialists who manage his treatment and directly carry it out. This also applies to those specialists who will treat the patient in the first days after the operation in the intensive care unit. It is absolutely unacceptable for a nurse to speak critically in the presence of patients about the work of any of the medical staff, even if there are grounds for such criticism.
An important element of the nurse's activity is breathing exercises, especially when preparing elderly patients for surgery. The nurse must
only to remind of the need to conduct breathing exercises in strict accordance with the doctor's prescription, she is obliged to explain to patients that the postoperative period is much easier for those who clearly followed all the doctor's prescriptions before the operation. Proper implementation of the breathing regimen (coughing up and removing the discharge of the respiratory tract) plays a huge role in the prevention of postoperative pulmonary complications.
The nurse must supervise smokers. It is necessary to convince them of the need to quit smoking, since smoking disrupts the cough reflex and contributes to the retention of sputum in the lungs, which leads to pulmonary complications after surgery.
The human oral cavity contains many microorganisms,

some of which are pathogenic. Especially a lot of them with dental caries, inflammation of the gums and chronic tonsillitis (inflammation of the tonsils). In a healthy person, natural cleaning of the mouth occurs. After the operation, the situation is different. Patients have reduced salivation, it is difficult and often impossible for them to brush their teeth. Restriction or cessation of drinking and eating through the mouth creates additional conditions for the development of an infection, which can always be sharply activated
and cause both local inflammation of the lining of the oral cavity, pharynx, parotid gland, and general life-threatening complications (sepsis).
In patients with diseases of the teeth and gums in the preoperative period, it is necessary to sanitize the oral cavity. In the absence of obvious lesions of the oral cavity, preoperative preparation is reduced to following the rules
hygiene: brushing your teeth 2 times a day (in the morning and before bedtime)
and obligatory rinsing of the mouth after each meal.
If the patient has not brushed his teeth for a long time, he should not be advised to start brushing his teeth in the preoperative period, as this will cause irritation and inflammation of the gums, which will delay the operation. Such a patient can wipe
teeth and tongue with a sterile gauze cloth moistened with a solution of baking soda (1/2-1 teaspoon per glass of warm water). After that, rinse your mouth with warm water.
Preparation of the gastrointestinal tract. Before any operation
the patient must be cleared of the gastrointestinal tract. Bloating of the stomach and intestines, filled with gases and contents, after surgery impairs the blood supply to these organs, which contributes to the development of infection in the intestines with its penetration beyond the intestinal wall, and as a result
increased pressure can break the stitches on the abdominal organs after surgery. In addition, bloating and
intestines sharply worsens the function of the cardiovascular and pulmonary systems, which in turn worsens the blood supply to the abdominal organs. The contents of the hollow organs of the abdomen during operations on these organs can enter the free abdominal cavity, causing inflammation of the peritoneum (peritonitis). The presence of contents in the stomach, which necessarily occurs when a tumor blocks the exit section of the stomach or with ulcerative narrowing, is dangerous because during induction anesthesia it can get into the patient's mouth, and from there into the lungs and cause suffocation.
In patients without impaired evacuation from the stomach, the preparation of the upper digestive tract for surgery is limited to complete fasting on the day of surgery. At
violations of evacuation from the stomach before the operation, the contents of the stomach are pumped out. To do this, use a thick

gastric tube and syringe for washing cavities.
With the accumulation of food debris of a thick consistency and mucus, a gastric lavage is performed - instead of a syringe, a large glass funnel is put on the end of the probe.
A large amount of gastric contents accumulates in patients with intestinal obstruction.
To cleanse the lower intestines, as a rule,
a cleansing enema is applied. A single enema or even two enemas (at night and in the morning) cannot effectively cleanse the intestines in a patient with chronic stool retention, therefore
one of the main tasks of the preoperative period is to achieve a daily independent stool in the patient. This is especially necessary for patients with a tendency to accumulate gases (flatulence) and suffering from chronic constipation. Normalization of bowel movements can be ensured by a proper diet.
Skin preparation. Microorganisms accumulate in the pores and folds of the skin, the entry of which into the wound should be excluded. This is the meaning of preparing the patient's skin for surgery. Moreover, contaminated skin after surgery can become a site for the development of purulent-inflammatory diseases, i.e., a source of infection for the whole organism. On the eve of the operation, the patient is washed and linen is changed. Especially carefully it is necessary to wash the places of accumulation of sweat and dirt (armpits, perineum, neck, feet, navel and all skin folds, very deep in obese patients).
The hair on the head of the patient should be neatly trimmed,
in men, the beard and mustache are shaved. Fingernails and toenails must be cut short. Nail polish must be washed off.
A more effective sanitization of the patient's body before the operation, of course, is a shower, which is more easily tolerated by many patients.
Bedridden patients are first wiped in bed with warm soapy water, then with alcohol, cologne, etc. An oilcloth should be placed on the bed. When wiping with water, use a sponge. The nurse is obliged to examine the entire body of the patient and, if pustular or other inflammatory skin lesions are found, be sure to inform the doctor about this.
Preparation of the operating field. The surgical field is the area of the skin that will undergo surgical intervention (dissection) during the operation. Proper preparation of the surgical field significantly reduces the number of microorganisms entering the surgical wound.
Responsibilities of the nurse in the preparation of the operating room

the fields are reduced to shaving the hairline of this area on the day of the operation before the patient takes medicines and injections. (Shave the hair of the surgical field is not performed on the eve of the operation in the evening, because the resulting small scratches may become inflamed by morning, which will make it impossible to perform the operation.)
Before the skin incision on the day of surgery on the operating table, the operating field will be treated at least three times 5-
10% alcohol iodine tincture, which significantly reduces the likelihood of infection not only after microtrauma of the surface layers of the skin with a razor, but also after it is cut to the full depth.
Before use, the razor must be disinfected for 5-10 minutes in a 3% carbolic acid solution or 2% chloramine solution.
It is necessary to shave, slightly pulling the skin in the opposite direction.
razor direction. Direct movement of the cutting edge of the razor strictly at right angles to the direction of shaving, it is advisable to carry out in relation to the hair "against the grain". Dry shaving is preferred, however, with thick hair, the hair is lathered. The shaved surgical field is washed with boiled water and wiped with alcohol. The boundaries of shaving should exceed the area of the skin that will be exposed after wrapping the surgical field with sterile sheets.
Before most major operations, the entire anatomical area of the surgical intervention is prepared: for head surgery, the entire head is shaved, for abdominal surgery, the entire abdomen, including the pubis, etc. You need to know which areas of the skin
shave before typical surgeries. In some cases, you should ask the surgeon about the course of the proposed skin incision, and sometimes the location of a possible additional incision, in order to
prepare both operating fields in advance. Transportation of the patient to the operating room. The day before the operation, the patient must spend in an environment of complete
mental and physical rest. The patient can get up in the morning
bed, brush your teeth, wash your face and hands, shave and go to the toilet. In the morning same time shave the hair of the operating room
fields. Returning to the ward, the patient should lie down in bed and not be active either in conversations or in movements. Later,
around 8 o'clock in the morning injections are usually carried out: the patient is injected with drugs that prepare him for anesthesia (sedatives, drugs, etc.). This preparation is called premedication.
After that, the patient must observe absolute rest and bed rest. The room must be quiet. If the patient is awake, it should be reminded of the need to at least take a nap with your eyes closed.

Before being transported to the operating room, the patient must urinate. In preparing some patients for surgery, it is useful to develop the habit of urinating while lying in bed, which
then it will alleviate the forced need to urinate lying down after the operation, and many will save the insertion of a rubber tube into
bladder - an unpleasant and serious event in the sense of possible infectious lesions of the urinary system. The nurse should teach the patient to urinate lying down.
Sometimes the patient can urinate while sitting on the bed, after which he lies down on a gurney.
Before transporting a patient, the nurse must ensure that
that he is properly dressed. If the operation is on the chest, he has shirts
must not be. During abdominal surgery, men should not wear underwear. Although underwear can be removed in the preoperative.
Long hair in women should be braided, neatly laid on the head and tied with a gauze scarf. Watches, rings
and other decorations must be removed. Removable dentures are left in the ward.
It is unacceptable to transport a patient without a pillow, with his head in weight. It must be remembered that before the operation, the patient experiences a strong emotional stress, so he must constantly feel the care and courtesy of the medical
personnel. Before transporting the patient to surgery, make sure that the operating room and anesthesia staff are ready to receive him. All instruments on the tables must be closed, traces of previous operations removed, and the operating room must be wet cleaned.
Patients are transported to the operation on a gurney in the supine position. Transportation of a patient lying down is explained by the need to protect him from dangerous reactions of the circulatory organs to a change in body position, which are possible after premedication. Transport the patient smoothly
moderate speed, without hitting the gurney against objects in the corridor
and doors.
Having delivered the patient to the operating table, the nurse helps him move to it, and lays him on the table in accordance with the instructions of the anesthetist or surgeon, covers the patient with a sterile sheet. endures a seriously ill patient
anesthesia team and operating room nurse. Together with the patient, a medical history, a test tube with blood or serum (with the patient's surname and initials) should be delivered to the operating room and transferred to the anesthesiologist to determine individual compatibility during blood transfusion, and in some cases, the medications that the patient needed during the operation that he used before.

If the patient is hearing impaired, a hearing aid should be handed over to the anesthesia team, as it will be needed for contact with the patient.
Preparing for emergency surgery. In conditions that threaten the life of the patient (injury, life-threatening loss of blood and
etc.), training is not carried out, the patient is urgently delivered to the operating room, without even taking off his clothes. In such cases, the operation begins simultaneously with the
anesthesia and resuscitation (resuscitation) without any preparation.
Before other emergency operations, preparation for them is nevertheless carried out, although in a significantly reduced volume. After deciding on the need for surgery, preoperative preparation is carried out in parallel with
continuation of the examination of the patient by the surgeon and anesthesiologist. Thus, the preparation of the oral cavity is limited to rinsing or rubbing. Preparation of the gastrointestinal tract may include pumping out gastric contents and even
leaving a gastric nasal tube (for example, with intestinal obstruction) for the duration of the operation. An enema is rarely given, only a siphon enema is allowed when trying
conservative treatment of intestinal obstruction. In all other acute surgical diseases of the abdominal cavity, an enema is contraindicated.
Hygienic water procedure is carried out in an abbreviated form
- shower or washing the patient. However, the preparation of the surgical field is carried out in full. If it is necessary to prepare patients who came from production or from the street, whose skin is heavily contaminated, the preparation of the patient's skin begins with mechanical cleaning of the surgical field, which in these cases should be at least 2 times larger than the intended incision. The skin is cleaned with a sterile gauze swab moistened with one of the following liquids: ethyl ether, 0.5% ammonia solution, pure ethyl alcohol. After cleaning the skin, the hair is shaved and the surgical field is further prepared.
In all cases, the nurse should receive clear instructions from the doctor on how much and by what time she must fulfill her duties.