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Ministry of Education of the Russian Federation

Krasnodar city ​​medical college

Nursing manipulations in therapy

Krasnodar

MINISTRY OF EDUCATION

RUSSIAN FEDERATION

Krasnodar City Medical College

NURSING MANIPULATIONS IN THERAPY

Educational and methodological manual

for medical college students

in specialty 0406 “Nursing”

Krasnodar 2004

UDC 616.253.53 616(091):378.661(07.07)

Reviewers: A.S. Adamczyk doctor medical sciences, professor, head Department of Propaedeutics of Internal Diseases of KSMA,

V.V. Kolesnikov Doctor of Medical Sciences, Professor Head. Department of Polyclinic Therapy with a course of FPK and PPS " Ambulance» KSMA

Nursing manipulations in therapy and primary care. Educational and methodological manual for students of medical colleges in specialty 0406 “Nursing”. - Krasnodar. - 2004

This methodological manual is intended to assist medical college students in mastering practical skills in caring for therapeutic patients and implementing the nursing process

© Krasnodar Municipal Medical Institute of Higher Education

nursing education

1. MEASUREMENT OF BODY TEMPERATURE IN THE ARMILLAR

PURPOSE: diagnostic, monitoring the patient’s condition.

INDICATIONS: doctor's orders.

EQUIPMENT: soap, medical thermometer, gauze wipes, containers for disinfection, temperature sheets, temperature log, black pencil (or pen), watch.

TECHNIQUE

Explain the procedure to the patient.

Inspect the armpit area and dry it with a tissue. Soak the cloth in a 3% chloramine solution for 60 minutes.

Shake the mercury in the thermometer to 35 degrees.

Place the thermometer in the armpit so that the mercury reservoir is in contact with the body on all sides.

Measure the temperature for 10 minutes.

Take out the thermometer and note the result in the temperature log, shake off the mercury in the thermometer to the 35o C mark.

Disinfect the thermometer in one of the specified solutions - 0.5% chloramine solution - exposure 30 minutes, or 2% chloramine solution - exposure 10 minutes, or 3% chloramine solution - exposure 5 minutes.

Rinse it under running water and dry.

Wash your hands and graph the result on the temperature sheet as a curve.

Store the thermometer dry (in its case).

2. PULSE STUDY ON THE RADIAL ARTERIES

PURPOSE: assessment of blood circulation parameters.

TASKS: determining the symmetry of the pulse, its rhythm, frequency, filling and tension.

INDICATIONS: doctor's prescription, urgent conditions.

EQUIPMENT: stopwatch (watch with second hand), red pencil (or pen), patient monitoring card (temperature sheet).

TECHNIQUE

Warn the patient about the upcoming procedure.

Ask the patient to sit in a chair.

Prepare a stopwatch, a red pencil and paper.

Wash your hands with soap and dry with a personal towel.

Place the 2-3-4 fingers of both hands on the back of your forearms, and the rest on their front surfaces.

Make sure that the pulse can be felt equally in both hands.

Take a stopwatch (watch) and count the number of pulse contractions in 1 minute.

Determine during palpation: symmetry of the pulse, rhythm (regularity) of pulse waves, filling and tension of the pulse (for this it is necessary to completely compress the pulsating artery).

Tell the patient the result.

Help the patient stand up or lie down.

Wash your hands and dry with a personal towel.

Record the observation data in the nursing care record (temperature sheet in column “P”).

3. MEASUREMENT OF BLOOD PRESSURE

PURPOSE: assessment of cardiac output and vascular tone.

OBJECTIVES: determination of systolic and diastolic blood pressure using the method of N.S. Korotkova.

INDICATIONS: doctor's prescriptions, urgent situations.

EQUIPMENT: tonometer, phonendoscope, blue pencil or pen, patient observation card (temperature sheet).

TECHNIQUE

1. Warn the patient about the upcoming blood pressure measurement 15 minutes in advance (when measuring random blood pressure) or the day before (when measuring basal blood pressure) and instruct him on the measurement technique.

2. Prepare a tonometer, phonendoscope, pencil and paper.

3. Ask the patient to sit or lie down.

4. Place the cuff on your bare shoulder 2-3 cm above the elbow and fasten it so that only 1 finger passes between it and the shoulder.

5. Place the patient’s arm in an extended position, palm up, muscles relaxed. When measuring in a sitting position, ask the patient to place the clenched fist of his free hand or a roller under his elbow.

6. Connect the pressure gauge to the cuff and check the position of the arrow relative to the zero mark (if necessary, set it to 0).

7. Feel the pulsation of the brachial artery in the ulnar fossa and apply a phonendoscope to this place.

8. Close the valve and pump air into the cuff until the pressure in it exceeds 20-30 mmHg. Art. the level at which tones are still detected.

9. Open the valve and slowly (at a speed of 1-2 mm per second) release air from the cuff.

10. Note the systolic pressure when the first sounds appear, and if the sounds suddenly weaken or completely disappear, note the diastolic pressure. The measurement must be made 3 times with an interval of 1-2 minutes. In this case, after each measurement, the air from the cuff is completely released.

11. Round the blood pressure data to 5 mmHg. Art. (when using electronic tonometers, rounding is not required).

12. Remove the cuff.

13. Help the patient lie down or sit up.

14. Wash your hands with soap and dry with a towel.

15. Record the data on the observation sheet (the minimum numbers of systolic and diastolic pressure are recorded in the form of a graph).

4. OBSERVATION OF BREATHING

PURPOSE: determination of the functional state of external respiration and identification of its disorders.

TASKS: determination of the frequency of respiratory movements in 1 minute, depth, rhythm, type of breathing, symmetry of the participation of both halves of the chest in the act of breathing.

EQUIPMENT: stopwatch, pencil, patient monitoring card (temperature sheet).

TECHNIQUE

1. Wash your hands with soap and dry with a towel.

2. Ask the patient to expose the chest and lie down more comfortably.

3. Look at the chest and evaluate its movements without the patient noticing (you can palpate the pulse in order to divert the patient’s attention). When breathing shallowly, place your hand on your chest.

4. Take a stopwatch (watch) and count the number of breathing movements in 1 minute.

5. Determine during observation:

· depth of breathing (shallow, deep);

· breathing rhythm (rhythmic, arrhythmic);

· type of breathing (thoracic, abdominal, mixed);

· symmetry of movements of both halves of the chest.

6. Help the patient sit up and get dressed.

7. Wash your hands with soap and dry with a towel.

8. Register observation data in medical. patient card.

5. DETERMINATION OF DAILY DIURESIS

PURPOSE: diagnostics functional state urinary system.

OBJECTIVES: determination of the daily volume of urine and the ratio of the amount of fluid excreted to the amount injected.

EQUIPMENT: volumetric flask, urinal with divisions, patient monitoring card (temperature sheet).

TECHNIQUE

Collect urine samples, noting the amount of urine in each sample (measuring flask). The daily amount of urine is determined.

Calculate the total amount of fluid administered to the patient (the volume of fluid given by injection is selected from the prescription sheet).

Calculate the total amount of fluid the patient drinks per day.

Consider the nature of sweating (300-500 ml in summer, 150 ml in winter), the release of fluid with feces - 200 ml, the release of fluid during breathing - 250-300 ml

Add up the fluid removed from the body and the fluid introduced.

Compare the two numbers (the normal difference is about 250 ml).

Note Hourly diuresis is determined every hour, the numbers are recorded in the observation diary. For unconscious patients, a catheter is inserted, which is secured to the thigh with an adhesive tape and connected to a urinal (preferably disposable, but always with divisions).

6. Preparation of a 10% clarified bleach solution (master) - 10 liters

Purpose: To prepare a basic solution of bleach, which will subsequently be used to prepare working solutions of various concentrations for the purpose of disinfecting premises, dishes, plumbing equipment, etc.

Equipment:

3. Dry bleach in standard packaging indicating the name, date of preparation, expiration date, CL (chlorine) activity.

4. Marked containers for disinfecting solutions with a capacity of 10 liters - 2 pieces (enamel, eraser with a tight-fitting lid or dark glass with a ground stopper).

5. Running water 9 liters.

7. Documentation: log for preparing a 10% bleach solution, log for monitoring the dry preparation for active chlorine, pen.

Required condition!

4. Persons under 18 years of age are not allowed to work, with hypersensitivity to chlorine.

execution technique:

2. For the purpose of safety and prevention of exposure to toxic substances on the body, wear protective clothing:

3. Prepare the equipment: an enamel or plastic container with a tight-fitting lid, 1 kg of dry bleach, a wooden spatula.

4. Pour 1.5-2 liters of running water into the container.

5. Carefully, avoiding spilling and splashing, pour 1 kg of dry bleach into a container of water, stir with a wooden spatula and mash out the lumps.

6. Add up to 10 liters of water into the container, stir the solution until a homogeneous mass is obtained.

7. Close the container with a lid and leave to stand for 1 day in a dark place inaccessible to the patient.

Note! Bleach decomposes in light.

8. Remove protective clothing. Wash your hands with soap and dry with a personal towel.

9. To ensure complete dissolution of the dry substance in water, stir the solution several times a day.

10. In 24 hours. Wear protective clothing (see above).

11. Prepare a container labeled 10% basic clarified bleach solution (master solution). Check the tightness of the lid.

12. Pour the settled solution into the prepared container without stirring!

13. Put the date of preparation of the solution and signature on the container label. Make a note of the date and time of preparation of the solution in the log book and put your signature.

14. Remove protective clothing. Wash your hands with soap and dry with a personal towel.

15. Store the resulting solution in a dark and cool place, out of reach of the patient and general use, separately from medications. The shelf life of the prepared solution is 7 days.

Note! If precautions are not followed, acute poisoning with bleach may occur, which will result in:

· severe irritation of the respiratory system - sore throat, nose, cough, difficulty breathing, runny nose, etc.

· irritation of the mucous membranes of the eyes - burning, pain, lacrimation, itching, coughing, etc.;

· dizziness, nausea, redness of the skin, etc.

7. Preparation of working solution of disinfectant of various concentrations

Purpose: Prepare a working disinfectant solution.

Equipment:

1. Personal hygiene products: soap, personal towel.

2. Overalls: long-sleeved robe, cap (or headscarf), oilcloth apron, cotton-gauze mask or RU-60M universal respirator, PO2 or PO3 safety glasses, replacement shoes or shoe covers, PVC gloves.

3. Disinfectant in the form of:

· solution or concentrate: bleach (stock solution), Lisetol, Lysoformin 3000, Samarovka, Virkon, Gigasept, etc.;

· dry powder: chloramine B, calcium hypochloride, perform, etc.;

granules or tablets: hydroperite (hydrogen peroxide), clorsept, etc.

4. Marked containers for the working solution - an enamel bucket with a lid or an EDPO container with a capacity of 10 liters.

5. Measuring containers - 2 pieces (the first - up to 1 liter, the second - up to 10 liters).

6. Wooden spatula for mixing the solution.

7. Required amount of running water.

Required condition!

2. For the purpose of prevention possible poisoning the solution must be prepared in a room with supply and exhaust ventilation and well-ventilated, with special tools and equipment, in the absence of unauthorized persons.

3. Persons who have passed training are allowed to work with disinfectants appropriate training on duties, safety precautions, precautions and prevention of accidental poisonings approved by relevant regulations.

4. Persons under 18 years of age with hypersensitivity to chlorine (if a chlorine-containing preparation is subject to dilution) are not allowed to work.

5. To prevent possible adverse effects of disinfectants on the body of staff and patients, it is necessary to strictly adhere to the technology for preparing working solutions, their consumption rates and exposure time.

6. Working solutions of disinfectants are prepared immediately before use and are used once!

execution technique:

2. Wash your hands with soap and dry with a personal towel.

3. For the purpose of safety and prevention of exposure to toxic substances on the body, wear protective clothing:

· take off your work robe and wear it with long sleeves;

· put your hair under a cap or scarf;

· wear an oilcloth apron, glasses, a mask;

· Wear gloves over the sleeves of your robe.

4. Carefully read the name of the disinfectant and its expiration date. Check physical properties drug and ensure its suitability for use.

5. Fill a measuring container (up to 10 liters) with the required amount of running water (see table). Pour part of the water (1.5 - 2 liters) into the prepared container for the working solution (EDPO container or enamel bucket).

	Name drug		Working solution
			A drug		A drug
	Bleaching powder (mother liquor)
	Chloramine B
	Lysoformin 3000
	Samarovka
	Nika - dez
	Gigasept
	Hydroperite		tablets

6. Very carefully, avoiding splashing and/or spraying, measure out the required amount of disinfectant (see table). Pour (pour out) the contents of the measuring container (up to 1 liter) into the water in the container for the working solution.

7. Stir the resulting solution with a wooden spatula, kneading the lumps. Add the remaining water. Stir again.

8. Close the container with a lid, check the labeling, put the date the solution was prepared and sign.

9. Remove overalls and place them in a laundry bag.

10. Wash your hands with soap and dry with a personal towel.

Note: Almost all working solutions (with the exception of Gigasept - can be stored for up to 16 days, see guidelines for use) are used immediately after preparation and once!

8. Social (household) level of hand washing

Goal: Ensuring infectious safety of the patient and staff, mechanical removal of transient microflora, ensuring cleanliness and hygiene.

Indications:

· Before and after examining the patient.

· Before and after performing various procedures.

· Before preparing and serving food, before eating.

· After visiting the toilet.

· After blowing your nose.

Equipment:

5. Container with 3% chloramine for disposal of wipes.

TECHNIQUE

1.

2. Open the tap.

· palm to palm;

9. Hygienic level of hand washing

Goal: Ensuring infectious safety of the patient and staff, mechanical removal of transient microflora.

Indications:

before performing invasive procedures;

before caring for an immunocompromised patient;

before and after wound and urinary catheter care;

before and after putting on gloves;

after contact with biological fluids body or after possible microbial contamination.

Necessary conditions: Healthy and intact skin of the hands, nails protruding no more than 1 mm beyond the fingertips, no varnish, no jewelry on the hands.

Equipment:

1. Tap: elbow - in the treatment room, dressing room, operating room and at the nurse's station in the neonatal department; with lambs - at the ward post, in the outpatient reception room, etc.

2. Bar or liquid soap with a dispenser.

3. Individual towel, changed at least every 6 hours, disposable napkins.

4. Nail cleaning device.

5. Skin antiseptic: 0.5% solution of chlorhexidine bigluconate, Lizanin, Octenisept, Octeniderm, Sagrosept, Hospidermin, etc.

6. Container with 3% chloramine for disposal of wipes.

TECHNIQUE

1. Check the integrity of the skin, remove watches and jewelry from your hands. Raise the p hem of clothing above elbow level.

2. Open the tap.

3. Moisturize your hands and forearms.

4. Apply liquid soap to the palm surface of your hands (bar soap can only be used once!).

5. Lather your hands, repeating each movement at least 5 times in the following sequence:

· palm to palm;

· right palm above the left rear;

· left palm over the right rear;

· palm to palm, fingers of one hand in the interdigital spaces of the other;

· “lock” - the palmar surfaces of the 1st and 2nd phalanges of the fingers of one hand to the other;

· the back of the fingers to the palm of the other hand;

rotational friction thumbs;

· rotational friction of the palms.

6. Clean the area under the nails with a nail cleaner under running water.

7. Hold your hands so that your hands are above your elbows and do not touch the sink.

8. Rinse your hands with running water until the soap is removed, allowing the water to flow freely down your hand from the cleanest area.

9. Turn off the tap with your elbow or towel.

10. Dry your hands using a dry, clean towel or disposable napkin using blotting movements.

11. Throw the towel or napkin into the waste container.

12. Apply 2-3 ml of any skin antiseptic from the dispenser (0.5% solution of chlorhexidine bigluconate, Lizanin, Octenisept, Octeniderm, Sagrosept, Hospidermin, etc.) to the surface of your hands.

13. Using gentle movements, rub the preparation over the surface of the skin until completely dry.

Note: The hand washing process lasts no more than 1.5 - 2 minutes.

10. USING MEDICAL GLOVES

Goal: Create a barrier to prevent the spread and transmission of infection from patient to staff and from staff to patient. Ensuring a high level of cleanliness and hygiene. Personnel health protection.

Indications: For aseptic procedures. In all cases of possible contact with blood, other biological fluids or infected surfaces or objects. In case of possible contact with chemicals. substances: detergents, disinfectants.

CONTRAINDICATIONS: Pustular or other skin lesions, cracks, wounds.

THE NECESSARY CONDITIONS: Sufficient quantity sterile and non-sterile gloves, single and multiple use; Before performing invasive manipulations and contact with sterile materials, care items, and other procedures, only sterile gloves are worn; in other cases, non-sterile ones.

equipment: tap, soap, individual towel, skin antiseptic - 0.5% solution of Chlorhexidine bigluconate, Lizanin, Octenisept, Octeniderm, Sagrosept, Hospidermin, etc., sterile gloves in standard packaging, sterile tweezers in a sterile cuvette, work table, tray for waste material, a container with a 3% chloramine solution for used gloves.

TECHNOLOGY

1. Remove watches and rings, remove long nails and nail polish.

2. Raise the sleeves of your robe above elbow level.

3. Wash your hands with soap, dry with a personal towel, and treat with a skin antiseptic.

4. Make sure that the gloves are packaged tightly and are suitable for work (expiration date).

5. Using non-sterile scissors, open the outer packaging of the gloves.

6. Using sterile tweezers, remove the gloves in the inner packaging without touching them with your hand and place them on the work surface.

7. Without lowering your hands below table level, discard the outer glove package into the waste tray.

8. Using sterile tweezers, open and unscrew the top edges of the standard package. Place the tweezers in a sterile tray.

9. Big and index finger With your right hand, grab the cuff-shaped edge of your left glove from the inside.

10. Raise the glove above table level. Gently insert your hand inside the glove and gently pull it over your left hand.

11. Place the fingers of your left hand, dressed in a sterile glove, under the lapel of your right glove from the outside.

12. Raise the glove above table level. Gently insert your right hand inside the glove and gently pull it over your right hand.

13. Without changing the position of your fingers, turn the folded edge of the right glove over the sleeve of the robe. In the same way, unscrew and straighten the edge of the left glove.

14. Using the gloved fingers of your left hand, pinch the surface of your right glove below wrist level.

15. Pull the right glove slightly away from the surface of the skin and very carefully Carefully, without violating the integrity of the glove and without splashing the patient’s secretions and glove juice, remove the glove by turning it inside out.

16. Grasp the removed right glove in your left hand.

17. Thumb insert your right hand (without gloves) inside under the edge of your left glove. Grab the inside of the glove and carefully turn it inside out to remove the glove.

18. Soak used gloves in a container with a 3% chloramine solution for 60 minutes.

19. Wash your hands with soap, dry with a personal towel, and treat with a skin antiseptic.

Note:

Gloves need to be changed if:

· their integrity is violated;

· after completion of the procedure;

· between contacts with patients or after contact with a contaminated object.

11. USE OF MEDICAL Gown

Goal: Create a barrier to prevent the spread and transmission of infection from patient to staff and from staff to patient. Ensuring a high level of cleanliness and hygiene. Personnel health protection.

Indications: All types professional activity in health care facilities.

Equipment: disposable or linen robe with long sleeves, suit or dress, soap, individual towel.

TECHNIQUE:

1. Wash your hands with soap and dry with a personal towel.

2. Put on a clean medical gown so that it completely covers your personal (home) clothing or medical suit.

3. When leaving the office (department), medical clothing is removed. If this is not possible, you should put on an outer robe and remove it upon return.

4. At the end of the work shift or in case of contamination, remove the gown, touching only the inner surface and turn it inside out and roll it up.

5. Place the used gown in a bag (container) for subsequent processing.

12. USE OF MEDICAL CAP AND MASK

Goal: creating a barrier to prevent the spread and transmission of infection. Ensuring a high level of cleanliness and hygiene. Personnel health protection.

Indications:

A medical cap and mask should be worn at all times when working in the treatment room, dressing room, operating room, maternity hospital, intensive care unit and intensive care unit. When performing invasive procedures. In boxes, infectious diseases departments. During an epidemic of infectious droplet infections.

Equipment: clean, disposable or linen, lint-free medical cap; clean (disinfected) disposable or four-layer gauze mask, reusable, mirror, bix, sterile tweezers in a sterile cuvette, soap, individual towel, container with 3% chloramine solution for disinfecting masks.

IMPLEMENTATION TECHNOLOGY

1. Wash your hands with soap and dry with a personal towel.

2. Looking in the mirror, put on a disposable or linen medical cap, tucking all the hair on your head and neck under it.

3. Using sterile tweezers, remove the disinfected or sterile mask from the bix and grasp it by the straps.

4. Looking in the mirror, put on the mask so that it fits tightly and covers your nose and mouth.

5. If necessary, wear safety glasses.

6. After use, remove the mask, touching only the strings.

7. Soak it in a container with a 3% chloramine solution.

Note:

· The mask changes as it gets wet and dirty, but at least every 2 hours.

· Masks should not be stored for later use by hanging them around your neck or putting them in your pocket.

13. Stages of PRE-STERILIZATION CLEANING OF MEDICAL INSTRUMENTS

PURPOSE: maintaining infection safety, removing protein, fat and other contaminants.

PREREQUISITE CONDITION: the manipulation is carried out in a washing room.

INDICATIONS: preparation for sterilization.

EQUIPMENT: running water, a container with a washing complex, a water thermometer, a container with distilled water, a brush, a brush or a cotton-gauze swab, mandrels, a dry-heat oven.

TECHNIQUE

Rinse the equipment under running water for 0.5 minutes or until the smell of the disinfectant disappears.

Soak the tools by completely immersing them in the cleaning complex for 15 minutes.

Note:

· Immerse all products in the washing complex only in disassembled form.

· The cleaning complex includes:

1. Synthetic detergent (SMS): “Astra”, “Aina”, “Lotus”, “Progress”, “Marichka” - 5 g.

2. Hydrogen peroxide 3% - 220 ml, hydrogen peroxide 6% - 110 ml, perhydrol 33% - 15 ml, perhydrol 27.5% - 17 ml, or 14 tablets of hydroperite.

3. Water - up to 1 liter

The washing complex of this composition is heated no more than 6 times to t 50-55 C0 and can be used until a pink color appears, but no more than 1 day.

· The washing complex may include Biolot powder - 3 grams and up to 1 liter of water. This solution is heated to 40-45 C0 and is used only once.

· Of the modern antiseptics for preparing a washing complex, you can use Lysoformin 3000 - 15 ml, Blanisol - 5 ml and up to 1 liter of water, etc.

Wash each product using a brush, a brush, a cotton-gauze swab in the washing complex for 0.5 minutes.

Rinse each product with running water after using the washing complex containing SMS: Biolot - 3 minutes, Progress - 5 minutes, Lotus - 10 minutes, Astra - 10 minutes, Aina - 10 minutes.

Rinse each product in distilled water (0.5 min).

Dry the instruments using a dry air method at a temperature of 80 - 85o C until the moisture completely disappears.

14. DETERMINING THE QUALITY of pre-sterilization CLEANING of medical instruments:

GOAL: compliance with infection safety

INDICATIONS: monitoring the effectiveness of pre-sterilization cleaning of medical instruments (self-monitoring in health care facilities, monitoring at sanitary and epidemiological stations).

OBJECTS OF RESEARCH: 1% of the batch of instruments that have undergone pre-sterilization cleaning, but not less than 3-5 units, and in the center for 1 shift, for example, syringe cylinders and pistons, injection needles.

AZOPYRAM TEST (from blood)

sterile tray, sterile tweezers in a sterile cuvette (sterility is maintained for 3 hours), two graduated sterile tubes, a rack for test tubes, a sterile pipette or sterile syringe for dilution and testing, cotton balls, azopyram reagent or Azopyram S (trademark), hydrogen peroxide 3%, containers with disinfectants, quality control log for pre-sterilization cleaning of medical instruments.

TECHNIQUE:

Wear gloves.

Prepare the azopyram reagent.

Note: azopyram reagent is a 1-1.5% solution of aniline hydrochloride in 96% ethyl alcohol) or azopyram C. It can be stored in a tightly closed bottle in the refrigerator at t 4 C0 for 2 months, and in the dark at room temperature (t 18 - 23 C0) no more than 1 month. Moderate yellowing of the reagent during storage without precipitation does not reduce its performance.

Check the bottle with the reagent for compliance with the name, expiration date, concentration and for absence of signs of its unsuitability.

Mix equal amounts of azopyram and 3% hydrogen peroxide solution (2-3 ml each) in a graduated test tube or syringe.

Draw up the azopyram reagent into a pipette or syringe. Apply it to a cotton ball.

Drop the reagent from the pipette (syringe) into the cylinder of the syringe being tested, and pass it through the syringe onto another cotton wool (the syringe cylinder is checked)

If there is blood contamination on the cotton wool or syringe barrel, a purple, then pink-lilac or brownish color appears immediately or within 1 minute. Color reactions that occur later are not taken into account!

Discard unused azopyram working solution. Soak test tubes, syringes and pipettes in 3% chloramine solution for 60 minutes.

Note:

· the working solution can be used within 1-2 hours; at ambient temperatures above 250, near heating devices and in bright light, spontaneous pink coloration of the reagent may appear;

AMIDOPYRINE TEST (from blood)

EQUIPMENT: soap, individual towel, gloves, sterile sterile tray, sterile tweezers in a sterile cuvette (sterility is maintained for 3 hours), two graduated sterile tubes, a rack for test tubes, a sterile pipette or sterile syringe for dilution and testing, cotton balls, bottles with 5% alcohol solution amidopyrine, 30% acetic acid solution and 3% hydrogen peroxide solution, containers with disinfectants, quality control log for pre-sterilization cleaning of medical instruments.

TECHNIQUE:

1. Wash your hands with soap and dry with a personal towel.

2. Wear gloves.

3. Prepare the reagent for the amidopyrine test.

Note: amidopyrine reagent is a 5% solution of amidopyrine in 95% ethyl alcohol - can be stored in the refrigerator in a bottle with a ground stopper for 1 month).

4. Check the bottle with the reagent for compliance with the name, expiration date, concentration and for absence of signs of its unsuitability.

5. Mix in a test tube or syringe equal amounts of 5% alcohol solution of amidopyrine, 30% acetic acid and 3% hydrogen peroxide solution (2-3 ml each).

6. Using sterile forceps, place the instrument being examined, such as a cylinder, piston and needle, into a sterile tray.

7. Draw up the amidopyrine reagent into a pipette or syringe. Apply it to a cotton ball.

8. If there is no color reaction on the cotton wool after a few seconds, wipe the piston, syringe barrel and needle from the outside with it.

9. Drop the reagent from a pipette (syringe) into the cylinder of the syringe being tested, and pass it through the syringe onto another cotton wool (the syringe cylinder is checked).

10. Attach the needle to the syringe. Re-drop the reagent into the cylinder and pass it through the syringe and needle (the needle is checked).

11. If there is blood contamination on the cotton wool, the syringe barrel immediately or within 1 minute a blue-green color appears. The color reaction that occurs later is not taken into account!

Note:

similar staining may occur if there is residue on the syringe medicines, chloramine and ternary solution;

· after mixing, the above reagent cannot be stored;

· if the sample is positive, the entire group of controlled products is subject to re-cleaning.

PHENOLPHTHALEIN TEST (from detergents)

EQUIPMENT: soap, individual towel, gloves, sterile tray, sterile tweezers in a sterile cuvette (sterility is maintained for 3 hours), two graduated sterile test tubes, a stand for test tubes, a sterile pipette or sterile syringe for dilution and testing, cotton balls, a bottle with a 1% alcohol solution of phenolphthalein, containers with disinfectants, quality control log for pre-sterilization cleaning of medical instruments.

TECHNIQUE:

Wash your hands with soap and dry with a personal towel.

Wear gloves.

Prepare the phenolphthalein reagent

Note: phenolphthalein reagent - this is a 1% alcohol solution of phenolphthalein - can be stored in the refrigerator in a bottle with a ground stopper for 1 month.

Check the bottle with the reagent for compliance with the name, expiration date, concentration and absence of signs of its unsuitability.

Using sterile forceps, place the instrument being examined, such as a cylinder, piston and needle, into a sterile tray.

Draw up the phenolphthalein reagent into a pipette or syringe. Apply it to a cotton ball.

If there is no color reaction on the cotton wool after a few seconds, wipe the piston, syringe barrel and needle from the outside with it.

Drop the reagent from a pipette (syringe) into the barrel of the syringe being tested, and pass it through the syringe onto another cotton wool (the syringe barrel is checked).

Attach the needle to the syringe. Re-drop the reagent into the cylinder and pass it through the syringe and needle (the needle is checked).

If there is contamination (residues of synthetic detergents) on the cotton wool, the syringe barrel immediately or within 1 minute a pink color appears. The color reaction that occurs later is not taken into account!

Soak used cotton balls in a container of 3% chloramine solution for 60 minutes.

Discard unused amidopyrine working solution. Soak test tubes, syringes and pipettes in 3% chloramine solution for 60 minutes.

Remove gloves and soak them in a container of 3% chloramine solution for 60 minutes.

Wash your hands with soap and dry with a personal towel.

Make a note of the test performed in the quality control log for pre-sterilization cleaning of medical instruments.

Note: if the sample is positive, the entire group of controlled products is subject to re-cleaning.

test with Sudan III (for fat residues)

EQUIPMENT: soap, individual towel, gloves, sterile tray, sterile tweezers in a sterile cuvette (sterility is maintained for 3 hours), two graduated sterile tubes, sterile pipette or sterile syringe for dilution and sample administration, test tube rack, cotton balls, bottle with Sudan III reagent, containers with disinfectants, quality control log for pre-sterilization cleaning of medical instruments.

TECHNIQUE EXECUTION:

1. Wash your hands with soap and dry with a personal towel.

2. Wear gloves.

3. Prepare Sudan III reagent.

Note: In 70 ml heated to 60 C0 (in a water bath) 95% ethyl alcohol dissolve 0.2 g of crushed Sudan III paint and methylene blue. Then add 10 ml of 20-25% ammonia solution and 20 ml of distilled water. This solution can be stored in the refrigerator in a bottle with a ground stopper for 6 months.

4. Check the bottle with the reagent for compliance with the name, expiration date, concentration and absence of signs of its unsuitability.

5. Using sterile forceps, place the instrument being examined, such as a cylinder, piston and needle, into a sterile tray.

6. Draw up Sudan III reagent into a pipette or syringe. Apply it to a cotton ball.

7. If there is no color reaction on the cotton wool after a few seconds, wipe the piston, syringe barrel and needle from the outside with it.

8. Drop the reagent from a pipette (syringe) into the cylinder of the syringe being tested, and pass it through the syringe onto another cotton wool (the syringe cylinder is checked).

9. Attach the needle to the syringe. Re-drop the reagent into the cylinder and pass it through the syringe and needle (the needle is checked).

10. After 10 seconds, rinse off the dye generously with water from each item being tested.

11. If there is grease contamination on the products, a yellow color appears immediately or within 1 minute. The color reaction that occurs later is not taken into account!

12. Soak used cotton balls in a container with 3% chloramine solution for 60 minutes.

13. Discard unused amidopyrine working solution. Soak test tubes, syringes and pipettes in 3% chloramine solution for 60 minutes.

14. Remove gloves and soak them in a container with 3% chloramine solution for 60 minutes.

15. Wash your hands with soap and dry with a personal towel.

16. Make a note of the test performed in the quality control log for pre-sterilization cleaning of medical instruments.

15. LAYING BOXES (or sterilization boxes)

PURPOSE: providing conditions for sterilization, storage and use of products medical purposes.

INDICATIONS: preparation for sterilization of medical products made of metal, glass and rubber, linen for the treatment room.

EQUIPMENT: soap, individual towel, gloves, wraps of various shapes and sizes, linen (sheets, diapers, gowns, etc.), medical products (tweezers, kidney-shaped trays, syringes, gloves, etc.), dressing(wipes, cotton balls), containers with disinfectants, rags for processing the bix, a linen napkin for lining the bix, a napkin for treating the nurse’s hands, placed under the lid of the bix, sterilization quality indicators (3 pcs. for each bix)..

TECHNIQUE

Wash your hands with soap and dry with a personal towel.

Check the serviceability of the bix and its tightness.

Wear gloves. Treat the bix from the inside with one of the disinfectants (3% chloramine solution, 6% hydrogen peroxide solution, 0.5% hibitan solution, etc.).

Take off your gloves. Soak gloves and used rags in 3% chloramine solution for 1 hour.

Determine the type of installation and prepare accordingly:

· for specific installation - materials or tools of the same type;

· for targeted installation: material or tools for one operation or procedure;

· for universal installation: everything you need to set a sterile table or to work during the day in the treatment room.

Line the inside of the bix with a linen napkin.

Place the first sterilization quality indicator on the bottom of the lined container, depending on the mode used for this type of product.

Start laying materials and products on top of the indicator: vertically, loosely, layer by layer and sectorally.

Place about half of it in the biscuits required material and place the second indicator in the middle of the bix.

Place the remaining half of the material in the bix and cover with a napkin lining the bix in the form of an “envelope”.

Place a hand sanitizer wipe and a third indicator on top of the wipe.

Close Bix.

Attach a tag to the handle of the bix, on which you indicate the name of the department and office, the type of sterile material, the date of installation, the name of the nurse who performed the installation and its signature.

Deliver the bix in a tight, moisture-resistant bag to the CSO (central sterilization department). The bag can also be sterilized along with the bag and is used for efficient return transport. When the bix is ​​delivered to the CSC, its side “windows” are open (closed in the CSC after sterilization).

Note. Thermal indicator tape "Vinar" IS 132, IS 120, urea, benzoic acid and others are used as indicators.

16. SANITARY TREATMENT OF THE PATIENT

PURPOSE: hygienic care for the patient.

1. Full (bath, shower).

2.Partial (washing, wiping, treatment of individual parts of the body).

3. Deferred (if emergency care is needed).

TASKS: warning infectious complications, creating a comfortable state for the patient.

HYGIENIC BATH

EQUIPMENT: bath, individual washcloth and soap, gloves, rags, bedding and underwear, towels for head and body, water thermometer, footrest, scissors, comb, bath equipment (brush, cleaning agent, disinfectant solution), bag for dirty linen, containers with disinfectants.

TECHNIQUE

Fill the bathtub with cold water and then hot water by 1/2.

Measure the water temperature with a water thermometer (t 37-42 C).

Install the footrest.

Place the patient in the bath so that the water reaches the xiphoid process of the sternum.

Wash the patient in a certain sequence: head, torso, upper limbs, perineum, lower back, abdomen. Duration hygienic bath is 15-30 minutes.

Help the patient get out of the bath and dry off with a warm towel or sheet.

Help the patient get dressed, dry their hair, comb their hair, and trim their fingernails and toenails (if necessary).

Treat the bathtub with a disinfectant solution (1% chloramine solution or 0.5% bleach solution).

Take the patient's laundry to the laundromat.

Remove gloves and soak them in 3% chloramine solution for 60 minutes, and used rags in 1% chloramine solution for 60 minutes (or other disinfectant).

Wash your hands with soap and dry with a personal towel.

HYGIENIC SHOWER

EQUIPMENT: shower, individual washcloth and soap, bed linen and underwear, towels for the patient’s head and body, water thermometer, patient bench or special stand, bath equipment (brush, cleaning agent, disinfectant solution, rags), dirty bag linen, containers with disinfectants.

TECHNIQUE

Wash your hands with soap, dry with a personal towel, put on gloves.

Treat the bathtub with a 0.5% bleach solution or 1% chloramine solution. Clean the tub with a brush and cleaning product. Rinse the bathtub. Dispose of the rags into the waste rags container.

Place a bench or special stand in the bathtub and seat the patient on it.

Select the desired water temperature and direct the stream of water towards the patient.

Help the patient wash in the same sequence as when washing in the bath (from head to feet).

Help the patient get out of the bath, dry off with a towel, and get dressed.

Place the patient's laundry in a laundry bag.

Treat the bathtub with a 0.5% bleach solution or 1% chloramine solution. Clean the tub with a brush and cleaning product. Rinse the bathtub.

Soak used rags in a container of 1% chloramine solution for 60 minutes. Remove gloves and soak in 3% chloramine solution for 60 minutes.

Wash your hands with soap and dry with a towel.

RUBBING THE PATIENT

INDICATIONS: serious condition patient.

EQUIPMENT: screen, gloves, container with water, oilcloth, diaper or waterproof diaper, soap, sponge or soft gauze, 2 towels, bag for dirty laundry, set of underwear or sheet, containers with disinfectants, water thermometer.

TECHNIQUE

Wash your hands with soap, dry with a towel, and put on gloves.

Separate the patient with a screen.

Place an oilcloth with a diaper or a disposable waterproof diaper under the patient.

Undress the patient. Collect the patient's clothes in a laundry bag.

Soak the sponge (napkin) in water (t 37-42 C), wring it out, wipe the patient’s body in the following sequence: face, ears, neck, chest, in women - folds under the mammary glands, axillary areas, back, arms, inguinal folds, crotch, stomach, thighs, legs, feet.

Dry the patient (use a different towel for the feet).

Dress the patient in clean underwear or cover him with a clean sheet.

Place the sponge in a container with a 1% chloramine solution, treat the oilcloth with a 1% chloramine solution (and if the patient’s secretions have come into contact with it, then treat it with a 3% chloramine solution).

Throw the towel into a dirty laundry bag, soak a disposable diaper in a container with a 5% chloramine solution, and then dispose of it.

Remove gloves and soak them in 3% chloramine solution for 60 minutes. Wash your hands with soap and dry with a personal towel.

Send a bag of dirty laundry to the laundry.

17. Anthropometry (study of human physical development)

Purpose: to obtain objective examination data of the patient.

Indications: initial examination patient, dynamic observation during treatment.

Contraindications: extremely serious condition of the patient.

Weighing the patient

Equipment: soap, individual towel, medical scales, a sheet for monitoring the patient’s condition, clean gloves, containers with disinfectant solutions, a disposable napkin under the patient’s feet (you can use a regular sheet of paper).

Necessary condition!

Weighing is always carried out under the same conditions - on an empty stomach, in underwear, after emptying the bladder and bowels, without shoes.

execution technique:

1. Prepare the patient:

· warn about manipulation,

· suggest emptying your bladder and bowels,

· Invite the patient to undress to his underwear and be sure to take off his shoes.

2. Check the serviceability and accuracy of the medical scales.

3. Place a disposable napkin or a regular sheet of paper on the scale platform.

4. Invite the patient to stand in the middle of the scale platform with the shutter lowered.

5. Raise the shutter of the scale, establish balance using weights located on the upper and lower bars of the scale - as a result, obtain the patient’s body weight.

6. Be sure to enter the obtained data in the appropriate column on the patient’s condition monitoring sheet.

7. Put on gloves and soak a used disposable napkin or a regular sheet of paper in a disinfectant solution (5% chloramine solution for 60 minutes).

8. Soak a clean rag in a container of disinfectant solution (1% chloramine solution for 60 minutes) and wipe the scale platform twice at 15-minute intervals. Place used rags in a container with a 1% waste rag solution for 60 minutes.

9. Remove gloves and soak used gloves in a container of 3% chloramine solution for 60 minutes.

10. Wash your hands with soap and dry individually.

Chest circumference measurement

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Kyakhtinsky branch

State autonomous educational institution

secondary vocational education

"Baikal Basic Medical College

Ministry of Health of the Republic of Buryatia"

T. D. Dansarunova

Self-study tutorial

for students

Professional module 04. PM.04. Performing work in the profession of a junior nurse caring for patients

MDK 04.01. Technology for the provision of medical services, organization of a safe environment for participants in the diagnostic and treatment process

340201 Nursing

Probe manipulations

Approved at a meeting of the Central Committee. Method approved. college council

E.L. Little Lys ____________ E.L. Little Lynx

Explanatory note

The manual is compiled in accordance with the requirements of the Federal educational standard for the minimum content and level of training of graduates in specialty 340201 “Nursing”.

Professional module 04. is the foundation necessary for the study of clinical disciplines, laying the foundation for all future practical work.

Study work a teacher of special disciplines should be professionally oriented in nature. In order to increase interest in deep study profile disciplines, creative personal development, instilling elements of a research culture, along with traditional forms, it is necessary to actively use additional, independent forms of training and education of students, since they have a role in improving the quality of teaching and the system of training highly qualified medical specialists great importance.

The teacher teaching the discipline, from the first days of study at the educational institution, must teach the student rational consistency in work and its planning.

This manual proposes a multi-level technique for monitoring mastery of the material. Toolkit includes various types of test tasks: situational problems, tables, crosswords and allows students to independently create a manipulation algorithm, solve and analyze a situational problem.

This manual aims to instill in students the skills of independent work with a book, the ability to find and use the necessary information to complete a specific task. Tasks contribute to the development of independent cognitive activity, self-control, and develop the ability to reason logically and think creatively.

Preparation and execution

gastric lavage

General competencies:

Purposes and indications for gastric lavage

Types of gastric tubes

Gastric lavage

Features of the manipulation for a patient in

unconscious

Taking wash water for research

Disinfection of used equipment

Care for vomiting;

Patient preparation;

Preparation of probes;

Methods of manipulation.

Professional competencies:

Prepare the patient;

Prepare the necessary equipment for gastric lavage;

Insert the probe, perform probing;

Collect wash water for laboratory research;

Write a referral to the laboratory;

Carry out pre-sterilization treatment of probes.

Questions for self-study

Study the anatomical structure of the stomach;

Goals, indications and contraindications for probe manipulations.

Deontological aspects for manipulation.

Necessary equipment for probe procedures.

5. Algorithms for gastric lavage.

6. The use of probeless methods, their positive and negative sides.

7. Carrying out gastric lavage in case of unconsciousness of the patient;

8.Vomiting and assistance with vomiting.

9.Types of probes.

10.Disinfection and pre-sterilization cleaning of probes

Ethical and deontological support

Probe manipulation is a rather difficult psychological procedure for patients. Many patients do not tolerate manipulations associated with the insertion of a probe. During the procedure, they experience coughing, vomiting, and salivation, which is explained by the increased sensitivity of the mucous membrane of the pharynx and esophagus. Therefore, the patient’s psychological attitude towards such a study is of no small importance. To eliminate the “fear of research,” the nurse should explain to the patient the purpose of the study, its benefits, and talk to him politely, calmly, and kindly from the beginning to the end of the procedure.

Good preparation patient, correct behavior during the procedure will reduce discomfort.

There are a few simple precautions to remember:

If blood appears in the material obtained as a result of probing or washing, it should be stopped immediately.

If the patient begins to choke, cough, or turn blue, the probe should be quickly removed as it has entered the respiratory tract.

The patient should be given the opportunity to rest and repeat the action after a few minutes.

Provide approximate instructions to the patient:

“Your well-being will largely depend on your behavior during probing. The most important thing is not to make sudden movements. Otherwise, nausea and cough may occur. You should relax, breathe slowly and not deeply. Hands should be kept on your knees. Breathe slowly and deeply. Having done deep breath, start making swallowing movements. If it’s difficult to breathe through your nose, you can breathe through your mouth.”

Safety regulations

Remember:

If during any probe manipulation there is blood in the resulting material, stop probing!

If, when the probe is inserted, the patient begins to cough, choke, or his face becomes cyanotic, the probe should be immediately removed, since it has entered the larynx or trachea, and not the esophagus.

If the patient has an increased gag reflex, treat the root of the tongue with an aerosol of 10% lidocaine solution.

Contraindications for all probe manipulations: gastric bleeding, tumors, bronchial asthma, severe cardiac pathology.

Theoretical part.

Name of manipulation

Gastric lavage

Indications:

Poisoning: food, drugs, alcohol, etc.

Contraindications:

Ulcers, tumors, bleeding of the gastrointestinal tract, bronchial asthma, severe cardiac pathology.

Equipment:

Sterile thick probe, 100-200 cm long, at the blind end there are 2 lateral oval holes at a distance of 45, 55, 65 cm from the blind end of the mark.

Sterile rubber tube, 70 cm long and sterile connecting glass tube, 8 mm in diameter.

Sterile funnel, 1 liter capacity.

Sterile Vaseline oil.

Basin for rinsing water.

Bucket clean water room temperature for 10-12 liters and a liter mug.

Rubber gloves, aprons.

Action algorithm:

Assemble the flushing system: probe, connecting tube, rubber tube, funnel.

Put on aprons for yourself and the patient, and seat him.

Wear gloves.

Moisten the probe with sterile petroleum jelly or warm boiled water.

Place the blind end of the probe on the root of the patient's tongue and suggest swallowing movements, breathing deeply through the nose.

As soon as the patient swallows, advance the probe into the esophagus.

Having brought the probe to the desired mark (length of the inserted probe: height – 100 cm), lower the funnel to the level of the patient’s knees.

Holding the funnel at an angle, pour 30 cm above the patient’s head.

Slowly raise the funnel 30 cm above the patient's head.

10. As soon as the water reaches the mouth of the funnel, lower it below the original position.

Pour the contents into the basin until the water passes through the connecting tube, but remains in the rubber and at the bottom of the funnel.

Start filling the funnel again, repeating all the steps.

Rinse until the waters are clear.

Measure the amount of fluid injected and excreted.

Send some of the wash water to the laboratory.

Remove the probe.

Perform pre-sterilization cleaning of the entire system.

Name of manipulation

Help with vomiting

Vomiting is a reflexive release of stomach contents out through the mouth.

Equipment:

Oilcloth, towel, basin, glass of water, electric suction or pear-shaped cylinder, oilcloth aprons, gauze napkins, rubber gloves

clean dry glass jar, containers with disinfectant solution

Algorithm of actions:

1. With the patient lying down, turn his head to the side. If possible, make him sit down.

2. When lying down, place an oilcloth and a kidney-shaped tray under the patient’s head; when sitting, place the oilcloth on the patient's chest and knees and place the pelvis next to him.

3. After vomiting, have the patient rinse the mouth or administer oral irrigation.

4. Remove the basin and oilcloth.

5. Inspect the vomit and disinfect it.

Note:

During vomiting (especially when the patient is lying down), aspiration may occur (vomit entering the respiratory tract). For this purpose, it is necessary to turn the patient's head to the side.

Vomit if there is blood in it will look like “ coffee grounds» - dark brown.

Disinfection of vomit: filled with disinfectant.

Pre-sterilization cleaning and sterilization of probes:

Place the probes in a disinfectant.

After exposure, rinse under running water.

Dry.

Hand over to CSO (laying - bixes)

Sterilization:

In a steam sterilizer:

pressure - 1.1 atm,

temperature – 120 0 C,

time - 45 min.

Glossary

Gastric tube– a rubber tube, 3-5 mm in diameter, with side oval holes at the blind end; there are marks on the probe every 10 cm.

Duodenal tube- a probe similar to a gastric one, but at the end with a metal olive, having several holes every 10 cm mark.

Duodenal sounding – probing during which bile from the duodenum is examined.

Fractional sensing- sounding, which examines the secretory function of the stomach.

Vomit - Involuntary ejection of stomach contents through the mouth, due to spasmodic contractions of the muscles of the stomach, diaphragm, and abdominal muscles.

Hiccups - reflex contractions of the diaphragm, causing sudden strong breaths with a characteristic sound.

Heartburn - oh burning sensation, mainly in the lower esophagus.

Nausea - painful sensation in the epigastric region and pharynx.

Flatulence - accumulation of gases in digestive tract, with bloating, belching, cramping pain.

Constipation - prolonged stool retention or difficulty defecating due to bowel function disorders

Diarrhea (diarrhea) - frequent and loose bowel movements due to bowel dysfunction.

Pain - an unpleasant (sometimes unbearable) sensation that occurs when the sensitive nerve endings located in organs and tissues are severely irritated.

Belching- involuntary expulsion of air from the stomach through the mouth.

Bleeding - leakage of blood from blood vessels due to a violation of their integrity.

Esophageal stenosis- narrowing of the lumen of the esophagus.

Gastric perforation- perforation of the stomach wall.

Asphyxia- obstruction of the airway.

Self-study assignment

	Question
	Types of gastric and duodenal tubes	T.P. Obukhovets “General nursing”;
	Assisting a conscious or unconscious patient with vomiting	A.G. Chizh "Manipulations in nursing»
	Gastric lavage with a thick gastric tube	T.P.Obukhovets “General nursing”; A.G. Chizh "Manipulations in Nursing"
	Help with stomach bleeding	S.A. Mukhina, I.I. Tarnovskaya “General nursing”
	Disinfection of probes	“Infection control. Prevention of nosocomial infections." Order No. 408, OST 42-21-2-85

Self-control tasks

Terminological dictation

Assignment: complete the sentences with terms.

Involuntary expulsion of stomach contents through the mouth due to spasmodic contractions of the stomach muscles is …

Reflex contractions of the diaphragm causing sudden strong inhalations with a characteristic sound are ...

A burning sensation, mainly in the lower esophagus, is ...

Unpleasant sensations in the epigastric region and pharynx - this is ...

Accumulation of gases with bloating and belching is ...

Prolonged stool retention due to bowel dysfunction is ...

Frequent and loose bowel movements caused by bowel dysfunction are ...

An unpleasant sensation that occurs due to severe irritation of sensitive nerve endings embedded in organs and tissues ...

Involuntary expulsion of air from the stomach through the mouth is .. .

Leakage of blood from blood vessels due to a violation of their integrity ...

Test control for choosing the correct answer

Task: choose one correct answer.

Pain in stomach diseases is localized:

a) lower abdomen

b) in the epigastric region

c) in the area of ​​the right hypochondrium

Probe manipulations are carried out:

a) after breakfast

b) on an empty stomach

c) at any time

a) thin rubber probe

b) probe with metal olive

c) thick gastric tube

When washing the stomach, the probe is inserted at a distance:

c) patient’s height minus 100 cm

To lavage the stomach you need to prepare:

a) 10 -12 liters of water

b) 1 – 1.5 liters of water

c) 5 liters of water

When vomiting, to prevent asphyxia, the head must be thrown back:

c) forward, supporting the forehead

If blood appears in the rinsing waters, you must:

a) continue washing

b) place an ice pack on the epigastric area

c) place a heating pad on the epigastric area

The resulting gastric juice is sent to:

a) to the biochemical laboratory

b) to a clinical laboratory

c) to the bacteriological laboratory

Rubber probes are sterilized in the following mode:

a) 180 for 60 minutes

b) at 2.2 atm., T 132 for 20 minutes

c) at 1.1 atm., T 120 for 45 minutes

Rubber probes are sterilized:

a) in dry-heat ovens

b) in autoclaves

c) in a 3% chloramine solution

Situational tasks

Instruction: in the proposed tasks it is necessary to assess the situation and determine the tactics of the nurse.

1. When a thick gastric tube is inserted, the patient begins to cough and choke. What's happened? What is the nurse's strategy?

The patient is being treated in therapeutic department. For the purpose of suicide, he took a large dose of sleeping pills and is unconscious. Your actions in this situation.

The patient was admitted to the emergency department with poisoning acetic acid. What method should be used to rinse the stomach?

When washing the stomach after 10 minutes, blood appeared in the washing water. What is the nurse's strategy?

In the evening, after 6 pm, on the eve of duodenal intubation, the patient ate black bread, mashed potatoes, fresh cucumbers. Is it possible to conduct research?

A patient approached the nurse on duty with complaints of pain in the epigastric region, vomiting black mass. What's wrong with the patient? Nurse tactics?

When performing duodenal intubation, portion “B”, the contents of the gallbladder, is not supplied. What's happened? Nurse tactics?

The patient is in surgical department to decide on surgery for a stomach tumor. The patient has food poisoning. Is it possible to do gastric lavage using the tube method?

Tests

Task: complete the sentence.

1. Sterilization of rubber probes is carried out in ……at the ………… mode

To lavage the stomach, you need to prepare ………………… water.

When…… appears during the probe procedure, manipulation is necessary……

Rubber probes are disinfected in ………….% solution ……………

For stimulation during duodenal intubation, a warm 33% solution is used………………………………

During ……………….probing, gastric juice is extracted every ………….minutes.

Portion “C” is the contents……………………

Basal secretion is portions from …………….. to ………………..

For gastric lavage use………………. gastric tube.

Warn the patient that after administration of histamine he may experience ………………. skin, dizziness, nausea.

5.Task

Assignment: indicate the number of the option with the correct answer

PRE-STERILIZATION CLEANING

1 Option

Option 2

Sterilization of probes:

(continue the sentence)

Pressure……………………

Temperature……………….

Time………………………

6.Situational tasks

Exercise: in the proposed tasks it is necessary to assess the situation and complete the tasks.

Task No. 1.

During fractional sounding, during the insertion of the probe, the patient began to cough, choke, and his face became cyanotic.

Task No. 2.

During fractional probing, the patient was administered a parenteral irritant of 0.1 histamine. Soon the patient felt dizzy, feeling hot, nauseated, shortness of breath, and blood pressure was 90/50.

What state can you think about?

2. Identify violated needs.

3. Identify real, priority, potential problems.

4. Tactics of the nurse.

Task No. 3.

The patient is prescribed duodenal intubation. In a conversation with a nurse, it became clear that the patient was afraid of the upcoming test.

Nurse tactics.

Task No. 4.

When performing duodenal intubation, portion “A” does not enter the test tube.

Nurse tactics.

Task No. 5.

When performing duodenal intubation, after introducing the stimulus, portion “B” does not enter the test tube.

1. What state can you think about?

Nurse tactics.

Standard answers

Terminological dictation

1. Involuntary ejection of stomach contents through the mouth, due to spasmodic contractions of the muscles of the stomach, diaphragm, and abdominal muscles - vomit.

Reflex contractions of the diaphragm, causing sudden strong breaths with a characteristic sound - hiccups

3. Burning sensation, mainly in the lower esophagus - heartburn.

Painful sensation in the epigastric region and pharynx - nausea.

Accumulation of gases in the digestive tract, with bloating, belching, cramping pain - flatulence.

Prolonged stool retention or difficulty in bowel movements caused by bowel function disorders - constipation.

Frequent and loose bowel movements due to bowel dysfunction - diarrhea (diarrhea).

An unpleasant (sometimes unbearable) sensation that occurs with severe irritation of sensitive nerve endings embedded in organs and tissues - pain.

Involuntary expulsion of air from the stomach through the mouth - belching.

Leakage of blood from blood vessels due to a violation of their integrity - bleeding.

Standard answers

Test control for choosing the correct answer

Helping a patient vomit
Have the patient sit down and put an oilcloth apron on him; wear an apron and gloves Reassure the patient Reassure the patient Wear an apron and gloves Hold the patient's forehead while vomiting Collect vomit for examination. Help the patient lie down Place the pelvis at the patient's feet After vomiting, have the patient rinse their mouth Use a screen to screen the patient if the procedure is being performed in the room.

Task: place the numbers in the correct sequence opposite the algorithm for actions when vomiting

Gastric lavage

	Make the patient sit down
	Explain to the patient the purpose of the upcoming procedure
	Wear sterile gloves
	Place your pelvis between the patient's legs
	Stand to the side of the patient
	Introduce yourself to the patient
	Slowly lift the funnel up
	Attach a funnel to the probe and lower it to the level of the patient’s knees
	Lubricate the blind end of the probe with Vaseline.
	Place the blind end of the probe on the root of the patient's tongue and slowly advance the probe to the desired mark
	Determine the distance to which the probe should be inserted
	As soon as the water reaches the mouth of the funnel, lower it to its original position and pour the contents into the basin
	Holding the funnel at the level of the patient's knees, slightly inclined, pour water
	Repeat the procedure until the rinsing water is clear
	Upon completion of lavage, disconnect the funnel, remove the tube from the stomach, and put the patient to bed
	Put on yourself and the patient an oilcloth apron

Standard response to situational tasks

This means that the probe did not enter the esophagus, but the larynx or trachea. The probe should be immediately removed, the patient reassured, and reinserted.

Gastric lavage, if the patient is unconscious, is carried out with the head on the side, the mouth is opened with a mouth dilator, and the tongue is fixed with a tongue holder. The probe is inserted under control to the desired mark, after which rinsing begins.

Washing in in this case carried out only by the probe method.

Stop rinsing. Call a doctor.

In this case, duodenal intubation cannot be performed, since these products cause bloating. The research result may be unreliable. Tell your doctor and postpone probing for 1–2 days.

The probe may become wrapped. Pull the probe slowly, but it is better to do this in the X-ray room.

Place the patient in the Fowler's position, immediately call a doctor, prepare medications (diphenhydramine, pipolfen, cordiamine, etc.)

Calm the patient, put him to bed, invite a doctor.

The sphincter of Oddi did not open. Prepare a 0.1% atropine solution, invite a doctor, and administer 1 ml of atropine subcutaneously as prescribed by the doctor. If after 15–20 minutes portion “B” does not arrive, stop probing.

Gastric lavage is contraindicated for stomach tumors. Call a doctor, follow the doctor's instructions.

Tests

1. The purpose of duodenal intubation is to obtain bile for research.

To carry out duodenal intubation, it is necessary to prepare thin gastric probe with metal olive at the end.

Sterilization of rubber probes is carried out in autoclave under regime 1.1 atm, 120 0 C, 45 min.

Gastric juice for research is obtained using factional probing.

5. Portion “A” during duodenal intubation is the contents 12 duodenum

The purpose of fractional gastric intubation is to obtain gastric juice

Bile is obtained using duodenal probing.

To perform duodenal intubation, the patient is placed on right side, placing under right hypochondrium heating pad

9. When studying gastric juice using the probeless method, use a sample with acidotest.

10. During duodenal intubation, portion “B” is the content gallbladder.

To stimulate the stomach during fractional intubation, a 0.1% solution is used histamine.

For gastric lavage it is necessary to prepare 10 – 12 liters water.

When blood During any probe procedure, manipulation must be stopped.

Rubber probes are disinfected in 3 % solution chloramine.

For stimulation during duodenal intubation, a warm 33% solution is used magnesium sulfate.

Gastric juice at factional probing is removed every 15 minutes.

Portion "C" is the contents hepatic ducts.

Basal secretion is portions with 2 By 5

Used for gastric lavage thick gastric tube.

Warn the patient that after administration of histamine he may experience hyperemia skin, dizziness, nausea.

Exercise

Right: Option 2

10. Situational tasks

Task No. 1.

The probe has entered the larynx or trachea.

Be healthy, breathe normally, sleep normally, do what you love

Real problems: cough, lack of air, bluish face; Priority issues: cough, lack of air;

The probe should be removed immediately.

Task No. 2.

Allergic reaction to the administered parenteral irritant.

Be healthy, breathe normally, maintain personal safety, do what you love.

Real problems: felt dizzy, feeling hot, nauseated, shortness of breath, blood pressure 90/50.

Priority problems: difficulty breathing.

Potential problems: asphyxia.

You should immediately stop administering the drug and call a doctor.

Task No. 3.

To eliminate the “fear of research,” the nurse should explain to the patient the purpose of the study, its benefits, and speak politely, calmly, and kindly from the beginning to the end of the procedure.

Task No. 4.

Most likely the probe is wrapped up or not inserted to the required level.

Pull the probe back a little, or to make sure of this you need to take a picture in the X-ray room.

Task No. 5.

The sphincter of Oddi did not open.

It is necessary to inject the patient with 1.0 subcutaneous 0.1% atropine solution to relieve sphincter spasm. If this does not help, stop probing.

Evaluation criteria for various types works

Frontal survey:

competent complete answer to the question - 5 points

attempted answer with obvious errors - 2 points

no answer - 0 points

Terminological dictation (10 questions)

At least 14 terms and concepts are defined - 5 points

At least 12 terms and concepts are defined - 4 points

At least 9 terms and concepts are defined - 3 points

8 or less concepts defined - 2 points

Test control for choosing the correct answer (10 questions):

Up to 10% - 2 errors – score “5”

Up to 20% - 4 errors – score “4”

Up to 30% - 6 errors – score “3”

More than 30% - more than 6 errors – score “2”

Crossword solution:

At least 9 concepts defined - 5 points

At least 8 concepts defined - 4 points

At least 7 concepts defined - 3 points

6 or less concepts defined - 2 points

Algorithm for performing manipulations:

The algorithm of actions is defined with inaccuracies - 4 points

The algorithm of actions is defined with obvious errors - 3 points

The algorithm of actions was drawn up incorrectly - 2 points

Solving situational tasks:

Correct solution in accordance with the standard - 5 points

The situational task was solved with inaccuracies - 4 points

The situational task was solved with obvious errors - 3 points

The task was not solved correctly - 2 points

No attempts to solve the task - 0 points

Tests (10 questions):

At least 18 terms and concepts are defined - 5 points

At least 16 terms and concepts are defined - 4 points

At least 14 terms and concepts are defined - 3 points

12 or less concepts defined - 2 points

Comparative characteristics of duodenal and fractional sounding:

2 mistakes – score “5”

4 mistakes – score “4”

6 mistakes – score “3”

more than 6 errors – score “2”

Exercise:

Correct answer - 5 points

incomplete answer with minor corrections - 4 points

no answer - 2 points

Exercise:

complete answer to the question - 5 points

incomplete answer to a question with minor corrections - 4 points

incomplete answer to the question with minor corrections

teacher or students - 3 points

no answer - 2 points

Solving situational problems:

Correct solution in accordance with the standard - 5 points

The situational problem was solved with inaccuracies - 4 points

The situational problem was solved with obvious errors - 3 points

Problem solved incorrectly - 2 points

No attempts to solve the problem - 0 points

Practicing practical skills:

Correct execution of the manipulation in accordance

with standards - 5 points

The manipulation was performed with minor errors - 4 points

The manipulation was carried out with obvious errors - 3 points

The manipulation was not completed, but there were attempts to do it - 2 points

No attempts to perform manipulation - 0 points

T. P. Obukhovets “Fundamentals of Nursing” 2009

2. V.R. Weber, G.I. Chuvakov, V.A. Lapotnikov “Fundamentals of Nursing” Moscow “Medicine” 2010.

3. Yu.D. Eliseev. Nurse's Handbook. Moscow. 2008

4. S.A. Mukhina, I.I. Tarnovskaya “General nursing” M, Medicine, 1989.

5. S.A. Mukhina, N.I. Tarnovskaya Practical guide to the subject “Fundamentals of Nursing”. Textbook 1998

6. S.A. Mukhina, N.I. Tarnovskaya “Atlas of manipulation techniques”

7. S.A. Mukhina, I.I. Tarnovskaya “ Theoretical basis nursing" Moscow 2001

8. T.P. Obukhovets “Fundamentals of nursing. Workshop" Rostov-on-Don Phoenix 2008

9. N.V. Shirokova “Collection of test tasks on the basics of nursing” Moscow Federal State Educational Institution “VUNMC Roszdrav” 2006

10. Internet resources.

Duodenal sounding, purpose: obtaining duodenal contents for laboratory testing.
Indications for duodenal intubation: diseases of the liver, gall bladder, biliary tract.
Contraindications
Equipment. Sterile duodenal tube with an olive at the end; sterile syringe with a capacity of 20 ml; soft roller; warm heating pad; towel; tray; 50 ml of 25% magnesium sulfate solution heated to +40...+42 °C; a stand with laboratory test tubes (at least three test tubes, on each test tube a portion of bile A, B, C is indicated); referral to the laboratory; clean dry jar; a hard trestle bed without a pillow; bench; set of linen; a glass of boiled water (pink potassium permanganate solution, 2% sodium bicarbonate solution or low-salt solution).

1. Explain to the patient the need for the procedure and its sequence.
2. The night before, they warn that the upcoming study is carried out on an empty stomach, and dinner before the study should be no later than 18.00.
3. The patient is invited to the sounding room, seated comfortably on a chair with a back, and his head is slightly tilted forward.
4. Place a towel on the patient’s neck and chest and ask him to remove dentures, if any. They give you a saliva tray.
5. Take out a sterile probe from the bix, moisten the end of the probe with olive oil with boiled water. Take it with your right hand at a distance of 10 - 15 cm from the olive, and support the free end with your left hand.
6. Standing to the patient’s right, they invite him to open his mouth. Place the olive on the root of the tongue and ask to make a swallowing movement. During swallowing, the probe is advanced into the esophagus.
7. Ask the patient to breathe deeply through his nose. Free deep breathing confirms the location of the probe in the esophagus and relieves the gag reflex from irritation back wall pharynx with a probe.
8. Each time the patient swallows, the probe is inserted deeper to the fourth mark, and then another 10 - 15 cm to advance the probe inside the stomach.
9. Attach a syringe to the probe and pull the plunger towards you. If a cloudy liquid enters the syringe, then the probe is in the stomach.
10. The patient is asked to swallow the probe up to the seventh mark. If his condition allows, it is better to do this while walking slowly.
11. The patient is placed on a trestle bed on his right side. A soft cushion is placed under the pelvis, and a warm heating pad is placed under the right hypochondrium. In this position, the advancement of the olive to the pylorus is facilitated.
12. While lying on the right side, the patient is asked to swallow the probe to the ninth mark. The probe advances at twelve duodenum.
13. The free end of the probe is lowered into the jar. The jar and stand with test tubes are placed on a low bench at the patient’s head.
14. As soon as yellow transparent liquid begins to flow from the probe into the jar, the free end of the probe is lowered into test tube A (duodenal bile of portion A is light yellow in color). In 20 - 30 minutes, 15 - 40 ml of bile arrives - an amount sufficient for research.
15. Using a syringe as a funnel, 30 - 50 ml of a 25% solution of magnesium sulfate, heated to +40...+42°C, is injected into the duodenum. A clamp is applied to the probe for 5-10 minutes or the free end is tied with a light knot.
16. After 5-10 minutes, remove the clamp. Lower the free end of the probe into the jar. When thick, dark olive-colored bile begins to flow, lower the end of the probe into tube B (portion B from the gallbladder). In 20 - 30 minutes, 50 - 60 ml of bile is released.
17. As soon as bright bile flows from the tube along with gallbladder bile, yellow color, lower its free end into the jar until clean, bright yellow liver bile is released.
18. Lower the probe into test tube C and collect 10 - 20 ml of liver bile (portion C).
19. Carefully and slowly sit the patient down. Remove the probe. The patient is given the opportunity to rinse his mouth with a prepared liquid (water or antiseptic).
20. Having inquired about the patient’s well-being, they take him to the ward, put him to bed, and ensure rest. He is advised to lie down, as magnesium sulfate can lower blood pressure.
21. Test tubes with directions are delivered to the laboratory.
22. After the study, the probe is soaked in a 3% chloramine solution for 1 hour, then treated according to OST 42-21-2-85.
23. The result of the study is pasted into the medical history.

Notes. Breakfast should be left for the patient in the department (the guard nurse should inform the handout in advance of the diet number and the number of servings). Monitor the patient’s well-being and blood pressure readings. They warn him that magnesium sulfate has a laxative effect and he may have loose stools. To test for Giardia, bile from portion B should be delivered to the laboratory warm.

Fractional duodenal intubation.

Target. Obtaining duodenal contents for laboratory research; study of the dynamics of bile secretion.
Indications. Diseases of the liver, gall bladder, biliary tract.
Contraindications. Acute cholecystitis; exacerbation of chronic cholecystitis; varicose veins of the esophagus; coronary insufficiency.
Equipment. Sterile duodenal tube with an olive at the end; sterile syringe with a capacity of 20 ml; soft roller; warm heating pad; towel; tray; 50 ml of 25% magnesium sulfate solution, heated to +40...+42 °C; a stand with laboratory test tubes (at least three test tubes, each test tube shows a portion of bile: A, B, C); referral to the laboratory; clean dry jar; a hard trestle bed without a pillow; bench; set of linen; a glass of boiled water (pink potassium permanganate solution, 2% sodium bicarbonate solution or low-salt solution).

Technique for performing fractional duodenal intubation.

The technique of conducting the study is similar to the technique of performing duodenal intubation.
Fractional duodenal intubation consists of five phases or stages.
In the first phase receive the first portion of bile from the common bile duct - transparent light yellow bile. The phase lasts 20 minutes. Usually during this time 15 - 40 ml of bile is secreted. Receiving more than 45 ml indicates hypersecretion or dilatation of the common bile duct. Less bile means bile hyposecretion or decreased capacity of the common bile duct. 20 minutes after the start of bile production, an irritant is introduced - a 25% solution of magnesium sulfate, heated to +40...+42 °C. At the end of the first phase, a clamp is applied to the probe.
At the beginning of the second phase fractional duodenal intubation, remove the clamp, lower the free end of the probe into the jar and wait for the bile to begin flowing. Normally, the phase lasts 2 - 6 minutes. A lengthening of the phase indicates hypertonicity of the common bile duct or the presence of an obstruction in it.
Third phase- this is the time before the appearance of cystic bile. Normally it lasts 2 - 4 minutes. During this time, 3 - 5 ml of light yellow bile is released - the remainder of the bile from the common bile duct. Lengthening the phase indicates an increase in sphincter tone. The bile obtained during the first and third phases constitutes portion A of classical duodenal intubation.
Fourth phase- This is a registration of the duration of emptying of the gallbladder and the volume of gallbladder bile. Normally, 30 - 70 ml of dark olive-colored bile is released in 30 minutes - this is the classic portion B. The rate of bladder bile release is 2 - 4 ml/min. The rate of gallbladder bile secretion within 10 minutes less than this indicator is characteristic of the hypomotor function of the gallbladder, and more - for the hypermotor function.
Fifth phase of duodenal intubation- obtaining liver bile (portions C). Normally, 15-30 ml of golden-colored bile (liver bile) is released in 20 minutes.
Notes. Breakfast should be left for the patient in the department (the guard nurse should inform the handout in advance of the diet number and the number of servings).
Gastric and duodenal intubation is performed by personnel trained to work in the sounding room.

Lecture TOPIC No. 16: Probe procedures

Purpose of the lecture: formation professional knowledge according to the methodology for performing probe procedures.

Lecture outline

1. Probe procedures – the concept of the term, the purpose of the procedures, types of probes.

2. Ethical and deontological nursing interventions during probing

3. Safety rules for probe procedures

4. Algorithm for fractional gastric intubation.

5. Algorithm for fractional gastric intubation with a parenteral stimulus.

6. Algorithm for duodenal intubation

7. Algorithm for gastric lavage

8. Nursing assistance when vomiting

9. Glossary.
Therapeutic probe procedures

Dependent nursing intervention when administering poor quality food, medications, chemicals- This is gastric lavage. Procedure in medical institution carried out using a probe.

To probe means to find out, to obtain information about the presence or absence of something using a care item - a probe.

Goals of probe procedures:

• 
  Therapeutic – detoxification – stopping the absorption of toxic substances and removing them from the stomach;
• 
  Diagnostic – laboratory – sampling of stomach/intestinal contents for research.

Probes are distinguished by

Duodenal tube at the working end has olive to overcome the pylorus of the stomach when passing from the stomach into the duodenum during the probing procedure.
Sensing ( French research) - instrumental study hollow and tubular organs, canals, wounds using probes.

Contraindications:

1) esophageal and gastric bleeding

2) inflammatory diseases with manifestations of the mucous membrane of the digestive tract

3) pronounced cardiovascular pathology

Ethical and deontological support for sounding

Many patients do not tolerate the insertion of the probe. The reason for this is an increased cough or gag reflex, high sensitivity of the mucous membrane of the pharynx and esophagus. In most cases, poor tolerability of probe procedures is caused by the patient’s negative psychological attitude towards the probing process; a “fear of examination” arises. To eliminate the “fear of research,” the patient should be explained the purpose of the study, its benefits, and talk to him politely, calmly, and kindly from the beginning to the end of the procedure.

“We will now begin the procedure. Your well-being will largely depend on your behavior during probing. The first and basic rule is not to make sudden movements. Otherwise, nausea and cough may occur. You should relax, breathe slowly and not deeply. Please open your mouth and keep your hands on your knees. Breathe slowly and deeply. Take a deep breath and swallow the tip of the probe. If you have difficulty breathing through your nose, breathe through your mouth and, while inhaling, carefully advance the probe.”

If you feel dizzy, breathe normally, not deeply, for a few minutes, then resume deep breathing. You swallow very well. It would be good if other patients swallowed the tube just as easily.

Safety regulations

If during any probe manipulation there is blood in the resulting material, stop probing!

Attention!

If, upon insertion of the probe, the patient begins to cough, choke, or his face becomes bluish, the probe should be immediately removed, since it has entered the larynx or trachea, and not the esophagus.

Attention!

Attention!

If the patient has an increased gag reflex, treat the root of the tongue with an aerosol of 10% lidocaine solution.

Attention!

Contraindications for all probe manipulations:

Manipulation algorithms

Fractional gastric intubation using the Leporsky method

Purpose of manipulation:

Obtaining gastric juice for research.

Contraindications:

Patient preparation:

In the morning, on an empty stomach.

Equipment:

A sterile, warm and moist gastric tube is a rubber tube with a diameter of 3-5 mm with a side oval hole at the blind end. There are marks on the probe every 10 cm. Sterile syringe with a capacity of 20.0 ml for extraction, Janet syringe for introducing cabbage solution.

Dishes: 7 clean bottles with labels.

Irritant: cabbage broth, heated to a temperature of 38 0 C, gloves, towel, tray, direction:

Direction

to a clinical laboratory

analysis of gastric juice obtained using an enteral stimulus

Patient: Full name, age

D.S: examination

Signature (doctor):

1. 
   Explain to the patient the procedure.
2. 
   Take written consent.
3. 
   Correctly seat the patient: leaning on the back of the chair, tilting the head forward.
4. 
   Wash your hands, put on gloves.

1. 
   
2. 
   Calculate the length of the probe: height – 100cm.
3. 
   Remove with sterile tweezers. Take it in your right hand and support the free end with your left hand.
4. 
   Moisten with warm water (boiled) or lubricate with sterile Vaseline oil.
5. 
   
6. 
   Place the end of the probe on the root of the tongue, ask the patient to swallow, breathing deeply through the nose.
7. 
   Enter to the desired mark.

Remember!

There are marks on the probe every 10 cm.

1. 
   Use a 20.0 syringe to extract one serving on an empty stomach.
2. 
   Using a Janet syringe, inject 200.0 cabbage broth, heated to 38 0 C.
3. 
   After 10 minutes, remove 10 ml of gastric contents (Zhanet syringe).
4. 
   After 15 minutes, remove all gastric contents (Zhanet syringe)
5. 
   Within an hour, after 15 minutes, 4 portions of gastric juice (stimulated secretion) (20.0 ml syringe)
6. 
   Send I, IV, V, VI, VII vials with a referral to the clinical laboratory.

Fractional gastric intubation with parenteral stimulus
Purpose of manipulation:

Obtaining gastric juice for examination.

Contraindications:

Stomach bleeding, tumors, bronchial asthma, severe cardiac pathology.

Patient preparation:

In the morning, on an empty stomach.

Equipment:

Sterile, warm and moist gastric tube - a rubber tube, 3-5 mm in diameter with side oval holes at the blind end, there are marks on the probe every 10 cm. Sterile syringe, 20.0 ml capacity for extraction.

Dishes: 9 clean jars with labels.

Irritant: histamine solution 0.1%, pentagastrin solution 0.025%.

gloves, towel, tray, direction:

Direction

to a clinical laboratory

analysis of gastric juice obtained using a parenteral stimulus

Patient: Full name age

Voronezh Central District Hospital, ter. department, ward no.

D.S: examination

Signature (doctor):

Algorithm of action when introducing a probe:

1. Explain to the patient the procedure for the procedure.

2. Take written consent.

3. Sit the patient correctly: leaning on the back of the chair, tilting the head forward.

4. Wash your hands and put on gloves.

5. Place a towel on the patient’s neck and chest; if there are removable dentures, remove them.

7. Remove with sterile tweezers. Take it in your right hand and support the free end with your left hand.

8. Moisten with warm water (boiled) or lubricate with sterile Vaseline oil.

9. Invite the patient to open his mouth.

10. Place the end of the probe on the root of the tongue, ask the patient to swallow, breathing deeply through the nose.

11. Enter to the desired mark.
Algorithm for obtaining material for research:

1. 
   Use a 20.0 ml syringe to extract one serving on an empty stomach.
2. 
   Within an hour (every 15 minutes), extract 4 portions of gastric juice (unstimulated or basal secretion).
3. 
   Inject subcutaneously a solution of histamine 0.1% at the rate of: 0.1 ml per 10 kg of body weight (warning the patient that he may experience redness of the skin, dizziness, nausea, pentagastrin is administered according to a special scheme, see instructions).
4. 
   Within an hour (after 15 minutes) 4 servings of gastric juice (stimulated secretion).
5. 
   Send with a referral to a clinical laboratory.

Duodenal sounding

Purpose of manipulation:

Obtaining bile for examination.

Contraindications:

Gastric bleeding, tumors, bronchial asthma, severe cardiac pathology.

Patient preparation:

In the morning, on an empty stomach.

Equipment:

The probe is similar to a gastric one, but at the end with a metal olive and has several holes. Olive is needed for better passage through the gatekeeper. Sterile syringe, capacity 20.0 ml.

Dishes: bottles for gastric juice, a stand with test tubes marked “A”, “B”, “C”.

Irritant: 40 ml of warm 33% magnesium sulfate solution or 40 ml of 40% glucose solution.

Gloves, towel, tray, heating pad, cushion, direction:

Direction

to a clinical laboratory

Bile

Patient: Full name, age

Voronezh Central District Hospital, ter. department, ward no.

D.S: examination

Signature (doctor):

Algorithm of action when introducing a probe:

1. 
   Explain to the patient the procedure.
2. 
   Take written consent.
3. 
   Sit the patient correctly: leaning on the back of the chair, tilting the head forward.
4. 
   Wash your hands, put on gloves.
5. 
   Place a towel on the patient’s neck and chest; if there are removable dentures, remove them.
6. 
   Calculate the length of the probe: height – 100 cm.
7. 
   Use sterile tweezers to remove the probe. Take it in your right hand and support the free end with your left hand.
8. 
   Moisten with warm boiled water or lubricate with sterile Vaseline.
9. 
   Invite the patient to open his mouth.
10. 
    Place the end of the probe on the root of the tongue and encourage patients to swallow while breathing through their nose.
11. 
    Enter to the desired mark.

Remember!

There are marks on the probe every 10 cm.

1. 
   Using a 20 ml syringe, obtain a cloudy liquid - gastric juice. This means the probe is in the stomach.
2. 
   Invite the patient to walk slowly, swallowing the probe to the 7th mark.
3. 
   Place the patient on the couch on the right side, placing a heating pad under the right hypochondrium and a cushion under the pelvis (facilitates the passage of the olive into the duodenum and the opening of the sphincters).
4. 
   Within 10-60 minutes, the patient swallows the probe to the 9th mark. The outer end of the probe is lowered into a container for gastric juice.

Algorithm for obtaining material for research:

1. 
   20-60 minutes after placing the patient on the couch, a yellow liquid will begin to flow - this is portion “A” - duodenal bile, that is, obtained from the duodenum and pancreas (its secretion also enters the duodenum ). Test tube "A".
2. 
   Inject 40 ml of warm stimulus (40% glucose or 33% magnesium sulfate, or vegetable oil) through the probe using a 20.0 ml syringe to open the ODDI sphincter.
3. 
   Tie the probe.
4. 
   After 5-7 minutes, untie: receive portion “B” - dark olive concentrated bile, which comes from the gallbladder. Test tube "B".
5. 
   Following this, a transparent golden-yellow portion “C” - liver bile - begins to flow. Test tube "C". Each portion arrives within 20-30 minutes.
6. 
   Send the bile to the clinical laboratory with a referral.

Gastric lavage

Indications:

Poisoning: food, drugs, alcohol, etc.

Contraindications:

Ulcers, tumors, bleeding of the gastrointestinal tract, bronchial asthma, severe cardiac pathology.

Equipment:

Sterile thick probe, 100-200 cm long, at the blind end there are 2 lateral oval holes at a distance of 45, 55, 65 cm from the blind end of the mark.

Sterile rubber tube, 70 cm long and sterile connecting glass tube, 8 mm in diameter.

Sterile funnel, 1 liter capacity.

Sterile petroleum jelly.

Basin for rinsing water.

A 10-12 liter bucket of clean water at room temperature and a liter mug.

Rubber gloves, aprons.
Action algorithm:

1. 
   Assemble the flushing system: probe, connecting tube, rubber tube, funnel.
2. 
   Put on aprons for yourself and the patient, and seat him.
3. 
   Wear gloves.
4. 
   Moisten the probe with sterile petroleum jelly or warm boiled water.
5. 
   Place the blind end of the probe on the root of the patient's tongue and suggest swallowing movements, breathing deeply through the nose.
6. 
   As soon as the patient swallows, advance the probe into the esophagus.
7. 
   Having brought the probe to the desired mark (length of the inserted probe: height – 100 cm), lower the funnel to the level of the patient’s knees.
8. 
   Holding the funnel at an angle, pour 30 cm above the patient’s head.
9. 
   Slowly raise the funnel 30 cm above the patient's head.

10. As soon as the water reaches the mouth of the funnel, lower it below the original position.

1. 
   Pour the contents into the basin until the water passes through the connecting tube, but remains in the rubber and at the bottom of the funnel.
2. 
   Start filling the funnel again, repeating all the steps.
3. 
   Rinse until the waters are clear.
4. 
   Measure the amount of fluid injected and excreted.
5. 
   Send some of the wash water to the laboratory.
6. 
   Remove the probe. Perform pre-sterilization cleaning of the entire system.

Note:

If, when inserting the probe, the patient begins to cough or begins to choke, remove the probe immediately, because it went into the trachea, not the esophagus.

Help with vomiting

The reflex return of stomach contents is called vomiting.

Equipment:

Oilcloth, towel, basin, glass of water.

Algorithm of actions:

1. With the patient lying down, turn his head to the side. If possible, make him sit down.

2. When lying down, place an oilcloth and a kidney-shaped tray under the patient’s head; when sitting, place the oilcloth on the patient's chest and knees and place the pelvis next to him.

3. After vomiting, have the patient rinse the mouth or administer oral irrigation.

4. Remove the basin and oilcloth.

5. Inspect the vomit and disinfect it.

Note:

During vomiting (especially when the patient is lying down), aspiration may occur (vomit entering the respiratory tract). For this purpose, it is necessary to turn the patient's head to the side.

Vomit if there is blood in it will have the appearance of “coffee grounds” - dark brown in color.

Disinfection of vomit is carried out by adding a stock solution of bleach to it at a rate of 1:1 for one hour or filling it with dry bleach (200 g per 1 liter of vomit).
We remind you!

Pre-sterilization cleaning and sterilization of probes:

1. 
   Rinse with water in a closed container, fill the water with a 10% bleach solution for 1 hour, then pour into the sewer.
2. 
   Place the probes in a 3% chloramine solution for 1 hour.
3. 
   Rinse under running water.
4. 
   Dry
5. 
   Hand over to CSO (laying - bixes)

Sterilization:

In a steam sterilizer:

• 
  pressure - 1.1 atm,
• 
  temperature – 120 0 C,
• 
  time - 45 min.

Probeless methods

Studies of gastric juice. They are used when there are contraindications for research using the probe method, or when the patient refuses it. One of these methods, “Acidotest,” is based on the detection in urine of a dye formed in the stomach during the interaction of an ingested ion exchange resin (yellow dragee) with free hydrochloric acid. Urine coloring different intensity depending on the amount of free hydrochloric acid. The result is conditionally reliable.

Workplace equipment:

1. 
   Gastric tube.
2. 
   Duodenal probe.
3. 
   Gloves.
4. 
   The tweezers are sterile.
5. 
   Bix.
6. 
   Hot water bottle, roller.
7. 
   Glassware for collecting samples:

• 
  clean dry jars
• 
  stand with test tubes and container (jar for gastric contents)
• 
  Direction forms.
• 
  Irritants:
• 
  200.0 cabbage broth
• 
  0.1% histamine
• 
  40 ml 40% glucose.
• 
  Syringes:
• 
  20.0 ml
• 
  1.0 – 2.0 ml

• 
  2 needles for ampoule and injection set

1. 
   Thick probe, glass connecting tube, thick rubber tube.
2. 
   Funnel.
3. 
   Aprons 2 pcs.
4. 
   Bucket with water.
5. 
   Mug, capacity 0.5 - 1.0 l.

Comparative characteristics of duodenal and fractional sounding

	Duodenal probing	Factional probing
Target	Obtaining bile for examination	Obtaining gastric juice for examination
Indications	Diagnosis of liver diseases	Diagnostics peptic ulcer, chronic gastritis
Contraindications	Gastric bleeding, tumors, bronchial asthma, severe cardiac pathology	Gastric bleeding, tumors, bronchial asthma, severe cardiac pathology
Probe type	A probe similar to a gastric one, but at the end with a metal olive, having several holes	Thin gastric tube with a diameter of 3-5 mm with lateral oval holes at the blind end
Patient preparation	In the morning, on an empty stomach	In the morning, on an empty stomach
Patient position during probing		Sitting leaning on the back of a chair with your head tilted forward
Irritants	40 ml of warm 33% magnesium sulfate solution or 40 ml of 40% glucose solution	Histamine solution 0.1%, pentagastrin solution 0.025%
The resulting secret	duodenal bile, concentrated bile, hepatic bile	Gastric juice
Number of servings	3	9
Name of portions	portion “A”, portion “B”, portion "C"	1-9 servings
Probing time	1,5 hour	2 hours

Glossary

1. 
   DUODENIM – 12 duodenum.
2. 
   Gastric tube – a rubber tube, 3-5 mm in diameter, with side oval holes at the blind end; there are marks on the probe every 10 cm.
3. 
   Duodenal tube - a probe similar to a gastric one, but at the end with a metal olive, having several holes every 10 cm mark.
4. 
   Duodenal sounding – probing during which bile from the duodenum is examined.
5. 
   Fractional sensing - sounding, which examines the secretory function of the stomach.
6. 
   Vomit - Involuntary ejection of stomach contents through the mouth, due to spasmodic contractions of the muscles of the stomach, diaphragm, and abdominal muscles.
7. 
   Hiccups - reflex contractions of the diaphragm, causing sudden strong breaths with a characteristic sound.
8. 
   Heartburn - O burning sensation, mainly in the lower esophagus.
9. 
   Nausea - painful sensation in the epigastric region and pharynx.
10. 
    Flatulence - accumulation of gases in the digestive tract, with bloating, belching, cramping pain.
11. 
    Constipation - prolonged stool retention or difficulty defecating due to bowel function disorders
12. 
    Diarrhea (diarrhea) - frequent and loose bowel movements due to bowel dysfunction.
13. 
    Pain - an unpleasant (sometimes unbearable) sensation that occurs when the sensitive nerve endings located in organs and tissues are severely irritated.
14. 
    Belching - involuntary expulsion of air from the stomach through the mouth.
15. 
    Bleeding - leakage of blood from blood vessels due to a violation of their integrity.
16. 
    Esophageal stenosis - narrowing of the lumen of the esophagus.
17. 
    Gastric perforation - perforation of the stomach wall.
18. 
    Asphyxia - airway obstruction.

Main:

1. 
   Mukhina S.A., Tarnovskaya I.I. Practical guide to the subject “Fundamentals of Nursing”, GEOTAR-Media, 2012.

Additional:

1. Ostrovskaya I.V., Shirokova N.V. Fundamentals of nursing: Textbook for honey. schools and colleges..-M. :GEOTAR-Media, 2008 -320p.

1. 
   Mukhina S.A., Tarnovskaya I.I. Theoretical foundations of nursing: Textbook for honey. schools and colleges. -2nd ed., revised and additional -M. : GOETAR-Media, 2009. -366 p. :il.

VOMITING is complex - a reflex act of expelling the contents of the stomach through the mouth or nose.

INDICATIONS: The patient is vomiting.

EQUIPMENT: basin; non-sterile tray; oilcloth or towel; wipes for oral care; 2% sodium bicarbonate solution or 0.05% potassium permanganate solution; electric suction or pear-shaped spray can; oilcloth apron; gloves.

1. Sit the patient down. Place a basin at your feet to collect vomit.

2. Cover the chest with oilcloth. Give me a towel.

3. Report the patient to the doctor through an intermediary

4. Wear gloves and personal protective equipment.

5. Hold the patient’s head during vomiting by placing your palm on his forehead.

6. Ensure the patient rinses the mouth with water after each act of vomiting.

7. Wipe the patient's face with a napkin.

8. Leave the vomit until the doctor arrives, after the examination, pour it into the sewer, and disinfect the basin.

9. Remove gloves and disinfect. Wash and dry your hands.

10. Monitor the patient’s condition.

The patient is weakened or unconscious

1. Turn the patient on his side. If it is impossible to change your body position, turn your head to the side.

2. Remove the pillow. If present, remove dentures.

3. Place an oilcloth under the patient’s head, or cover the neck and chest with oilcloth, and place a kidney-shaped tray near the mouth.

4. Urgently report the patient to the doctor through an intermediary. Wear gloves and PPE.

5. Carry out care for the oral and nasal cavity after each act of vomiting - suck out the vomit from the oral and nasal cavity with an electric suction device or a pear-shaped balloon.

6. After the end of vomiting, perform oral hygiene. Wipe the patient's face with a tissue.

7. Leave the vomit until the doctor arrives; after the examination, pour the vomit down the drain and disinfect the basin.

8. Remove gloves and disinfect. Wash and dry your hands.

3.Check the condition patient. Document the execution of the manipulation.

Gastric lavage with a thick probe

INDICATIONS: poisoning with various poisons, alcohol, drugs, mushrooms; consumption of poor quality food.

CONTRAINDICATIONS: organic narrowing of the esophagus; bleeding from the gastrointestinal tract; stomach ulcers and tumors; severe chemical burns of the mucous membrane of the pharynx, esophagus and stomach with acids; myocardial infarction; cerebrovascular accident; bronchial asthma.

EQUIPMENT: sterile: tray, tweezers, thick gastric tube 100-200 cm long with oval holes at the blind end, rubber tube 70 cm long and a connecting glass tube with a diameter of 8 mm, funnel with a capacity of 1 liter, petroleum jelly, gloves;

A glass of water for removable dentures, a towel or diaper; jug with a capacity of 1 liter; container with water 8-10 l (20°C); oilcloth apron – 2 pcs; container for collecting rinsing water; container for a portion of gastric contents and direction to the laboratory;

1. Explain the purpose and course of the manipulation, obtain informed consent.

2. Put on PPE. 4. Put an apron on the patient.

3. Sit the patient on a chair, leaning firmly against the back of the chair, slightly tilting the head forward and spreading the knees.

4.If there is one, remove the removable teeth

5. Place a container between the patient’s legs to collect rinsing water.

6. Determine the distance to which the probe should be inserted:

according to the formula: patient’s height in cm – 100; (measure the distance from the tip of the nose, to the earlobe, and then to the xiphoid process).

7. Carry out hand hygiene and put on gloves.

8. Moisten the blind end of the probe with sterile petroleum jelly or warm boiled water.

3. Stand to the patient’s right. Ask the patient to open his mouth wide and breathe through his nose.

4. Place the blind end of the probe on the root of the tongue. Ask the patient to make several swallowing movements.

7. As soon as the patient makes a swallowing movement, advance the probe into the esophagus. Pass the probe through the esophagus into the stomach to the desired mark.

8. Lower the funnel to the level of the patient’s knees: gastric contents will begin to flow into it.

9. Holding the funnel at an angle, pour about 1 liter of water into it.

10. Slowly raise the funnel 30 cm above the patient’s head. As soon as the water reaches the mouth of the funnel, lower it below its original position.

11. When the funnel is full, pour the contents into a container for rinsing water.

12. Repeat steps p. 8-11 until clean wash water appears. Measure the amount of fluid injected and excreted.

13. Disconnect the funnel, carefully remove the probe from the stomach, wrapping it in gauze.

14. Invite the patient to rinse his mouth with boiled water.

15. Remove the patient's apron. Take him to the bed and help him lie down.

16. Send some of the rinsing water to the laboratory, and pour the rest into the sewer.

17. Disinfect used equipment. Remove gloves and disinfect. Wash and dry your hands.

8. Document the execution of the manipulation.