Systemic care of sick adults and children with diseases of the digestive system. Features of hygiene of children and care for them in the inpatient department of a children's hospital

08.07.2019

When you leave with love, your recovery will go faster; this also applies to your sick child. Now he needs, first of all, your attentiveness, your closeness and your warmth. However, taking care of a sick child also requires some specialized knowledge.

You don't have to learn too much to care for a sick child; after all, a child cannot live without your care, even when he is completely healthy. You are used to taking care of his purity, his nutrition and his health. The same thing, only in a much larger volume, is required for him even in case of poor health.

Caring for a sick child up to one year old

If a child is treated at home for up to a year, then, as a rule, it becomes necessary to measure the temperature, give various medications (and in different forms - both solid tablets and drops).

How to measure the temperature of a child under one year old?

An extremely important step in caring for a sick child is measuring body temperature. Before the age of five, measuring body temperature in the mouth is ineffective. Remember that a mercury thermometer is not safe, so the best option is to use an electronic thermometer, where the temperature is measured is under the arm. Take the child in your arms, calm it down - for a more accurate meaning, the child should be calm for at least half an hour. Even if the thermometer squeaked, do not rush to take it out from under the child's armpit, hold it for another 4-5 minutes.

What to do if a child is vomiting?

Vomiting is an extremely unpleasant manifestation of the disease. You need to take care of a sick child as follows: sit him on one knee, and, putting one hand on the child's forehead, and the other on the stomach, help the child, making sure that the vomit does not enter the respiratory tract. When vomiting stops, wash the child, rinse his mouth - to remove the unpleasant aftertaste. In no case leave him alone, and in case of repeated vomiting, be sure to call an ambulance.

How to properly care for a sick child?

Caring for a sick child under one year old includes the ability to properly administer medications to the baby. If the medicine tastes bad, either dissolve it in your baby's favorite drink, or prepare a drink to wash down the tasteless solution. Also try to pour the medicine deeper - on the tip of the tongue there is the largest concentration of taste buds, and the further into the mouth, the less of them and the taste is not felt so sharply.

How to properly drop drops for a child?

It can be difficult to get drops in your eye. Place the child so that his head is in your lap, with one hand, open the eyelids, and with the other, drip the required amount of medicine. If the child dodges, ask someone to help you.

The ear is an organ that is very sensitive to temperature differences, and therefore the instillation of cold droplets can be a very unpleasant procedure for a baby. Heat the bottle in a water bath or under a stream of warm water - but do not overheat so as not to cause a burn.

If there is a need to drip nose drops for a child, first clean it as much as possible - an older child can blow his nose on his own, with the kids you will have to use an aspirator. Tilt the baby's head back, drop the drops and ask the baby to inhale.

How to care for a sick child

How to properly care for a sick baby?

Your little one doesn't know what happened to him. Often he does not even have the strength to communicate what he needs.

Due to illness, he became even more passive than even before. Therefore, your closeness and your attentiveness are now especially necessary for him. It's good if at this time you can fully focus on your child and not be distracted. Then you do not miss out on the most important things, namely, that there is enough liquid for drinking and that discharge is regularly collected - full or at least wet diapers.

Keep in mind that your child especially needs your closeness at this time (and do not forget to reduce the degree of this attentiveness somewhat after recovery). Provide him with an atmosphere of tenderness and warmth, because every kind word, even just a simple stroke, strengthens the will to live and the defenses of the little patient's body.

As a rule, diseases of young children are harmless, so do not show unnecessary fear and concern. But when the disease becomes serious, it is especially dangerous for the child. The art of caring for a sick child is to distinguish one condition from another and, even in extreme circumstances, keep your nerves calm and do the right thing. With the help of your doctor, you should be able to do this.

Caring for a ballroom child is not just your wife's business. Especially if both of you are working, you need to make sure to tap into this too. If your wife has already spent her days off, now it's your turn. You will be needed even if the wife is sick herself. Now take part in childcare in your free time, regardless of whether the baby is healthy or sick. Then, in extreme cases, you will not be knocked out of a rut. Confidence in this alone will take some of the burden off your wife.

Caring for a sick child at home

It is best for both you and your sick child if it is possible to care for him at home. Because in a familiar environment, he will rest very well, and it will be easier for you to work within your own four walls. However, a prerequisite is needed here - observation of the child should be around the clock. Because now the baby cannot be left alone for a minute.

Of course, your husband, your mother or a friend can replace you, but the child will first of all look for your closeness. He feels bad - and looks for comfort and support from you. This does not mean that you have to constantly sit near his crib, but you should stay nearby and take him in a room or baby stroller, moving around the apartment. Switch on the internal telephone if the child is in another room. And leave the baby for this time to sleep at night in his room near his bed.

Sick child's room

The baby sleeps best when the room temperature is 18-20 ° C. The temperature can be 2 degrees lower at night.

Fresh, not too dry air is especially pleasant. If it's warm outside, you can open a window. In cold weather, you need to ventilate the room when there is no child in it.

A humidifier will spread dust and bacteria throughout the room. To care for a sick child, it is better to hang damp rags on radiators and dryers.

If your child suffers from a respiratory problem, you can bring chamomile tea (chamomile extract from a pharmacy) to a boil in a saucepan, stir it according to the directions on the package, and continue to boil it in the room with a boiler. This steam will humidify the air and have a calming effect on the baby's mucous membrane. Place the pot in a safe place while staying in the room.

The specificity of caring for sick children of different ages lies in the peculiarities of direct observation of a sick child, communication with him, methods of collecting material for laboratory research, and carrying out medical procedures.

The creation of a hygienic environment for a sick child consists of the general hygienic installations presented to the premises of children's hospitals, the hygiene features of a newborn and an infant.

Small wards or boxes, closed and open, are needed for young children. If an infectious disease is suspected, the child should be placed in an isolation ward with special equipment. A bedroom and a dining room should be allocated for mothers hospitalized with their children. For walks of sick children, a veranda or special rooms with constantly open windows are allocated.

Beds for infants should have high drop-down or drop-down walls. A hard mattress made of horsehair, bast, and sea grass is placed in the bed. Do not use down or feather mattresses. A flat small pillow is placed under the head.

The air temperature in the ward for a premature baby is 22-26 C, depending on body weight, for a full-term baby - 20 C. It is necessary to daily systematic ventilation of the wards at any time of the year.

Clothes should not hinder the movements of the child, but should be light and warm. It is convenient to use envelopes for swaddling premature babies. Free swaddling is indicated for children with normal thermoregulatory function, regardless of their body weight, age and location (open incubator, bed).

The basis for caring for newborns (full-term and premature) is the observance of the strictest cleanliness, in some cases - sterility. Persons with acute and chronic infectious diseases are not allowed to take care of newborns. Wearing woolen items and rings is not allowed.

The staff is obliged to observe the rules of personal hygiene and, at the same time, to work strictly in a gauze mask, which is changed every 3 hours. Every month, all employees of the department must carry out examinations of mucus from the nose and throat for the carriage of diphtheria sticks, hemolytic streptococcus. Checking for the absence of staphylococci in hand wash is also performed once a month.

Care of the umbilical wound requires special attention, which must be carried out under strictly aseptic conditions. Every day, a newborn's toilet is made: the eyes are washed with a sterile cotton swab dipped in a solution of potassium permanganate (1: 10000) or a solution of furacillin (1: 5000), in the direction from the outer edge to the inner; the nose is cleaned with cotton wicks dipped in boiled vegetable oil (Fig. 122); the child is washed, the skin folds are lubricated; washed away after each act of defecation.

A daily examination of the throat of a sick child is required. Every day, the temperature, body weight, quantity and quality of bowel movements, the presence of regurgitation, vomiting, coughing fits, asphyxia, and convulsions are recorded. Children are weighed in the morning, before the first feeding.

When appointing a walk, body weight, age of the child, season and local climatic conditions are taken into account. Premature babies can be taken for a walk at the age of over 3-4 weeks in the spring-summer period when they reach a weight of 2100-2500 g, in autumn-winter - when they reach a weight of 2500-3000 g. The first walk of these children in winter should not exceed 5 10 minutes, in the summer - 20-30 minutes. Full-term babies from 2-3 weeks of age are allowed to walk in winter at an air temperature of - 10 C in the absence of wind. If the child has increased cyanosis, cough, pallor, anxiety appears, the walk stops.

The organization of feeding a sick child requires special clarity, self-control and skill from the personnel. Difficulties in feeding can be caused by the underdevelopment of the sucking reflex, the presence of congenital deformities, the child's refusal to eat, unconsciousness, etc. In such cases, feeding is done through a gastric tube, through a pipette, from a spoon; use parenteral and rectal nutrition.

Collecting material from children for laboratory research is difficult and requires special skills. Children under 5-6 years old do not cough up phlegm. Therefore, at the moment when the child coughs, with a spatula, holding the root of the tongue, sputum is removed with a sterile swab, which is then injected into a sterile tube. In infants, sputum is removed from the stomach using a tube inserted into the stomach on an empty stomach.

Taking blood for serological, biochemical and other studies is performed by venipuncture. Stool for bacteriological examination is collected with a glass tube, melted at both ends, which is sterilized and inserted into the anus. The tube filled with feces is closed at both ends with a sterile cotton swab, lowered into a test tube and sent to the laboratory. Feces for testing for worm eggs are collected in a clean, small glass dish. With a cleanly planed stick, feces are taken from 5-6 different places, then the dishes are tightly covered with clean paper.

Caring for a sick child is often as important as treatment. Features of care depend on the age of the child, on what he is sick with, on the severity of the disease. But there are some general rules as well. The main ones, of course, are careful and accurate adherence to the doctor's prescriptions, the recommended diet and regimen.

It is not always easy to perform some of the prescribed procedures: give a bitter medicine, put mustard plasters or,. It all depends on the patience and ingenuity of the parents. Do not just deceive the baby, tell him that it "does not hurt at all," and the drug prescribed by the doctor is sweet and tasty, while it has a disgusting bitter taste. If you make such a mistake, the child, quite possibly, will stop trusting you and in the future may be afraid of the most harmless medical procedures. We advise you to translate your persuasion into a slightly different plane - that the ukolchik will hurt, but not for long, and you can reduce the pain if the baby breathes often with you, tell a tongue twister, repeat any phrase "topsy-turvy" ("ball-finger "," Finger-ball ") ...

Taking medication

First of all, it should be remembered that medications must not be available to the child. After each intake of pills, syrups and other medications, they must be removed away from the baby's eyes.

Carefulness and caution will be useful - after all, in a hurry, it is quite possible to confuse medicines, especially those made in the form of tablets.

Follow your medication regimen and dosage exactly. Be guided by the instructions of the attending physician, which, however, it is useful to double-check by reading the instructions for the medication.

The tablets are usually given in whole (or in fractions - half, quarter), although it is also possible to take a pre-ground tablet mixed with a small amount of water or milk (for infants).

Syrups are given using special spoons in the medicine box, if there is no such spoon, use a regular stainless steel spoon. After taking the syrup, be sure to wash the spoon. The temperature of the syrup should be at room temperature, unless otherwise indicated in the instructions for use of the drug.

Bitter medicines are best taken with plain water, or, in extreme cases, with sugar syrup. It's not bad if you turn the procedure for taking medicine into a game that is interesting for the child - play in the hospital with your daughter or son, "give" medicine to the doll first, have pity on her and tell why you need to drink the bitter medicine, and only then give the medicine to the child.

Feeding a sick child

Feeding sometimes becomes an equally difficult problem. A large child has a low appetite, but he needs to eat. In no case do not force-feed him: this will only reinforce a negative attitude towards food, or may even provoke vomiting. It is better to reduce portions, cook (within the prescribed diet) more favorite dishes, and decorate them beautifully. The regimen of food intake must also be strictly observed.

If your baby has a sore throat, wipe or chop the food, feed it carefully and slowly.

A special approach is required when feeding a sick child who is on bed rest. Feed him yourself, or arrange a table in bed by placing a stool near the sofa or bed. You can build a table in bed using a large tray as a table top.

Cleanliness and peace

The child needs to create peace. But this does not mean that he should be deprived of toys and other available entertainment. They are necessary to maintain a good mood, cheerfulness; you just need to make sure that the child does not get tired, do not give too heavy and bulky, such that it is inconvenient to play while on bed rest.

It is better to put a sick baby on a separate bed in a bright place in the room. A prerequisite is the daily change of bed linen. Make sure that there are no folds, bumps and irregularities - if the child is "lying" this can cause bedsores.

A child in bed should have a towel, a handkerchief, boiled water, dishes, a pot, books.

Watch the cleanliness of the child's body - wash, bathe, change into clean clothes. Babies on bed rest are washed with cotton wool with warm boiled water. Don't forget to rub the folds on your skin, ears, neck.

Ask your doctor if you can bathe the child, if possible - do not ignore this procedure. The optimum water temperature for bathing is 37-38 ° C, and the bathing time should be limited to 7-8 minutes. After leaving the bathroom, give your baby some warm tea. Make sure that it does not open when lying in bed after bathing.

Timely clean your child's ears, trim nails and hair.

The room in which the sick child is located must be ventilated daily.
After airing, if the temperature in the room has dropped, heat the air to room temperature. Do wet cleaning more often in the room where the sick baby is.

The best clothing for a sick child is a short warm blouse with long sleeves and comfortable buttons or pajamas. It is better not to dress your child in clothes that have ties, zippers, hoods. Legs can be left without clothes, or you can use wide pants made of soft fabric.

Young children are wrapped in a diaper, a diaper is put on, which should be checked much more often than usual.

Parental love and attention

In addition to the procedures prescribed by the doctor, the psychological factor is also of no small importance in recovery.

The mental state of a sick child is aggravated by the fact that during the period of treatment he practically does not contact with friends, classmates and classmates. It is hard for him to realize that he is sick, limited in many things and gives unnecessary worries to those around him. So all worries about maintaining a normal mood in a sick child are entirely on the conscience of the parents.

Do not talk about the course of the disease and the procedures prescribed by the doctor in the presence of the child - this may worry him. Pay more attention to your child - talk about kindergarten, school, tell about your childhood, read a book together. Draw together, do handicrafts - in one word, show him your care and love. And remember that this must be done not only during illness!

At birth, a person receives legal capacity, i.e. becomes the owner of the rights and obligations (paragraph 1 of the Civil Code). According to paragraph 1 of the Civil Code, the fruit is considered incompetent, but is protected by some special regulations; so, for example, the unborn child already has inheritance rights.

Legal capacity should be distinguished from legal capacity, i.e. the ability to independently conclude legal contracts. Up to the full 7 years, the child is incapacitated, therefore, the child's will is not taken into account when concluding a contract, for example, when deciding on hospitalization, concluding a trade agreement, informed consent of the patient (paragraph 105 of the Civil Code). From the age of 7, the child has limited legal capacity, but this does not in any way apply to the hospitalization procedure. At the same time, from the age of 7, limited civil and criminal liability occurs, i.e. in accordance with the development of the child, it is possible to bring to financial responsibility for the damage caused to him, for example, in a hospital.

From the age of 16, a minor has the right to draw up a notarial will. A person receives full legal capacity upon reaching the age of 18.

In case of failure to fulfill the duties of caring for a child, the person who has the right of custody may be held liable. Criminal sanctions follow when a child who is not receiving the necessary supervision harms himself or others.

Deprivation of parental rights

Parental law is a fundamental right (article 6 of the Constitution), it covers the rights and obligations that ensure the well-being of the child. If the child is born in wedlock, then both parents have the same parental rights; as a rule, this distribution of rights remains after divorce. Parental rights for a child born out of wedlock belong only to the mother; however, upon application by the mother, parental rights may also be granted to the father.

Deprivation of parental rights constitutes an interference with the fundamental rights of citizens and requires imperative urgent conditions (power to intervene).

Conditions required for deprivation of parental rights

Abuse of parental rights: Parental decisions jeopardize the well-being of the child, for example, by refusing the treatment the child needs. If there is an alternative to the proposed treatment, then the child's caregivers have a choice.

In case of disagreement about what is best for the good of the child, the main good of the child becomes decisive, in such cases - life and health. Other benefits, such as freedom of religion, are relegated to the background in this distribution. For example, the refusal of blood transfusion, preached by representatives of certain religious communities, is not justified.

Formal conditions

Deprivation of parental rights based on a decision of the guardianship court. Such a decision can only be made on the basis of the testimony of the attending physician.

Exception: danger of delay, i.e. any delay in treatment can pose a threat to the child's life. For reasons of child welfare, in an emergency, the doctor may act without a decision to terminate parental rights.

Abuse of parental rights also exists in child abuse. In such a situation, the interests of the child collide with the duty of the staff to keep medical confidentiality, since the testimony of the staff is a necessary condition for starting the process of deprivation of parental rights. The right to initiate the process in this case belongs only to the doctor, the actions of the caring personnel depend on the doctor's decision.

Explanatory conversation and obtaining voluntary consent

Any interference with the integrity of the body requires a principled rationale (for example, the patient's consent). Each intervention (medical and nursing) requires the consent of the patient or his legal representative if the patient is incapacitated. However, legally binding consent can be given by the patient or his legal representative only after a detailed explanation of the possible consequences of the intervention.

If the child is born in marriage, then the parental right belongs to both parents: the explanatory conversation is carried out in the presence of both parents, consent to the intervention must be obtained from both parents.

An exception is, for example, the deprivation of parental rights or the waiver of one of the parents. A contract for the provision of medical services can be concluded by one of the parents (the wife's right to conclude transactions related to the household of the spouses, Germany).

If a minor works under an employment contract or studies in state institutions and, as a result, has medical insurance, then his status corresponds to the status of a fully capable person.

Minors who, on the basis of their mental and moral level of development, are able to assess the consequences of the intervention, have the right to an explanatory conversation and to give consent. The level of development is determined by the doctor. The actions of the caring staff depend on his decision.

Carrying out an explanatory conversation is referred to the tasks of the doctor, the tasks of the caring personnel include explanations of the content of the conversation conducted by the doctor. Nursing staff have neither the right nor the obligation to conduct an explanatory conversation on their own.

If a teenager refuses to undergo treatment, then this refusal has legal force.

In principle, from the age of 14, the right to an independent decision begins to be observed.

Compulsory registration of births and deaths

Births and deaths are registered with the relevant civil registry offices. Registration is carried out by one of the following persons (in order of priority):

father (if the child was born in marriage);
the midwife who was present at the birth;
a doctor who was present at the birth;
mother, as soon as her health condition allows her;
any other person who has been notified of the birth.

The application must be submitted within a week.

Stillbirth and childbirth or death during childbirth is reported to the vital statistics office on the next business day. A miscarriage does not require a statement.

Deaths are reported to the vital statistics office the next business day. In this case, the application is submitted by the head of the family, as well as any person who was present at the death or received information about the death. In hospitals, this task is carried out primarily by the head of the clinic or an employee authorized by him.

Stillbirth

From a legal point of view, birth is considered to be completed when the fetus completely leaves the mother's womb. In this regard, the ligation of the umbilical cord is not decisive. A stillbirth is said to be when the following signs of life are absent after birth:

palpitations;
pulsation of the umbilical cord;
normal pulmonary respiration.

In this case, the child's body weight is at least 500 g.

Spontaneous abortion

Spontaneous abortion is said to be when the child's body weight is less than 500 g and the above signs of life are absent.

Diseases subject to mandatory registration

The registration procedure for specific diseases is regulated by the law on protection against infectious diseases.

In the law on protection against infectious diseases, persons with infectious diseases are grouped according to specific criteria; the case of any of the diseases specified in the law is subject to a mandatory statement.

A case of illness in a hospital must be reported to the appropriate institutions:

Therapist;
any other person who, due to professional duties, was involved in treatment or care;
attending midwife.

Nursing staff can independently report a case of illness (if they do not follow the instructions of the doctor).

The disease must be reported immediately, no later than 24 hours.

The spread of any contagious disease in a hospital should be similarly recorded.

HIV infection is not included in the list of notifiable diseases. Based on the results of laboratory tests, HIV infection is reported to the appropriate health care structures (with observance of anonymity).

Medical secrecy

Violation of medical confidentiality is a punishable offense, possibly leading to civil law consequences, for example, a claim for damages, a claim for compensation for harm to health.

All patient information is protected; information about other persons is also protected if such a desire is expressed by the patient.

All persons who, by virtue of their professional employment, are directly involved in diagnostics, treatment and care and who receive or have received state professional education, which gives appropriate authority, as well as their assistants, are associated with a medical secret.

Medical confidentiality must also be observed:

people not directly involved in diagnosis, treatment and care, such as colleagues, doctors, other specialists working in the hospital;
persons monitoring the observance of public interests and assignments, for example, representatives of law enforcement agencies and prosecutors, relatives, with the exception of legal representatives, for example, minors, since they do not have their own right to express their will.

Only persons who have this right can exempt from the obligation to maintain medical secrecy, i.e. the patient or his legal representative. In exceptional cases, deviations from this rule are permissible, for example, the alleged will of the patient (unconsciousness), on the basis of the law (the law on protection against infectious diseases), on the basis of the civil and criminal codes, as well as, if it is necessary for legal self-defense and prevention of criminal punishable acts.

The anonymity of the patient's identity must be maintained.

If a minor has the right to independently decide on the treatment, then his legal representative is also obliged to keep secrecy.

Legal separation of duties of doctors, nurses and nurses

General care of sick children (basic care) is carried out by the care staff independently. At the same time, it is assumed that this type of care does not require additional orders or the consent of a doctor.

In the case of special care for sick children (curative care), each action of the personnel is prescribed or strictly corresponds to a specific purpose.

A distinction should be made between transferable activities (performed by both a physician and caregivers) and non-transferable activities (performed only by a physician), such as blood transfusions. The list of transferred actions should be provided.

The doctor has the right to transfer the execution of the procedure and at the same time is responsible for the appointment. The right to transfer the performance of an action also includes the need to assess the professional preparedness of personnel, i.e. tasks are set in accordance with the competence / ability of employees.

Responsibility for carrying out the procedure: only the executor, i.e. in this case, the caregiver.

Responsibility for transferred actions: Only executable tasks are allowed. In this regard, the need for advanced training should also be taken into account. Areas that do not require the participation of a doctor do not exist, i.e. overall responsibility for all procedures is with the physician. The physician's responsibility for prescribing does not relieve caregivers of the obligation to pay attention to erroneous prescriptions.

The concepts of “general” and “special” care or “basic and curative care”, as presented in some guidelines, are increasingly being criticized. First of all, many of the activities performed by caregivers cannot be attributed to any one area, such as putting on compression stockings. In addition, such a separation of care is often incomprehensible to the patient and his relatives, since “general” and “special” patient care is often carried out alternately or simultaneously.

Determination of the content, volume and duration of work of the caring personnel:

professional: bosses (department management, nursing staff management) and a doctor;
disciplinary and organizational: the head of the caring staff.

Legal situations in the learning process

The duty of supervision (supervision) concerns, first of all, the managers of the caring personnel and the doctor. The student is obliged to allow himself to be observed, i.e. don't mind watching. This does not exclude the possibility of partial self-study. The student should not shy away from control, for the student there are no areas in which he does not need observation. Observation does not mean the constant presence of a curator, but the reliability of control.

Places of industrial education and training of personnel caring for sick children, as well as the corresponding schools, are legally fixed.

The representative of the school authorities acts as the disciplinary leader of the students, and not the leadership of the department or caring personnel.

Protecting the rights of adolescents in education

A teenager, in accordance with labor law, is considered a person under the age of 18. In such cases, the law on the protection of young people applies.
It should be remembered: regulation of work breaks, shift times, exclusion of night shifts, regulation of weekends and vacations.

Protection of maternal rights

The Maternity Protection Act protects the pregnant woman, as well as the mother and child after birth. Legal protection begins from the moment a woman declares her pregnancy. A woman is required, but not required, to report pregnancy.

The employer or his representative office (department management) are obliged to respect maternal rights in accordance with the law and to keep the text of the law, making it accessible to everyone. Compliance with the law on the protection of maternal rights on the spot is monitored by employees in managerial positions, general control is carried out by the labor protection service.

The ban on dismissal is valid during pregnancy and four months after childbirth or during parenting leave.

Working instructions

Opening hours: only between 6-00 and 22-00 hours, weekends and holidays are negotiated.

Prohibition of employment:

6 weeks before childbirth, a woman has the right to choose and, if desired, can continue to work;
8 or 12 weeks (for example, with twins, premature baby) after childbirth without the right to choose;
in general, the prohibition of labor activity applies to 14 weeks.

Lifting weights: it is forbidden to regularly lift weights weighing more than 5 kg; lifting weights weighing more than 10 kg (without auxiliary equipment) is absolutely prohibited.

Standing: with a gestational age of more than 5 months, standing work is allowed no longer than 4 hours.

Radiation Protection: Pregnant women should not be sent to work with an increased dose of radiation.

Breastfeeding times and breaks are regulated by law.

Fundamentals of tariffication of employees

The basis for the tariffication of employees' labor is the result of the joint work of trade unions as representatives of employees and state employers. This bill concerns work in the civil service, i.e. the employer is the community, land and state (union of lands). The content of the basis of tariffication is equated to the law and therefore is considered a peremptory law.

Control and observance of the basis of tariffication are the tasks of the employer and his representatives, for example, the management of the department. This also applies to being aware of current changes to the document.

It is important to comply with the working hours, vacation time regulations, take into account overtime and extraordinary leave.

Contact faces:

employer;
works council member or employee representative;
trade union representative.

In an employment relationship that is not on a state basis (for example, a church), there are also agreements with this law.

Medical products - Ordinance "On the use of medical products"

This instruction regulates the safety of installed medical technical devices. The instruction applies to all devices intended for examination and treatment of people, including laboratory devices.

Service

The manufacturer or supplier is responsible for the manufacture of the device and putting it into operation. Handling instructions may only be given by authorized personnel such as laboratory technicians, anesthesiologists, ICU personnel. A medical device technician can also provide briefing. Nursing personnel are not allowed to service irradiation devices and X-ray machines.

Before commissioning, it is necessary to check the serviceability of the devices. In case of errors, the devices are immediately withdrawn from circulation and transferred to the technician. Use only manufacturer-recommended accessories such as tubing, syringes, and wires.

Improper handling of devices due to insufficient instruction is punishable, since violation of the operating rules can pose a danger to the life and health of the patient and the integrity of material assets.

When handling medical technical devices, it is recommended to develop nosocomial instructions for use.

Radiation protection

The radiation protection measures in Germany are based on the following laws, directives and orders:

X-ray protection instructions;
Radiation protection instruction;
Atomic Energy Law;
Euratom (European Atomic Energy Society) - radiation protection standards.

The first two instructions are of a medical nature. In X-ray diagnostics and traditional radiation therapy, instructions for protection against X-rays are used, in other types of radiation therapy and in nuclear medicine, they are based on the instructions for radiation protection.

A responsibility

The responsibility for protecting against radiation lies with the funding organizations of the hospital and the owners of private institutions. They guarantee compliance with the standards set by the permits and instructions for protection against radiation, but do not have to be experts in this field and personally supervise everything, this is the task of the radiation protection officers.

Radiation protection instructions

Only trained personnel who are familiar with the working methods, who are aware of the possible dangers and the protective measures used are allowed to work with X-rays. The staff undergoes repeated training courses every six months.

Depending on the area of radiation, different forms of protection against radiation are distinguished. Radiation dose indicators are presented in established, generally accepted units of measurement.

Pregnant women, minors and persons whose presence is optional should not stay in the radiation zone.

Detailed information can be found in the radiation protection instructions.

X-ray protection instructions

The employer must provide personnel with instructions for X-ray protection and radiation protection.

The lowest possible radiation dose for patients and subjects should be used. X-rays can be used by doctors, dentists, technicians who have specialized in radiology, and unskilled workers under the supervision of a doctor.

For infants, children and adolescents, X-rays are used only with plates that protect the genitals (testicles, ovaries), or a bandage. With scattered radiation, protection of the gonads is not required.

Unnecessary radiation exposure should be avoided:

hold infants firmly to avoid blurring the picture and, thereby, repeated examinations;
limit the number of shots (only for strict indications);
choose suitable radiation and automatic exposure characteristics;
expose only the examined organs to radiation;
remove clothing, bandages, diapers, electrocardiographic (ECG) electrodes from the area being examined to prevent artifacts;
use protective clothing against X-rays (apron with lead plates); cover the front surface of the body completely, the back surface of the body partially; at a high dose of radiation, use a protective raincoat that covers the front and back surfaces of the body.

Bedside care can be specific and general. The special is understood as the general principles of carrying out activities that are necessary for all patients, without exception. Special care implies special actions of the caregiver based on the specifics of the disease or pathology.

Nursing is not a method of treatment; it is an adjunct to mainstream treatment to help avoid complications and difficulties.

How is the proper care of bedridden patients built?

The basis of caring for bedridden and seriously ill people is the creation of a special regime that will protect the patient's peace, protect his psyche from negative influences and at the same time create a comfortable environment around him. In such conditions, patients will feel more comfortable, they will develop an optimistic approach to the disease and a mood for a speedy recovery.

People who are called upon to care for the sick must create not only comfortable conditions for their stay, but also sympathize with the sick. It is necessary to understand that physical suffering disturbs patients, causes a feeling of helplessness and hopelessness, they can be irritable and even aggressive.

The ability to find an approach to the patient, support him in such a period, the sensitivity and indifference of the staff allow patients to be distracted from their position, tune in to recovery and maintain a good mood.

If the care is provided by doctors, they usually undergo special training, but if they are close relatives, there are a few things to learn.

Caring for bedridden patients: basic rules

The room should be light and airy and, if possible, should be isolated from noise and visitors. Fresh air and a comfortable temperature in the range of 20-22 degrees with a humidity of no more than 40-60% are needed. There should be soft lighting with lampshades during the day, and bedside lamps or bedside lamps at night.
Indoors, it is necessary to do wet cleaning at least twice a day, wiping dust from furniture, windows and doors, rinse the floors with a damp cloth. It is preferable to remove curtains and curtains, replacing them with blinds. You need to talk in the room in an undertone, turn on the TV or radio quietly, if the patient asks. It is better to ventilate the room at night, when the air is fresh, or in the morning, when the amount of dust and gases is minimal. In the summer, you can keep a window or window open. When airing, care must be taken that air does not fall on the body, cover the head with a towel, leaving the face, and cover the body with a blanket.
It is very important to properly transport patients to procedures and treatment events. This is done on a stretcher or gurney, while trying to avoid sudden movements, jolts and impacts. It is necessary to shift the patient together, if it is a child - it is permissible for one person to do it. If the patient has to be carried by one person, it is necessary to lift the patient by taking it under the shoulder blades and under the hips, while the patient's hands should hold onto the carer's neck. Transfer the patient to the bed, having previously prepared everything necessary for the implementation of care.

Bedside care equipment

Bedridden patients need an oilcloth bed, a rubber circle, a bedpan and a urine bag. The bed is made neatly and conveniently for the patient; an even and semi-rigid bed with a mattress is used, on which an oilcloth is laid and a sheet on it. If spinal treatment is needed, a hard shield is placed under the mattress. The bed should not stand close to radiators or heaters. There should be free access to the bed from both sides.

The patient is put on the bed undressed, in pajamas or without her. They help him to undress, and if there is no way to do this (burns or serious injuries), the clothes are carefully cut.

Bedside care: change of linen

For the patient, the cleanliness of the linen is important, so the bed and underwear are regularly changed. When changing clothes, care must be taken to ensure that the procedure does not cause pain or discomfort.

The patient is moved to the edge of the bed, part of the sheet is rolled up to his body, a clean sheet is laid in its place and the patient is moved to a clean sheet, removing the dirty one and covering it to the end with a clean one. Sometimes it is used to roll the sheet from the legs to the lower back, and then up, lifting the patient. The edges of the sheet are attached with pins so that it does not roll. When changing the sheet, change the duvet cover and shake out the blanket.

The underwear of seriously ill patients is special - these are shirts or undershirts, they are rolled up from the waist to the neck, removed from one hand, then from the other and carefully removed from the head. In some cases, a wrap-around shirt is worn at the back. Linen contaminated with blood or secretions of the patient is immediately changed to clean.

Other principles of care are based on the regimen prescribed by the doctor. It is important how often and in what position to feed the patient, how to take medicine, how to bathe him.

Bedside care: administration and hygiene

Severely ill patients carry out physiological procedures in bed with the help of a urine collection bag and a bed vessel. It is important to always have washed and disinfected boats on hand to keep them warm. All patient care products should be at hand, cleaned and comfortable for the caregiver and patient.
Personal hygiene is essential. In seriously ill patients, rubbing the body with a damp sponge or swab soaked in warm soapy water is used. Then wash with warm water without soap and wipe dry. Cut your nails and toenails short once a week. Hair in severely ill patients is cut short to ensure adequate hygiene.
Hands are washed at every meal, feet are washed once a day before bedtime, and the feet are washed twice a day. If the patient is very fat, daily washing of skin folds is indicated to avoid diaper rash.
Also, for the prevention of diaper rash, it is necessary to often change the position of the patient's body, put rubber circles under the places of greatest contact with the bed, and eliminate the slightest irregularities in the bed.

Feeding the seriously ill

One of the most important points in grooming is the need to strictly adhere to feeding times and diet.

Severely ill bedridden patients are given the most comfortable position so that the patient can eat and not get tired. This is usually a half-sitting position or an elevated position in bed.

The neck and chest are covered with a napkin, the patients are fed from a spoon with chopped or pureed food, in small portions. If the patient is asleep, they wait until he wakes up. Seriously ill patients are given a drink from a sippy cup, and if they cannot swallow, they switch to artificial nutrition - by tube or intravenously.

In addition, it is important to monitor the patient's condition and his state of health, to maintain his mood and contact with conversations, but not to get bored.