Technique for giving a newborn a hygienic bath. Algorithm for a hygienic bath for a newborn. Purpose: assessment of physical development

(IN HEALTH CARE ORGANIZATIONS)

GENERAL INFORMATION

First hygienic bath for a newborn child, it is performed 1-2 days after the umbilical cord falls off. During the first weeks of life, the child is bathed in boiled water. Add potassium permanganate solution to the bath until light Pink colour. It is recommended to carry out a hygienic bath with potassium permanganate solution until complete healing. umbilical wound.

In the first half of life, hygienic baths are performed daily, in the second - every other day, after a year - 2 times a week. The water temperature in the bath should be 37–37.5°C, for premature babies – 37.5–38°C. When rinsing a child, use water at a temperature 1°C lower. The duration of the bath for children in the first year of life is no more than 5–7 minutes, in the second year 8–10 minutes, for children over 2 years old 10–15 minutes. It is advisable to carry out hygienic baths at certain hours, no earlier than 1 hour after feeding or 10–15 minutes before it, 1–1.5 hours before bedtime. When swimming, precautions must be taken.

EQUIPMENT

2.1. Medical furniture: changing table; holding table disinfection measures; baby cot.

2.2.LS: Vaseline oil; filtered potassium permanganate solution (1:10000 or 1 ml of 5% solution per 100 ml of water).

2.3.Enameled bath (plastic), jug.

1.1. Thermometers (2) for measuring water and air temperature
in the room.

2.5. Children's shampoo (baby soap, liquid cleanser for bathing), cosmetic skin care products.

2.6. Diapers (children's clothing); disposable diapers; “mitten” made of terry cloth (flannel).

2.7. PPE: gloves; apron.

2.8. Containers: “No. 3”, “No. 4” or “Physical method”.

2.9. Sanitary products: wall-mounted elbow dispenser with antiseptic; wall dispenser with liquid soap; towel.

2.10. Sanitary equipment: washbasin; pedal bucket; "Diaper" container.

TECHNIQUE

PREPARATORY STAGE

2.2. Treat hands in accordance with TNLA.

2.3. Wear an apron and gloves.

3.3. Disinfect the outer surfaces of the apron and changing table with a working solution of a chemical disinfectant in accordance with Instruction No. 2.

3.4. Wash the bath with a brush and soap. Carry out disinfection by wiping (irrigation) chemical agent disinfection, rinse with water.

3.5. Remove gloves, place in container No. 4 or the “Physical method” container.

3.6. Treat hands in accordance with TNLA.

3.1. Inform the child's mother (legal representative)
about the upcoming manipulation.

3.6. Prepare the necessary equipment. Spread a diaper on the changing table, lay out vests and clothes (diapers).

3.7. Fill the bath 1/2 or 1/3 full with water. First pour cold, then hot water in small portions alternately to avoid the formation of water vapor in the room and possible skin burns.

3.8. Measure the water temperature. The readings are recorded without removing the thermometer from the water.

3.9. Fill a jug with water from the baby's bath to rinse.

MAIN STAGE

3.10. Treat hands in accordance with TNLA. If necessary, wear gloves (long type).

3.11. Undress the child. After defecation, you should wash it with running water. Place dirty laundry in the “Diaper” container. Wash the hands.

3.12. Fix the child with your hand, covering his axillary area with your hand (place 4 fingers in the armpit, wrap your thumb around the shoulder from above and outside; the back of the child’s head and head rest on the nurse’s forearm). Use the thumb and middle fingers of the other hand to grasp the child’s legs at the level of the ankle joints.

3.13. Slowly immerse the child in the bath: first the buttocks, then the legs and torso. The level of immersion in water should reach the nipples. Release the child's legs and hold the shoulder during the entire bath.

3.14. Put the “mitten” on your hand.

3.15. Lather the body with soft circular movements and immediately rinse the soaped areas: first wash your hair (from the forehead to the back of the head so that soap does not get into the eyes and water into the ears), neck, armpits, upper limbs, chest, abdomen, lower limbs. Rinse natural folds especially thoroughly. Lastly, wash the genitals and intergluteal area.

3.16. Remove the “mitten”.

3.17. Remove the child from the water in a face down position.

3.18. Rinse your body and wash your face with water from a jug (an assistant holds the jug).

3.19. Throw a diaper on the baby, place him on the changing table, dry the skin with careful blotting movements.

3.20. Treat skin folds in accordance with subparagraph 3.21. Instructions No. 5.

3.21. For a newborn child, treat the umbilical wound according to Instruction No. 6.2.

3.22. Swaddle (dress) the baby and put him in the crib.

THE FINAL STAGE

3.23. Place the used diapers and mitten in the “Diapers” container.

3.24. Drain the water.

3.25. Disinfect the bath, the working surface of the changing table, and the apron (after each child) according to Instruction No. 2.

3.26. Take off the apron.

3.26. Remove gloves, place in container No. 4 or the “Physical method” container.

3.27. Treat hands in accordance with TNLA.

3.28. Make an entry in the appointment sheet and the inpatient medical record (f. 003/u-07).

INSTRUCTION No. 12

ANTHROPOMETRY

GENERAL INFORMATION

Body weight is measured in the morning before meals, preferably with the child naked. It is recommended to weigh weakened children in clothes, subtracting their weight from the resulting value.

Body weight in children under two years of age is measured on a weighing scale infants(electronic or cup), for children over two years old - on electronic or lever medical scales.

Body length in children under 1 year of age is measured with a horizontal stadiometer, in older children - with a vertical one. At the age of 1 to 3 years, instead of the lower platform, a folding bench is used and the body length is measured using the scale on the left.

Measuring body length in older children is performed using a vertical stadiometer. The child is placed on the stadiometer platform with his back to vertical rack so that he touches her with his heels, buttocks, back and parietal region. Arms should be lowered along the body, heels together, toes apart. The head is placed in a position in which the lower eyelid and the upper edge of the ear tragus are in horizontal plane. Then, without pressure, the movable bar is lowered to the head and from it bottom edge determined by the body length scale.

The head and chest circumference is measured using a centimeter tape. Chest circumference in young children is determined only at rest, in older children - at rest,
when inhaling and exhaling. The arms should be freely lowered along the body. It is necessary to control that the child does not raise his shoulders or move his arms forward or to the side.

EQUIPMENT

2.1. Medical furniture and equipment: changing table (medical couch); table for carrying out disinfection measures; medical scales; stadiometer (horizontal, vertical); measuring tape.

Target:

Maintaining body hygiene;

Ensuring the child’s universal need to “be clean”;

Formation of cleanliness skills;

Hardening the child.

Indications:

Correct hygiene care for the baby's skin.

Contraindications:

Increased body temperature;

Diseases of the child;

Violation of the integrity of the skin.

Equipment:

Bath for bathing;

Bath diaper;

Water jug;

Water thermometer;

Terry or flannel mitten;

Baby soap

A bottle with a 5% solution of potassium permanganate*;

Large terry towel;

A clean changing kit or clothes placed on the changing table;

Sterile vegetable oil or baby cream;

Latex gloves;

Disinfectant solution, rags;

Bag for dirty laundry.

Required conditions:

The first hygienic bath should be carried out after the umbilical wound has healed;

Do not bathe immediately after feeding;

When swimming, ensure the room temperature is 22-24°C;

Determine the temperature of the bathing water only with a thermometer

(it is not allowed to determine the water temperature by immersing your elbow in the water).

Safety precautions:- do not leave the child alone unattended in the bathtub or on the changing table to avoid the danger of aspiration of water or falling;

Pay attention to the child’s condition, breathing, skin color, movements.

* instead of a solution of potassium permanganate, you can use a decoction of chamomile or string

Note:- the first hygienic bath is carried out after the umbilical cord has fallen off;

In the first half of life, hygienic baths are performed daily, in the second - every other day, after a year - 2 times a week;

The duration of the bath for children of the first year of life is no more than 5-7 minutes, in the second year 8-10 minutes, for children over 2 years old - 10-15 minutes;

When bathing children of the first year of life, soap is used 2 times a week, for older children - 1 time a week;

It is advisable to carry out hygienic baths at certain hours, no earlier than 1 hour after feeding or 10-15 minutes before it, 1-1.5 hours before bedtime;

Items needed for bathing and caring for the baby should be prepared in advance so that bathing, skin care and changing are completed as quickly as possible;

The air temperature in the room should be 22-24 degrees, doors and windows should be closed;

If necessary, turn on a heater next to the bath and changing table.

Technique hygienic bath

Purpose: hygienic care.

Indications: for cleansing the skin.

Contraindications: increased body temperature above 38 degrees, pustular diseases skin.

Equipment: bath, baby soap, soft sponge (mitten), water thermometer, water (t - 37), jug with warm water (t - 36 -) for rinsing the child, sheet or towel for drying, clean clothes for the child, for infants children 5% permanganate solution potassium or decoction of herbs, chamomile, etc.

Note:

1. The first hygienic bath for a newborn baby is carried out after the umbilical cord has fallen off and the umbilical wound has been epithelialized.

Up to 6 months, the baby is bathed daily;

From 6 months - every other day;

Up to 2 years - 2 times a week;

From 2 years - 1 time per week;

In summer, children should be bathed more often.

2.Water temperature:

for children in the first half of the year 36.5-37 degrees

Over 6 months 36-36.5 degrees

3.Bath duration:

For children of the first year 5-7 minutes;

In the second year of life 8-10 minutes;

Over 2 years old 10-20 minutes.

4. Do not wash your face with bath water;

5.Children in the first half of the year are bathed in a lying position, and older children are bathed in a sitting position;

6. Children should be bathed before feeding, preferably before bedtime; Try not to bathe your baby immediately after eating (to avoid regurgitation), or immediately before feeding (to prevent your baby from feeling hungry or nervous).

7. Children under 2 months are bathed in boiled water. The child should be bathed in boiled water at least until the umbilical wound heals.

9. While bathing, talk gently to your baby to calm him down. Bathing should be carried out by two people according to the principle - one holds the child, the other waters. If your baby cries during the first baths, be patient and gentle; this is not a reason to refuse bathing. Over time, the child will get used to it, will feel free, and the bath will become a pleasure not only for him, but also for you.

Preparation for the procedure:

1. Wash the bath with warm water and soap

Rinse it off hot water;

Note: if bathing is done in children's institution, That

Wash the tub with hot water, soap and a brush;

Treat the bath with disinfectant. solution;

Rinse the bath with hot water;

2.Pour water into the bath at a temperature of 36.5-37 degrees (check with a thermometer);

3. Prepare a jug of water at a temperature of 37C.

4. Wash your hands.

5. Undress the child.

Performing the procedure:

1. Place the child on your left arm so that his head lies on the middle third of your forearm, and grab the child’s left shoulder with your hand;

Using your right hand to support the baby's legs, carefully lower the baby into the water;

Lower the baby into the water so that the head is above the water.

2. Put on and soap a flannel mitten.

Lather the baby's body with a mitten.

Wash all the folds of the baby's body.

Turn the baby upside down.

Wash your hair with water from a jug.

REMEMBER! Natural skin folds should be washed especially carefully.

3. Douse the child clean water 36-36.5 degrees from the jug.

4.Wrap the baby in a towel.

End of the procedure:

5. Dry the skin using blotting movements.

6. Dress your child in clean clothes appropriate for his age.

If necessary: ​​Treat folds with baby oil. Dry the ear canals, eyes, and clean the nasal passages.

Infection control:

1. Treat the bath with disinfectant. solution.

2.Wash hands at a social level and dry with an individual towel.

Hygienic bath technique

maintaining body hygiene

fulfilling the universal need to be clean

developing cleanliness skills

hardening the child

Equipment:

Bathtub

Bath diaper

Jug of water for dousing the baby

Water thermometer

Terry or flannel mitten, terry napkin

Baby soap

5% potassium permanganate solution

Warm diaper

Changing kit

Bucket of boiled chilled water

Bucket of hot boiled water

Required conditions:

It is better to take the first hygienic bath the day after discharge from the maternity hospital, after the umbilical cord has fallen off, since on the first day the child adapts to the conditions of being at home.

Bath your baby before feeding.

The temperature in the bathing room is 22 - 24 degrees.

The duration of bathing is 5 – 6 minutes.

Determine the temperature of the water for swimming only using a water thermometer (it is not allowed to determine the water temperature by immersing your elbow in the water)

Using baby soap, bathe 2-3 times a week.

Until 6 months of age, bathe daily, then every other day (up to 1 year).

Premature babies begin to be bathed at the age of 12 - 14 days after the umbilical cord falls off, and children weighing up to 1000 grams - at 15 - 18 days of life.

Preparation for the procedure

Explain to the mother/relatives the purpose and progress of the procedure

Wash and dry your hands. Place the bath in a stable position.

Wash the bathtub with hot water and soap, a brush, and pour boiling water over it.

Place a diaper folded in several layers on the bottom of the bath (the edges of the diaper should not extend beyond the side walls of the bath).

Place a water thermometer in the bath. Fill 1/3 or 2/3 full of water.

When filling the bath with water, first pour cold boiled water to a temperature of 37 - 38 degrees for a full-term baby and a temperature of 38 degrees for a premature baby.

Prepare water in a jug for rinsing the baby.

Use a water thermometer to check the temperature.

Before dousing, it should be 1 - 2 degrees below the bathing temperature (35 - 360) in full-term infants and 380 in premature infants.

Before bathing a premature baby, you must:

turn on the heating equipment

warm diapers and undershirts

close the door latch to prevent air movement during bathing

Executing the procedure

Lower the undressed child into the bath slowly, holding the back of the head and shoulders with your left hand, and the buttocks and thighs with your right hand.

When immersing in water, first lower the legs, buttocks, then the upper half of the body

The water should reach the baby's nipple line, leaving the upper part of the breast open

Left hand pass under the back so that the child is positioned on the left forearm

Using your hand, secure the child by the buttocks and hips

And only after that release your right hand

With the freed right hand in the mitten (or gauze pad) wash their hair, moving from the face to the back of the head, then the neck, torso, limbs

The folds are especially thoroughly washed in the following order: neck, behind the ears, armpits, elbow bends, under the knees. Lastly - inguinal, gluteal

Then turn the child with his back up (right hand on the chest and stomach, left hand on the back) and pour water from a jug, starting from the head

Without releasing the child from both hands, transfer him to a warm prepared diaper and quickly dry him with careful blotting movements.

Completing the procedure

After this, lubricate the skin folds with sterile vegetable oil and clean the umbilical wound

Loosely swaddle the baby and put him in the crib for 10 - 15 minutes.

After 10 - 15 minutes, remove the wet underwear, dress the child and change him into dry underwear.

Target: preventative: prevention of skin diseases

Indications: daily bathing of a healthy child.

Contraindications: acute diseases of the child, pustular skin diseases.

Possible problems: child's anxiety,

Safety precautions:

Do not leave the child unattended,

Stable position of the children's bathtub for bathing

The water temperature should not be higher than 38.5 0 C

The air temperature in the room should be 22-24 0 C

The water level in the bath should reach approximately xiphoid process baby's sternum.

Do not wash your child's face with bath water.

It is necessary to wash your child with soap no more than once a week.

It is necessary to bathe a child in the first month of life in boiled water.

The duration of bathing is no more than 5-10 minutes.

It is better to bathe a child together.

Patient preparation:

Undressing a child in bed

If necessary, wash the child

Equipment:

Baby bath for bathing a child

Water thermometer

Terry mitten or soft cloth or sponge

Baby soap, baby shampoo

Clean diaper or bath stand

Flannel diaper or soft towel

Changing kit or set of clean underwear: diaper (diaper), rompers, vests, blouse

- Container with sterile Vaseline or vegetable oil

Sterile cotton balls and sterile tweezers in a craft bag or box.

Tray for discarding used material balls

- Container for discarding used linen.

- A container with disinfectant solution and clean rags, a container for discarding rags.

- A container for discarding used mittens (soft cloth or sponge).

Sequencing:

Obtain the consent of the child’s parents to carry out the manipulation.

1. Prepare a changing kit or a set of clean underwear on the changing table (treated with a rag moistened with a disinfectant solution).
2. Wash the bathtub with hot water.
3. Fill the bath first cold water, then hot.
4. Measure the temperature of the water in the bath (38-38.5 o C) with a water thermometer.
5. Fill the jug with water 1 °C lower than the water in the bathtub and place it next to the bathtub
6. Place a clean diaper or a special stand on the bottom of the bathtub
7. Gently immerse the child in the bath, holding the head and shoulders with your left hand, so that the water in the bath reaches the xiphoid process of the child's sternum.
8. Wash the child with your right hand using a terry mitten (cloth or sponge), starting from the scalp. Throw the used mitten (cloth or sponge) into a special container for disposal.
9. Take the child out of the bath with both hands, so that his face is facing you, clasp the child’s chest in the armpits with your palms, fixing his back and back of the neck with your fingers.
10. Place the baby on your left forearm, face down.
11. Take the jug with your right hand and pour clean water over the child. Return the jug to old place.
12. Take a clean flannel diaper (towel) with your right hand and cover the baby with it
13. Dry your baby's skin using gentle blotting movements.
14. Transfer the baby to the changing table, remove the wet flannel diaper (towel) from him and throw the diaper (towel) into a container for discarding used linen
15. Treat natural skin folds according to the algorithm
16. Swaddle the baby according to the algorithm or dress him.
17. Give the child something to drink.
18. Place your baby in bed on his side.

Note:

1. After a hygienic bath in a children's institution, the children's bathtub is disinfected.

Manipulation No. 14

Techniques for measuring body temperature in children of different ages.

Graphic recording

Target: diagnostic.

Indications: measure body temperature as prescribed by a doctor.

Contraindications: No.

Possible problems: child's anxiety, feelings of anxiety and fear, refusal to undergo the procedure. Negative attitude of the mother towards the manipulation, distrust of the medical staff.

Safety precautions: do not leave the child unattended, check the integrity of the thermometer.

Patient preparation:

Equipment:

• Medical thermometer
• Tray with disinfectant solution
• Temperature sheet, pen.

Sequencing:

1. Dry the skin where the thermometer is placed (for older children, place the thermometer in the armpit, for children - in the groin).

2. Shake off the mercury column if it is above 35°C.

3. Place the mercury reservoir of the thermometer in the axillary (groin) area so that it is completely covered by the skin fold and does not come into contact with the underwear.

4. Fix the child’s arm (press the shoulder to the chest) or the child’s leg (leg is slightly bent at the hip joint)

5. Record the time and after 10 minutes, remove the thermometer and determine its readings.

6. Record the temperature in the temperature sheet (each cell of the temperature sheet corresponds to 0.2°C. The point recording the temperature must be placed in the center, and not along the edges of the cell)

7. Shake the thermometer so that the mercury column drops into the reservoir.

8. Completely immerse the thermometer in the tray with the disinfectant solution (the duration of disinfection depends on the disinfectant solution used)

9. Remove the thermometer from the disinfectant solution, rinse under running water and wipe dry with a napkin.

10. Place the thermometer in the case or glass jar, at the bottom of which cotton wool is laid.

Note.

1. It is possible to measure the temperature in the rectum (according to indications). Before this, the child is given a cleansing enema. The child is placed on his side, the buttocks are spread apart with the left hand, and a mercury reservoir lubricated with Vaseline is inserted into the rectum with the right hand to a depth of 2 centimeters. The baby's buttocks are then squeezed and held for 5 minutes. It must be remembered that the temperature in the rectum is 0.5 degrees higher than in the armpit. Contraindications are diseases of the rectum, constipation, diarrhea.
2. In the hospital, temperature measurements are carried out twice a day: at 7-8 am and at 17-18 pm. According to indications, sometimes the temperature is measured every 2-3 hours.
3. At home, you can measure body temperature by mouth and ear electronic thermometers, not forgetting to process them. It is desirable that such a thermometer be individual.
4. Unless absolutely necessary, you should not wake up your child in the morning or at any other time of the day to measure his temperature.
5. The results of thermometry should not be discussed in the presence of preschool and school age.
6. It is not recommended to measure the temperature of children a short time after psycho-emotional arousal, eating, significant muscle activity, or physical therapy procedures.

Manipulation No. 15

Determination of respiratory rate,

Blood pressure measurement.

Pulse study.

Target: diagnostic, assessment of the state of the respiratory system.

Indications: as prescribed by the doctor.

Contraindications: No.

Possible problems: child's anxiety, refusal to undergo the procedure. Negative attitude of the mother towards the manipulation, distrust of the medical staff.

Safety precautions: do not leave the child unattended.

Patient preparation: reassure the child and mother, explain the purpose of the manipulation, convince of the need for the procedure. Provide instructions on the progress of the manipulation.

Equipment:

• Stopwatch or watch with second hand
• Phonendoscope
• Temperature sheet, pen

Sequencing:

1. Calm the child down or wait until he falls asleep (in young children, it is better to calculate the respiratory rate in a dream by holding a phonendoscope to the child’s nose).
2. Give the child a comfortable position (sitting or lying down).
3. Wash the hands. Sit face to face with the child.
4. Take his hand in the area of ​​the pulse and place the other hand on the child’s stomach or chest, without fixing his attention on the count being made.
5. Count the number of breathing movements in 1 minute (pretending to count the pulse in order to distract the child).
6. Record the data obtained on a temperature sheet or observation sheet and compare with the age norm.

Note:

1. A rise in body temperature is accompanied by an increase in breathing rate:

For every degree it increases, respiratory rate increases by 4 breaths

Respiratory rate to pulse ratio: newborn 1: 2.5-3

for older ones 1: 3.5-4

in adults 1:4

1. The younger the child, the shallower his breathing.
2. In the first 2-3 weeks, a newborn baby experiences respiratory arrhythmia.
3. Type of breathing: at an early age abdominal breathing, at 3-4 years thoracic breathing predominates,

during puberty: boys have an abdominal type, girls have a thoracic type of breathing.

Age norms of NPV

Nurse

should prepare warm water at a temperature of 37.5 ° C, a bath baby soap, flannel mitten, water thermometer, jug with warm water for rinsing, flannel diaper, bottle of concentrated potassium permanganate (5% KMnO4 solution), sheet for wiping, clean set of linen

wash the bath with soap and rinse with hot water

pour warm water at 37.5 degrees

add a solution of potassium permanganate to the water until the water turns slightly pink

stir the water

put a folded flannel diaper on the bottom

measure the water temperature with a water thermometer;

Put a mitten on your right hand, pick up the child in your arms so that his head rests on the forearm of your left hand, and use the fingers of your left hand to support the body under the child’s left arm. Support the child under the knees with your right hand

first lower the legs, buttocks and then the entire body into the water so that the water level reaches the middle of the child’s chest;

soap a wet mitten with baby soap;

soap the scalp, neck, then the torso front and back, and finally the legs;

Carefully rinse off the soap with water from the bath in the same sequence in which you lathered

take the baby out of the water

pour over warm water from a jug (water temperature is 1° lower than in the bath)

wrap the baby in a sheet

dry the skin with gentle blotting movements

treat skin folds with sterile sunflower oil

swaddle the baby in clean linen

Note: do not wash your face with bath water to avoid infection; The duration of the hygienic bath is 7-10 minutes.

Methods for giving a hygienic bath to older children

Nurse:

washes the bathtub with detergent and soap, rinses with hot water

takes a bath first cold water, and then adds hot water to it so that there is no steam formation, bringing the water temperature to 36.5-37 degrees

stirs the water, controls the temperature with a water thermometer

helps the child sit in the bathtub, places a rolled up towel on the floor of the head, rests his feet on a special wooden support

To prevent the baby from slipping, the water should reach the middle of the chest

Lathers the washcloth with baby soap and soaps the baby's entire body from top to bottom.

washes off the soap with water from a jug or shower (the temperature of this water is 1-2 degrees lower than in the bath)

wraps the child in sheets, wipes him:

puts on clean linen, clean clothes

Note: the duration of a hygienic bath is 10-15 minutes, after each child the bath must be thoroughly washed and disinfected

Skin care, bedsore prevention

The nurse covers the skin with a towel or soft cloth, wetted disinfectant(semi-alcohol solution, cologne, table vinegar, camphor alcohol). One end of the towel is moistened with a disinfectant, lightly wrung out and wiped behind the ears, neck, back, buttock area, front of the chest, axillary and inguinal folds, folds on the arms and legs. Then use the dry end of the towel to wipe the skin dry in the same order.

The nurse should change the child’s position in bed every 2 hours, examining areas of possible bedsore formation.

Make sure there are no folds or crumbs on the sheet.

Change wet or soiled laundry immediately.

Place a rubber circle (in a case) under the sacrum and tailbone, and cotton-gauze circles under the heels, elbows, and back of the head.

Usage airfalls- air mattresses with a corrugated surface and air supply through special holes.

Note: the appearance of bedsores in children indicates improper, poor care, low medical culture and the nurse’s dishonest attitude towards their duties.