Toplam Sayfa Görüntüleme Sayısı

23 Haziran 2014 Pazartesi

OXYGEN THERAPY

OXYGEN THERAPY


I - DEFINITION :
This is a technique that consists in supplying the body greater than the area ambiant.Elle is particularly useful in the treatment of hypoxic conditions resulting from a decrease in O2 concentration in the blood . The purpose of the process is xygénothérapie hypoxia while reducing the work of the respiratory system and the myocardial stress .
All transport of oxygen to tissues depends on several factors :
- From cardiac output
- The amount of O2 pressure
- The concentration of hemoglobin
- The need for metabolism

II - INDICATIONS:
   A / Lack of saturation of hemoglobin O2

- Drop the pressure of O2 in ambient air
- Airway obstruction eg oviposition or foreign body
- Impairment of respiratory muscle reached by the nerve centers or paralysis eg tetanus
- Any bronchopulmonary disease resulting in insufficient ventilation eg asthma
- Emphysema
   B / Insufficient hemoglobin necessary for the transport of O2:

- Hypoxemia anemic eg anemia
- In case of massive hemorrhage
- In case of CO2 poisoning
   C / Traffic slowed causing a poor transport of O2 in the blood :

- Heart Failure
- Shock and collapse
III - AGAINST - INDICATIONS:
Are not formal , however the O2 should be used with extreme caution in older chronic respiratory insufficiency , in PA and in NNE

IV - SOURCE O2:
The O2 can be provided by:

A / Obus O2 pressure or O2 cylinder :
Distribution is provided by a suitable pressure regulator on each shell to reduce the pressure
A meter indicating the number of liters / min
Precautions are necessary for the use of the shell :
- Never lubricate the valves and fittings regulators as the combination of a fat + O2 yields a mixture deteriorating
- Remove the shells of excessive heat as the temperature may rise dangerously high pressure shell
- Remove the shells with great caution
- Do not smoke near
B / receivable in wall socket :
  Allows to control the number of liters per min



V - FORMS OF GOVERNMENT :
The O2 is distributed by different devices, all have the same principles:
- The flow rate is 6 to 8 l / min in adults and three to 6L/min except complications in children
- The O2 must be humidified by passing it through a bubbler bottle filled ¾ of the distilled
• The nasopharyngeal probes : Irritating and risk of infection
• The tents O2 generates an atmosphere containing 50-60 % O2 ¼ hours after commissioning
                                   marche.Certaines people feel claustrophobic anxiety tent .
• Incubators : Can be used in children and have the same principles as tents adults
• Eyeglasses O2
• O2 masks : it is necessary to connect and adjust the speed before adjusting the mask on
                                        sick

 VI - PREPARATION OF MATERIALS :
- To administer : glasses, among other probe
- Provide a source of O2
- Check the piping must be properly sealed
- Fill distilled water in the bottle ( bubbler ) to mark water
- Set the number of l / min
- Possibly tape to fixing probe

VII - THE PATIENT MONITORING :

A - Monitoring of the patient :

* Monitoring of respiratory movements and heart rate
* The color of the face, lips and corners
* Presence or absence of sweat
* Head Position
* Fall of the language
* Congestion
* The patient's condition improved
* While natural ventilation continue monitoring
* Spontaneous breathing stops : - check the airway
                                                          - Begin artificial ventilation
  - Check the respiratory status and the need to associate with cardiac massage
                                                             external ventilation
* Health care and frequent mouth nose because O2 dry mucous
* Frequent blood gas control prescription or as service protocol

B - Monitoring of the O2 system :

- If nasal tube : - Check the location and attachment of the probe
                              - Check frequently for proper flow through the probe (nasal secretion)
                              - Change daily e probe and nostril healthy gloves

C- Flow Monitoring :

Prescribed at the start rate may change depending on the monitor and the patient's condition

D - Monitoring source :
- Ensure that no pipe is bent or disconnected
- Check the stability of the flowmeter
- IT must frequently check the pressure in a cylinder O
VIII - PRECAUTIONS :

- An O2 excess can have :
       ex a toxic effect on the lungs and the CNS : O2 intoxication in artificial ventilation
       attenuation of respiratory stimulation with low respiration eg IRC - emphysema
       chronic obstructive bronchitis
should always monitor : the state of consciousness , facial color , change in BP , PULSE and FR
- The O2 is a combustible material there tjs fire risk
- The equipment O2peut be a source of bacterial cross infection
- The breathing circuits are changed daily and sterilized

IX - ACCIDENTS :

• O2 pressure ( dosing error )
• O2 unhumidified
• OAP
• Blindness
• Apnoea in chronic respiratory insufficient
• Bloating of the stomach when introduced probes deeply

The O2 is a very effective treatment side must be used with caution































                                                                                                                                                                                             J - R
INTUBATION

I - DEFINITION :
It is the establishment d4une endotracheal tube for mechanical ventilation

II - INDICATIONS:
- Emergency Oxygenation
- General anesthesia
- Artificial respiration

III - CONTRAINDICATIONS :
- Laryngeal lesions
- Tumors of the larynx
- Head Injury

IV - MATERIAL:
- With different laryngoscope blades suitable for illuminating adult and pediatric ( This equipment must be maintained checked after each use
- Sterile Gloves
- Endotracheal Tube with inflatable balloon at different sizes
- Sterile single-use syringe
- Sterile forceps to guide the probe MAGILLE
- Stethoscope
- Fixing
- Source suction and O2
- Cannula GUEDEL of different sizes ( avoid the trauma and fall of language )
- Local anesthesia ( Xylocaine 5% spray )
- A mouthguard
- Gastric tube
- Broncho - dilators ( Ventolin )

V - dificulties AIRWAY AND COMPLICATIONS :
 A - Difficulties in intubation :
They are due either :
- A anatomical problems : * Short neck or cervical spondylosis
                                                         * Small mouth opening
                                                         * Not visibility of the glottis and soft palate
                                                         tumors
- A etiological criteria: * laryngeal edema
                                                         * Laryngeal spasm
                                                         * Poor dental status
                                                         * Obesity
B - Complications:
- Esophageal Intubation
- Cardiac Stimulation with hypertension , heart rhythm disorder , bronchospasm
- Wound lips and tongue
- Inhalation
- Herniated balloon
- Cranking probe
- Trauma to the trachea

                                                                                                                                                                         J - R
LUNG ASPIRATION AND ENDOTRACHEAL

I - VACUUM ORAL ORAL OR NASAL :
It is a technique of removing liquid or solid substances out of the airways in order to: - facilitate breathing
                 - Prevent pneumonia
1 / INDICATIONS:
- People bedridden
- Patients suffering from respiratory problems

2 / MATERIAL:
- Sterile equipment: * sterile gauze
                                * Clamp to serve
- Antiseptic
- Sterile syringe
- Glove non sterile single use
- Bottle of sterile saline to change every day
- Sterile suction probe with a rounded tip straight or curved adaptive caliber sick
- Bag Waste
- Apparatus maintained daily source of suction or suction wall

3 / PREPARATION OF THE PATIENT :

- Information on the purpose and the process explained: introduction of a suction catheter into the cavities
   nose or mouth to suck secretions and make breathing easier
- Place the patient in proper head position hyperextension
- To protect the patient's chest

4 / TECHNICAL :

- Put clean gloves
- Insert the probe and sterile moistened deeply with a swab containing serum
   physiological without aspiration ( clamp the socket area or pinching the probe by hand)
- Vacuum cleaner and the entire region of the nose and / or throat carefully without causing
   vomiting in patients
- Take immediately after the disposables including gloves removed and the probe
- Rinse the suction system saline
- Soak in a disinfectant reusable equipment (pipes, etc ... ). , Clean and sterilize , clean and
   sterilize


II - VACUUM ENDOTRACHEAL :
This is a method often used in intensive care and which is to suck the bronchial secretions by an endotracheal tube ( intubation ) , a tracheostomy tube

1 / INDICATIONS:
- Persons having undergone a tracheotomy
- People intubated

2 / MATERIAL:

- Sterile equipment: sterile gauze
                             clamp used
- Antiseptic
- Sterile disposable gloves
- Syringe with rinsing solution
- Suction probe disposable provided with a rounded tip
- Bottle of sterile solution ( saline ) to change 2 times / day
- Extractor : pipe, container and lid to renew every day
- Source mobile central vacuum or electric pump
- Réanimas
- Sterile syringe eventually inflate the balloon of the endotracheal tube

3 / PREPARATION OF THE PATIENT :

- Inform the patient care
- Instill a washing solution in the trachea and bronchi
- Place the patient in proper position ( hyperextension )

4 / TECHNICAL :

- Let the patient deeply surventiler
- Instill prescription under a special washing solution with vent. providing antibiotic
- Put on sterile gloves
- Take the probe and moisten with sterile saline and enter without aspiration
- If you remove the probe abuts qq centimeters before withdrawing to avoid trauma
   bronchial mucosa
- Carefully aspirate at various heights from the bottom up to the region to be sucked
- Remove the probe slowly under vacuum by turning slightly without moving to avoid injury
- The duration of intake should not exceed 15-20 sec vent again after a pause
- Monitor ECG waveform and saturation on the monitor
- Let the patient surventiler
- Throw away any equipment used
- Clean fittings and hoses with a disinfectant
- Before tracheal aspirate always first carefully mouth and nose with another probe to
   prevent a flow of secretions in the trachea at the suction


III - COMPLICATIONS :

- Injury to the mucosa
- Infection of the patient or staff
- Cardiac arrest from vagal reaction in the region of the trachea and larynx
- Regional perforation by the tip of the probe into the tissue already damaged (ulcers)











                                                                                                                                         J - R
GASTRIC ASPIRATION

I - DEFINITION :
This is a technique of aspirating the stomach contents using a gastric probe or dual stream by gravity ( the probe is connected to a collecting bag ) or depression ( the probe is connected to a pressure gauge for a gentle suction and continuous)

II - INDICATIONS:
- Patient postoperative
- Patient intubated ventilated (avoid gastric inhalation)

III - GOAL:
- Ensure the aspiration of gastric contents
- Prevent acute dilatation of the stomach
- Encourage the postoperative digestive tract

IV - MATERIAL:
- Jar suction Disposable collecting the liquid sucked
- Gauge
- Two sterile tubes
- Biconical connection
- Syringe 60 CC big tip
- Stethoscope

V - TECHNICAL :

- Prepare the patient properly
- Ask the gastric tube if necessary
- If sensor already in place, verify its correct position by injecting approximately 10CC area by listening to the abdomen
   stethoscope should hear an air-fluid noise franc
- Aspirate gastric contents then gently with a syringe by gently pulling the piston there must
  have onset of gastric fluid to confirm the correct position of the probe
• Suction Gravity : adapt the hose of the manifold cover to the gastric tube
• Suction vacuum : * mount the gauge on empty wall outlet and check
                                                         operation known suction system
                                                      * Adapt the hose from the gauge on one of the inputs of the jar
                                                            * Fix the gastric tube to a pipe of the jar through
                                                               a connector
                                                            * Adjust the pressure between 10 and 30 CC depending on the desired effect
                                                               and prescription
                                                   * Mount the sensor on the patient's cheek and hose bed sheet to
                                                               avoid traction on the probe or violent displacement
* Collect biological examinations in medical prescription
                                                            * Offset losses as prescribed to avoid alkalosis
- During ablation, close the gauge and let the suction by gravity (if asp depression. )
- Clamp (if asp gravity . ) If patient makes his gasses and / or stool remove the probe clamped to avoid
   fluid leak slowly but with a rapid gesture
- Clean the nostrils and make a careful mouth




VI - DAILY CARE :

- Check maintaining the probe correctly for each
- Perform mouth care at least every 6 h
- Clean and lubricate nostrils mobilizing the probe gently
- Varying the fixing areas of the probe in order to avoid skin irritation
- Record the amount of liquid collected and appearance
- Empty the jar or throw the bag regularly
- Check on the care and monitoring sheet that the result

VII - SURVEILLANCE:

- Drainage system : * position of the probe
                                         Permeability * Probe
                                         * Verification of the absence of the probe fold
                                         * Control adjustment depression
                                         * Daily amount of gastric fluid
                                         * Aspect of the liquid , odor, color , presence of biles , blood or secretions
- Clinical Supervision: * signs of dehydration
                                         * breathing
                                         * Measuring the blood pressure and temperature
                                         * Presence of edema
                                         * Laxation

VIII - INCIDENTS AND ACCIDENTS :

- Occlusion of the probe with secretions or reflux of gastric fluid ( aspiration stop , disconnect the
   probe and inject saline
- Occlusion of the probe by the gastrointestinal mucosa ( check the pressure gauge and move slightly
   probe
- Gastric tube collabée by excessive depression or defective pipe ( check the pressure
   gauge hose and change if necessary
- Dehydration resulting in a sensation of thirst , dry mucous membranes , fall in BP ,
   hyperthermia ( start compensation on prescription )
- Hyperhydratation digestive disorders and elevated BP, PAO (reduce compensation)
- Bleeding due to excessive pressure or suction of the mucosa

















                                                           J - R
SUCTION CHEST

I - DEFINITION :

This is a technique that consists in evacuating liquids and gasses intra thoracic and pleural . The drain connects the pleural cavity to a single jar ( siphonages ) or with a continuous extraction system

II - INDICATIONS:

- Spontaneous Pneumothorax
- Purulent pleurisy
- Hemothorax
- Nécrotomie superinfected

III - GOALS :

The establishment of a chest tube designed to:
- Evacuate gas or Fluid thoracic effusions
- Perform chest washes continuously in case of empyema and pneumonia

IV - MATERIAL:

- Drain implemented by a metal trocar MONALDI which introduces light into the pleural
  drains fine gauge which tend to clog quickly blood clots
- Trocar MONALDI
- Drains JOLLY disposable
- Sterile equipment: * sterile gauze
                             * Clamp to serve
- Antiseptics
- Sterile gloves
- Plaster
- Scissors
- Field pierced
- Local anesthetics ( Xylocaine 2% )
- Sterile syringe needle +
- Box of minor surgery
- Jar sterile graduated 3l containing an antiseptic
- Closing the jar cap crossed by two pipes in a plunging antiseptic , the other in connection with the
   Suction system
- Sterile tubing

V - PREPARATION OF THE PATIENT :

- Explain the patient care
- Put in proper position : supine torso raised , link bars behind the head





VI - NURSING ROLE :

- Make available the intubation equipment and emergency drugs
- Preparation of the suction device : * fill with saline
                                                                    * Connect with the suction source
                                                                    * Verification of operation
                                                                    * Ensure the connection with the drain pipe connected to the
                                                                       Suction system
- Sanitize the puncture
- Put a bandage and secure with tape elbows in the suction pipe
- Changing the drain suction sterile device

VII - SURVEILLANCE:

- Check the suction device
- Findings of the liquid and suction volume
- Take stock of outputs

VIII - COMPLICATIONS :

- Drain Output
- Moving the drain ( emphysema s / c)
- Compressive pneumothorax
- Bleeding intercostal vascular or pulmonary
- Lung Injury
- Lesion of an abdominal organ


























                                                                                                                                                                     J - R
TRACHEOTOMY OR tracheostomy

I - DEFINITION :

The tracheostomy is a surgical procedure which involves making a surgical opening on the front side of the trachea to establish an endotracheal tube without modification of the anatomical structures . Tracheostomy may be temporary or permanent . Breathing is through the tracheal opening but also the airway. The orifice without cannula may quit quickly.

II - OBJECTIVES :

- Maintain the freedom of the airways.
- Ensure adequate gas exchange .
- Extract effectively bronchial secretions .
- Assist patients who can not tolerate intubation .
- Allow the patient to gain greater autonomy.

III - INDICATIONS:

- Breach of the respiratory centers without paralysis of swallowing ( mennigé state).
- Paralysis of swallowing (poliomyelitis) .
- In case of temporary or permanent laryngeal disorders ( obstructive tumor benign or malignant ) .
- Trauma of the larynx.
- Diphtheria .
- Brain tumors leading to impairment of the respiratory centers .
- Tetanus .

IV - MATERIAL:

- 10ml syringe .
- Sterile compresses .
- Serving tongs .
- Broad-spectrum antiseptic .
- Gans sterile disposable .
- Gloves non sterile single use.
- Disposable mask .
- Cording .
- Tracheostomy cannula with sterile balloon.
- Tape or tape.
- A pair of sterile scissors .
- Local anesthetics .
- Tracheal suction equipment .
- Bean .
- Bag disposal.

V - TECHNICAL :

The surgeon makes a horizontal incision in the patient's right under the first cartilaginous rings , the tracheal cannula with a curved mandrel or plug is inserted into this opening
After inserting the shutter is immediately removed so that the patient can breathe. The tracheal cannula is inserted and then is internally latched . Tracheal cannula was held in place by a cord gas tied around the neck of the patient.
VI - NURSING ROLE AND MONITORING POST -OPERATIVE :
- Humidification of the air we breathe :
* This is necessary because the natural humidification is removed by tracheotomy , we risk
    thus increasing the concentration of bronchial secretions and therefore result in an obstruction.
      * It can be achieved either by saturating the air with humidity by spraying or serum
          physiological by the tracheostomy tube .
 
- Aspiration of bronchial secretions :
* For this there must be a vacuum in working condition and sterile probes to soft side ports
    béquillées slightly .
      * Depression used for vacuuming should be moderate .
      * Starting after insertion of the probe into the trachea probe should never be pinched
          when suction is on.
      * The frequency of aspirations vary with the condition of the bulk of the disease but it will know that
          it not a trivial gesture.

- Change of dressing and cannula :
* If the patient is conscious, prevention care and explain the course .
* Perform a simple hand washing.
* Gather materials .
* Put on disposable gloves to avoid contact with secretions and put on a mask to avoid
   risk projection secretions.
* Remove the pads and discard.
* Clean the area around the opening of the tracheostomy with sterile gauze soaked in antiseptic
   sliding the pad under the flange of the cannula .
* Clean the flange of the cannula .
* Firmly grasp the cannula and cut the cord and discard soiled .
* Change the cord and insert the precut under the collar compresses to absorb
   flow and prevent infection.
* Remove the sterile gloves.
* Make an antiseptic wash.

- Other treatments:
* A patient can eat tracheotomy if no swallowing disorders if this is the case it is
   pose a gastric tube .
* The caregiver must not forget that the patient is aphonique and thus provide him what to write.
Monitoring will depend in part the cause of tracheotomy :
      * A temperature curve of pulse and respiration TA .
      * Observation facies and the patient's condition , cyanosis , agitation being signs of respiratory problems
      * Radiation monitoring (chest clichet ) , biological ( blood gas ) ( electrolytes ) .

VII - ACCIDENTS AND INCIDENTS :
- Sudden Death in the very rare introduction may occur especially during aspirations in tetanus .
- Trigger cough reflex during the insertion of the cannula : remove the cannula and ask the patient to
   to qq . of inspiratory and expiratory movements.
- Accidental decannulation due to inadequate fixation.
- Stenosis of the trachea and vocal cord paralysis ( nerve damage reccurents ) .
- Bronchial irritation and exacerbation of the hole due to tracheal aspiration of secretions and
   inadequate care .

VIII - Conclusion :
Tracheotomy is almost always benign early intervention that could save bcp . life , it is still necessary that the post-op care and monitoring. is level so as not to lose the patient the benefit of the tracheotomy. J - R
AROUND THE VENOUS

I - GENERAL :

Venous approaches rely on a complex system of channels , arteries, capillaries and heart . Veins drained blood to the heart . There are 2 types of veins
- Receptive veins which plays a passive role in the return circulation .
- Propelling veins which circulates back managed by gravity.

II - GENERAL RECOMMENDATIONS :

 The patient should be informed of the technique he will undergo .
 Ensure comfort to gain his cooperation.
 The operator must comply with hygiene by washing hands , skill and knowledge.

III - ADVANTAGES AND DISADVANTAGES:

- ADVANTAGES: - implemented in a vessel of large caliber and therefore a larger and faster throughput
                                 for a faster effect of drugs .
                              - Allow the measurement of PVC.

- DISADVANTAGES: - risk of injury and bleeding arteries and adjacent veins.
                                       - Risk of perforation.

IV - MONITORING AND TECHNICAL :
( See courses in medicine SI )

V - CONCLUSION :

Take a venous access is an important technique that should be taken into consideration so it will avoid incidents and accidents that may occur to avoid complications .

   


















        J - R
The hEMODIALYSIS

I - DEFINITION AND GENERAL :

 This is a method of exchange between two solutions , blood and a liquid called dialysate through a semipermeable membrane synthetic .
Hemodialysis is performed using a device called a generator that produces the dialysis fluid or dialysate and a filter called a dialyzer or artificial kidney
It aims to prevent and correct the manifestations of uremic syndrome and its complications and to maintain homeostasis ( maintenance of normal value for different physiological constants , eliminate excess water , to overcome kidney failure and purify the blood of toxic waste, some toxic drugs.

II - MATERIAL:
- For the dialysis equipment :
* Capillary dialyzer fibers disposable.
* Bottles of saline .
* CC syringe 20 to increase the level of the expansion rooms.
* Heparin according to medical prescription.
* Extracorporeal circuit : arterial line and venous line .
* Bicarbonate.
Acetic acid * .
* Sterile compresses .
* Antiseptic.
- For connection :
* Needle arteriovenous fistula.
* Four clamp.
* Tray containing sterile hemodialysis : - two masks.
                                                                     - A waterproof field.
                                                                     - Sterile disposable gloves.
                                                                     - Boulle sponge for the patient's hand .
                                                                     - Sterile gauze .
                                                                     - Hypoallergenic tape .
                                                                     - Withers decontaminated and cleaned.
                                                                     - Antiseptic.
                                                                     - Tube for examination.
- To disconnect :
* Disposable gloves sterile and non- sterile.
* Mask .
* Sterile gauze .
* Antiseptic.
* 2 syringes of 5 CC .
* 2 10 CC syringes .
* 0.9% saline .
* 5 CC syringe containing heparin e .

III - PREPARATION OF THE PATIENT :

- Ensure cleanliness arm fistulized or support arm of the shunt.
- Take the weight before to assess weight relative to the weight lost on the checklist .
- BP and pulse after a rest.
- Take the patient's temperature .
- Place the patient supine elevated bars.
IV - TECHNICAL :

- Select the puncture which must be no closer than 6 inches to avoid recirculation.
- Sanitize the area of puncture on the arm and place the sterile field.
- Insert the needle into the blood arterial shunt but in the direction of blood flow and venous needle
  above the venous shunt.
- Fix 2 needles with hypoallergenic tape.
- The needles used must first be rinsed with saline.
- Turn on the blood pump .
- After stabilization , check: * 200A blood flow 300 ml / min
                                                   * Venous pressure
                                                   * Depression, and the conductivity of the dialysate flow
- Turn on the pump heparin.
- Check the TA and FC.
- Stop the heparin pump 1-15 minutes before the end of the dialysis session and measure the remaining content and
   note on the control sheet .
- Stop the blood pump and clamp the tubing and the arterial needle
- To empty the blood circuit by remaining saline.
- Keep the arm elevated patient.
- Ranger, clean and sterilize equipment .















V - SURVEILLANCE:

1 / BEFORE :

- Weigh the patient and check for digestive disorders.
- Take the patient's temperature .
- Examine the fistula pain inflammation or edema.
- Rinse all the dialyzer with saline to avoid serious namely shock accident.
  Anaphylactic , back pain .....
- To monitor the performance of the generator.
- Check pump heparin.
- Check the pressure at the bubble trap .

2 / DURING:

- Monitor BP and HR at least 3 times to detect in time the beginning of voltage drop.
- Monitor the facies of the patient.

3 / AFTER :

- Monitor the appearance of the dialyzer and verify the absence of clotted blood.
- Weigh the patient and take his TA .
- Take his temperature.
- Establish a long-term monitoring for vascular aging was found mainly in
   chronic patients.
- Pre joint pain were noted in the wrist of the vertebrae.
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