Task number 2. Solution of situational problems.

Instructions for completing the task: read the situation and give detailed answers to the questions.

Case study 1.

A patient was admitted to the surgical department. After taking a blood test, it turned out that he was a carrier of hepatitis B. He was hospitalized in the infectious diseases department. The injections were given


1. What should be done in the focus of an infectious disease?


Methods for examining the focus:

– questioning the sick person (epidemiological history)

– examination of the hearth

– taking material for bacteriological examination

– study of documentation (disability certificate, outpatient card, medical history, vaccination card)

– drawing up a conclusion

Medical workers carry out active and passive detection of sick people in the outbreak (household rounds, preventive examination, observation).

In order to prevent the development of the epidemic process, it is necessary to carry out preventive measures, which are divided into 3 groups:

1 measures in relation to the source of infection

2 measures regarding the mechanism and ways of transmission of the pathogen.

3 measures to increase the resilience of the population

The 1st group includes:

– timely detection of patients and carriers, their registration

– isolation of the source of infection

– treatment of infectious patients

– Sanitation of carriers of infection and patients with chronic forms

– bacteriological control over the completeness of release from pathogens

– dynamic monitoring of recovered patients with chronic forms

To the 2nd group:

– current and final disinfection


– (disinfection) a set of measures aimed at removing and/or destroying IS pathogens at environmental objects.


– preventive focal

– current final

Current disinfection is carried out in the focus of the disease to destroy pathogens immediately after they are isolated from the source of infection. The purpose of the current disinfection is to prevent the spread of infection. The final disinfection is carried out in the focus of the disease after hospitalization, recovery of the patient. Monitoring the effectiveness of ongoing and final disinfection is carried out by taking swabs from various environmental objects (door handles, furnishings, etc.).

Disinfection methods:

1 Mechanical

2 Physical

3 Chemical

To the 3rd group: Measures to increase the population’s resistance to infectious agents include improving the environmental and social conditions of the population, conducting sanitary and educational work and other measures of general impact. A special place in increasing the immunity of the population to IB pathogens is occupied by measures aimed at creating artificially acquired immunity. Immunity is understood as the immunity of the body to infectious and non-infectious agents that have the properties of foreign antigens. The anti-infective reaction of a macroorganism is based on non-specific and specific protective factors, the effectiveness of which depends on age, genetic status, nutrition, the presence or absence of somatic pathology, etc.

2. Possible ways of transmission of infection from the patient.


The disease develops as a result of the type B hepatitis virus entering the human body. Viral hepatitis B itself is transmitted by contact of an infected person with a healthy person.

This can happen in the following ways:

– through wounds, bites of animals and insects;

– with the saliva of an infected person (with a kiss);

– as a result of contact with infected blood or damaged mucous membranes and skin (general shaving accessories, toothbrushes, handkerchiefs, towels);

– through the placenta from mother to child, during childbirth and breastfeeding;

– unprotected sexual intercourse with a carrier of the hepatitis virus;

– as a result of medical interventions of a parenteral nature: transfusion of blood components, injections.

3. What rules must be observed by the medical staff on the day of prevention of nosocomial infections?

Health worker safety in the workplace.

Prevention of the possibility of transmission of microorganisms from patients to medical staff is the most important component of infectious safety.

1. Infection of medical personnel occurs as a result of natural transmission mechanisms;

2. artificial transmission mechanism (artificial, medical – invasive and medical procedures).

Each patient must be considered as potentially infected with blood-borne infections.

Nurse safety rules in the workplace

  • wash hands before and after contact with the patient;
  • use special clothing, gown, cap, gloves, mask, goggles;
  • consider the patient’s blood and secretions as potentially infectious and work with them only with gloves;
  • treat all laboratory specimens as potentially infectious;
  • consider all linen soiled with blood or liquid secretions as potentially infectious;
  • observe the rules for removing gloves and washing hands;
  • cleaning with latex gloves;
  • have at the workplace various labeled containers with lids, containers with disinfectant for used syringes, needles, gloves, cotton-gauze material;
  • carry out transportation of biological fluids in closed containers;
  • follow the rules of personal hygiene.

An important point in the prevention of nosocomial infections among staff is personal hygiene.

The rules of personal hygiene include:

  • daily shower or bath, with special attention paid to hair and nails;
  • thorough laundering of gowns and other personal clothing;
  • protection of the mouth and nose (if possible, disposable protective equipment);
  • scrupulous hand washing.

Case study 2.

A patient with a diagnosis of varicose veins of both lower extremities is in the hospital. Suddenly, a varicose vein ruptured and significant bleeding began.

During the examination, the nurse revealed that everything around was covered in blood. The patient is pale, frightened, complains of weakness, dizziness. Veins protruding with nodular extensions are visible on the inner surface of both legs. The skin above them is thinned, pigmented. On the middle third (c/3) of the lateral surface of the right leg, there is a defect in the skin, from which dark cherry-colored blood flows. Pulse 100 per minute. BP 105/65 mmHg Art. NPV 22 min. Violations of the internal organs were not revealed.


1. Determine the patient’s condition.

Answer: The patient has venous bleeding from the veins of the lower limb.

2. Make an algorithm for the actions of a nurse with the motivation for each stage.

Plan Motivation
1. M / s will ensure the imposition of a pressure bandage. To stop venous bleeding.
2. M / s will hold the immobilization of the limb, giving an elevated position. To prevent slippage of the pressure bandage
3. M / s will call a doctor. To decide on further treatment
4. As prescribed by the doctor, m / s will administer hemostatic drugs. For the final stop of bleeding
5. M / will observe the appearance and condition of the patient (pulse, blood pressure), bandage. To determine the effectiveness of the treatment

Prevention of varicose bleeding.

You should not wait for the appearance of bleeding from a vein with varicose veins – if you find yourself with systematic swelling of the legs, the appearance of a vascular pattern on the feet and lower legs, with pain in the calf muscles, do not postpone a visit to the doctor. It is advisable to immediately contact a phlebologist. Modern medicine offers a lot of medicines and folk remedies to get rid of varicose veins in the early stages at low cost. The main thing is to notice the signs in time and find a competent specialist.

People who have discovered varicose veins and are undergoing treatment should get rid of tight, tight shoes and high-heeled shoes. The same applies to narrow, squeezing clothing, socks with elastic bands that tightly pull the leg.

A large risk group is overweight people. With varicose veins in the middle and advanced stages, it is worth starting to follow the arrow of the scales, stick to a diet with fresh vegetables and fruits, and vitamins. It is also worth giving up fried and fatty foods, drinking more water (not liquids, but clean drinking water).

Do not lift or carry too heavy bags, refuse to play sports with heavy objects and sudden loads. With a sedentary lifestyle, increase physical activity – do therapeutic exercises, swim, start walking for at least 30-50 minutes a day. With a busy work schedule, start prevention with small exercises after waking up, gradually increasing the load.

Prevention will help not only to get on the path of fighting varicose veins, but also to avoid life-threatening bleeding. But if it does happen, you should immediately call an ambulance and take all of the above steps to stop the blood while waiting for a team of doctors. Attentive attitude to your health and the right lifestyle will help you cope and recover even with severe stages of varicose veins.

Case study 3.

A patient is in the recovery room after an appendectomy. By the end of the second day the patient’s condition worsened, complains of increased pain in the area of the postoperative suture.

Objectively: the general condition is satisfactory, the tongue is dry, covered with white coating. In the area of the postoperative suture hyperemia, edema, two sutures erupted, temperature 37.7, respiratory rate 20 per minute, blood pressure 120/70.


1. Identify the patient’s problems;


Patient problems:

The real problems of the patient:

Pulsating pain in the area of the postoperative wound;

· temperature increase;

redness and swelling of the edges of the wound;

Violation of the integrity of the skin (postoperative wound).

Priority problem: throbbing pain in the area of the postoperative wound due to suppuration.

2. Formulate goals and plan nursing care for a priority problem with the motivation for each nursing intervention.


The goal is short-term: the patient will reduce pain, signs of inflammation in the postoperative wound.

Plan Motivation
1.M/S will call the doctor. To receive appointments.
2. M / s will treat, as prescribed by the doctor, the skin around the wound. To prevent the spread of inflammation
3. M / s, as prescribed by the doctor, will treat the edges of the wound with alcohol-containing antiseptics, remove the stitches, apply a bandage with a hypertonic solution. To ensure the outflow of pus from the wound
4. M / s will provide observation of the sick (pulse, respiratory rate, temperature, blood pressure). To monitor the general condition of the patient
5. As prescribed by the doctor, will provide a course of anti-inflammatory therapy. To relieve signs of inflammation and detoxification.

3. Conduct a conversation with the patient about the nature and possible causes of the complication.


Postoperative complications in patients with acute appendicitis.

Postoperative complicated appendicitis leads to the development of pathologies from the wound and internal organs. Complications after surgery are divided into several groups, they include:

– Complications identified from the side of the sutured wound. This is a hematoma, infiltrate, suppuration, divergence of the edges of the wound, bleeding, fistula.

– acute inflammatory reactions from the abdominal cavity. Most often, these are infiltrates and abscesses that form in different parts of the abdominal cavity.

Also, after surgery, local or general peritonitis may develop.

Complications affecting the gastrointestinal tract

. Appendectomy can lead to intestinal obstruction, bleeding, fistula formation in different parts of the intestine. Complications from the heart, blood vessels and respiratory system.

In the postoperative period, some patients develop thrombophlebitis, pylephlebitis, pulmonary embolism, pneumonia, abscesses in the lungs.

Complications from the urinary system – acute cystitis and nephritis, urinary retention.

Most complications of the postoperative period are prevented by the implementation of the doctor’s recommendations. So, for example, intestinal obstruction can occur when the diet is not followed and under the influence of insufficient physical activity.

Thrombophlebitis is prevented by the use of compression underwear before and after surgery, the introduction of anticoagulants.

Complications of acute appendicitis from the side of the wound are considered the most frequent, but at the same time the safest. The development of pathology is judged by the appearance of a seal in the wound area, an increase in general and local temperature, and the release of pus from the suture.

Treatment consists in re-treatment of the wound, in the introduction of drainage, the use of antibiotics. The most severe complications after surgery include pylephlebitis and intestinal fistulas.

Case study 4.

A patient with a diagnosis of stomach disease is in the surgical department. The patient is concerned about epigastric pain not associated with eating. I have lost 8 kg in the last 3 months. He notes a decrease in appetite, an aversion to meat food, a feeling of fullness in the stomach after eating. Sometimes he vomits for relief.

The examination revealed that the tumor is located in the pyloric part of the stomach. On the round, the doctor told the patient that he was going to have an operation, after which the patient began to worry, in a conversation with his sister, he expressed fears that he was unlikely to undergo the operation, since his friend allegedly died from such an operation.


1. Identify the patient’s problems.


Patient problems:

– weight loss

– constant pain in the epigastric region;

– loss of appetite;

– aversion to meat food;

– fear of the upcoming operation.

Priority problem: fear of the upcoming operation.

2. Formulate goals and plan nursing care for a priority problem with the motivation for each nursing intervention.


The goal is short-term: the patient will overcome the fear of the upcoming operation.

Plan Motivation
1. M / s daily for 5-10 minutes. will discuss with the patient his fears and worries. provide moral support
2. M / s, answering the questions of the patient, will acquaint him with the methods of anesthesia, the plan of preoperative preparation, the course of the postoperative period. instill confidence in the patient that all the actions of health workers are aimed at preventing complications during anesthesia and the postoperative period
3. M / s will introduce the patient to a patient who has successfully undergone such an operation back up your words with the words of another patient who underwent the same operation
4. M / s will provide moral support to the patient from relatives. provide moral support to the patient from loved ones
5. M / s organizes the leisure of the patient. distract the patient from thoughts about the adverse outcome
6. By the time of the operation, the m / s will make sure that the patient has overcome fear. evaluate your actions

3. Draw up and agree with the patient a plan for preparing for surgery.

Preoperative preparation plan:

1. On the eve of the operation, in the evening, feed the patient a light supper and warn him not to eat or drink in the morning.

2. Make a cleansing enema at night.

3. In the evening, carry out a complete sanitization.

4. According to the doctor’s prescription, give sleeping pills at night.

5. On the morning of the operation:

a) measure the temperature

b) give a cleansing enema

c) shave the surgical field

d) as prescribed by the doctor, rinse the stomach through a tube

e) before premedication, offer the patient to urinate

e) premedicate

g) take the patient on a gurney to the operating room

Case study 5.

A woman came to the surgical room with complaints of severe pain in the area of the right mammary gland. Breastfeeding, baby two weeks old.

On examination: a painful infiltrate 6 cm in diameter is determined in the upper outer quadrant of the right mammary gland, there is hyperemia above it, the axillary lymph nodes on the right are enlarged and painful, the temperature rises to 39 ° C.


1. Identify the patient’s problems.


Patient problems:


– Severe pain in the right mammary gland.

– Temperature increase.

– Hungry child.

– Stagnation of milk.

Potential issues:

– Risk of breast abscess.

Priority issue:

– pain in the right mammary gland and milk stasis due to the development of lactational mastitis.

2. Formulate goals and plan nursing care for a priority problem with the motivation for each nursing intervention.

Answer: The short-term goal is to reduce pain and restore lactation.

Plan Motivation
1. M / s will fulfill the doctor’s prescription: – inject an antibiotic into the nipple, diluted in novocaine reduce inflammation, relieve pain
2. Apply a support bandage to the mammary gland create peace and relieve pain
3. Conduct a conversation about the causes and measures to prevent the development of mastitis address knowledge gaps and prevent relapse
4. Ms will perform gland massage, milk expression reduce inflammation and relieve pain

3. Have a conversation with the patient about the prevention of a possible recurrence of the disease.


Prevention of mastitis:

– preparation of nipples before childbirth;

– processing of nipples before feeding;

– hygiene of the skin, clothes;

– pumping milk after feeding.

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