Indications:
· Meteorism.
Contraindications:
Equipment:
· Sterile gas feed tube with a diameter of 3 -5 mm and a length of 15 - 30 cm (early and preschool children); 30 - 50 cm (schoolchildren).
· Water tank (to control gases).
· Capacities with deshercy for disinfection of the changing table and the equipment used.
· Sterile cotton balls, sterile tweezers and scissors, alcohol.
· Pelleys, gloves, waterproof dispenseed apron.
Algorithm of actions:
1. In the absence of a chair for 20 - 30 minutes before the procedure make a cleansing enema.
2. Wash and dry your hands, put on gloves and apron, wash your hands again,
3. Process the changing table with a deeschor twice with an interval of 15 minutes.
4. Wash your hands, set the table with a pelleon. Under the pelvis, the child is put two pelleys: the end of the gas feed tube is inserted into the first, the child is dryed by another pelleny after the arms.
5. Missing a child, leaving in a sprawling and flannel blouse. Support it to a changing table. At the age of 6 months, the child is put on the back, after 6 months - on the left side with the legs given to the belly (in such a position of the child holds the assistant).
6. Remove the gas pipe from the sterile package, lubricate the end with sterile vegetable oil.
7. Left-handed the buttocks (a small child in the position of "lying on the back" with his left hand lift the legs - when working without an assistant; or the leg holds the assistant), right hand with rotational movements without an effort, directing the end of the tube first to the navel (in the position of the child " Loki on the back "Kepenta and upstairs), and then, after passing out the external and internal anal sphincters, several forces, in parallel, enter the crooking tube:
Breast children - by 5 - 8 cm
From 1 to 3 years - by 8 - 10 cm
From3 to 7 years - by 10 - 15 cm
Senior Children - for 20 - 30 cm
8. The outer end of the gas-conductive tube is brought into a tray with water, bubbles should appear when gases. For early ages, the end of the gas feed tube to bring into loose crumpled pellery.
9. Circular abdomen massage clockwise. Cover the child with a pelleon to prevent cooling.
10. Leave the gauge tube in the intestine for 30 to 60 minutes, it is less common for a longer time, up to several hours.
11. Extract the gas pipe, flush and dry the skin, lubricate the perianal area with sterile vegetable oil. Lower the gas pipe into the container with the deceoration, to another container to lower the gloves, treat the apron to the deeschor. Wash the hands.
If necessary, manipulation can be repeated after 3 to 4 hours.
Cleaning enema.
Indications:
· Koprostaz (lack of chair in children up to a year - within 36 hours, older - 48 hours).
· Poison (food, dosage, poisons).
· Food allergies.
· Before medicinal cells.
· Preparation for endoscopic examination (rectoscopy, colophybroscopy).
· Preparation for the x-ray study of the stomach, intestines, kidneys.
· Preparation for ultrasound examination of the abdominal organs.
· Preparation for operational interventions.
Contraindications:
· Inflammatory changes in the lower sector of the colon.
· Gastrointestinal bleeding.
· Acute inflammatory and ulcerative processes in the area of \u200b\u200bthe rear passage, the cracked passage.
· Launch of the mucosa of the rectum.
· Suspicion of appendicitis.
Equipment:
· Sterile rubber balloon with a soft tip (children under 5 years old), children over 5 years old - a cylinder with a solid tip or curb Esmark and a solid tip.
· Boiled water.
· Sterile vegetable oil, sterile cotton balls.
· Capacity with deeschor to disinfection of the changing table.
· Capacity with deshercy for disinfection of the used canister.
· Pelainka.
Algorithm of actions:
1. Wash hands, put on gloves, wash your hands again.
2. Treat a changing table or couch by deceper, wash your hands.
3. Button the changing table with a pelleon.
4. Remove the sterile can be removed from sterile packaging, hold it with his right hand tip up (the tip is located between the index and middle fingers, the thumb rests into the bottom).
5. Release air from the balloon, squeezing it with a thumb, lower the tip into the water and dial the liquid. Then to release air residual from the cylinder (before the appearance of a liquid in the tip) and again dial the liquid.
6. Lubricate the tip of vegetable oil.
7. To lay a child (under the age of 6 months - on the back, raising legs; older - on the left side with bent and led to the belly legs. The assistant holds the child). Under the pelvis put a folded several times 2 - 3 pelleys.
8. Stand comfortably near the child, with your left hand to dissolve the buttocks, and with the right rotational movements, like a spiral, without an effort to enter the tip first towards the navel (in the position of the child on the back - up and the kaper), passing the outer and internal sphincters of the anal opening - By the stopper, parallel to the smoking. The tip is introduced to a depth of 3 - 5 cm for children up to 5 years and 6 - 8 cm children over 5 years old. When working without an assistant, the left forearm to hold the baby's body, and the left brush is bent in her knees.
9. Slowly squeezing the balloon, enter the liquid, without sprinkling the balloon, remove the tip, simultaneously with the left hand, squeezing the buttings, hold them 2 - 3 minutes.
10. Lower the spray in the container with the deeschor.
11. The child lies on a changing table of 8 - 10 minutes until the defecation appears for a defecation, to put a pellin on the crotch area.
12. Defecation of the child of the 1st year of life - Lyzhka on the changing table in the pelleb, the older baby is planted on the pot.
13. Wake up the child, dry the skin, dress. Dirty pelleys remove into the bag.
Drug enema.
Indications:
· For local exposure with inflammatory processes in the colon.
· For general impact - administration of medicines.
Contraindications:
· Inflammatory changes in the lower sector of the colon.
· Gastrointestinal bleeding.
· Acute inflammatory and ulcerative processes in the area of \u200b\u200bthe rear passage, the cracked passage.
· Launch of the mucosa of the rectum.
Equipment:
· Sterile gas feed tube.
· Medicine:
A) no more than 15 - 30 ml. Children up to the year.
B) no more than 50 ml of elder children.
· Pan with hot water.
· Sterile syringe (20 ml or 50 ml).
· Tanks with disinfectant solutions.
· Sterile vegetable oil.
· Pelainka.
Algorithm of actions:
Drug enema is carried out immediately after the natural act of defecation or after the action of the pre-made cleansing enema.
1. Heat the drug up to 37 - 38 degrees.
2. Wash your hands, put on gloves, handle the changing table by desravory, wash your hands, bow the table with a pelleon.
3. To put the child on the left side with the bent and the legs shown to the belly, under the pelvis, put the folded several times 2 - 3 pelleins. The child under the age of 6 is placed on the back.
4. Dial the drug into sterile syringe.
5. Remove the gas pipe from a sterile package, pour its end with sterile vegetable oil.
6. Left-handed the buttocks, and the right rotational movements, like a spiral, without an effort to introduce a gas-conductive tube at first towards the navel (in the position of the child on the back - up and kaperi), passing the outer and internal sphincters of the anal hole - the stop to depth:
A) children up to a year - 5 - 8 cm,
B) from 1 to 3 years - 8 - 10 cm,
C) from 3 to 7 years - 10 - 15 cm,
D) Senior Children - 20 - 30 cm.
7. Connect a gas-conductive tube with a syringe and slowly, enter the drug.
8. Remove the syringe, squeeze the outdoor end of the gas pipe with your fingers, dial air into the syringe and, having joining it with a gas-conductive tube, enter the air into the tube to push the drug from the tube into the intestine.
9. Remove the gas pipe, while simultaneously squeezing the buttocks to the fingers of the left hand.
10. Rotate the child on the stomach and hold it in this position for 10 minutes.
11. The gas feed tube is omitted into the container with a deceor, rinse it with the help of a syringe, to dial deesorsor into it, the disassembled syringe is lowered there. Remove gloves and omit into another container with deeschor.
Siphone enema.
Indications:
· Koprostaz (with the ineffectiveness of the cleansing enema).
· Medicinal poisoning, chemical or vegetable poisons.
· Suspections for dynamic intestinal obstruction.
Contraindications:
· Appendicitis, peritonitis. Inflammatory changes in the lower division of the colon.
· Gastrointestinal bleeding.
· Acute inflammatory and ulcerative processes in the area of \u200b\u200bthe rear passage, the cracked passage.
· Launch of the mucosa of the rectum.
· First days after surgery on the abdominal organs.
Equipment:
· Sterile rubber tube with a diameter of 8 - 10 mm, 1.5 m long.
· Rubber tip 20 - 30 cm long.
· Funnel.
· Jug with a 2% sodium bicarbonate solution or a weak-pink solution of potassium permanganate temperature 36 - 37 degrees.
The volume of fluid in ml:
Up to 6 months. - 800 - 1000
6 - 12 months - 1000 - 1500
2 - 5 years - 2000 - 5000
6 - 10 years - 5000 - 6000
Older age - 8000
· Tanks with dees basins.
Algorithm of actions:
1. Wash your hands, put on gloves and wash your hands again.
2. Treat a changing table or a couch by decement, wash your hands and store the table with a pelleon.
3. To put the child on the left side with the legs given to the stomach and bent in the knees.
4. Remove the sterile tube, tip, funnel.
5. Wear on the end of the tube tip, lubricate it with vaseline or vegetable oil.
6. Slide the buttock with his left hand, right without effort to enter the tip for 20-30 cm. In the rectum (the tip is sent first to the kappy to the navel, after passing the sphincters of the anal hole turns the hopper, parallel to the smoke).
7. On the free end of the tube to wear a funnel.
8. Fill the funnel with a liquid from the jug and raise 50 to 60 cm to a height above the changing table (or above the couch).
9. When the fluid comes to the roar of the funnel, lower the last level of the couch (changing table), pouring the washing water with wheel masses in the pelvis
10. Fully fill the funnel and raise again. The procedure is repeated up to 10 times before obtaining pure washing waters.
Washing the stomach.
Indications:
· Food and medicinal poisoning, chemical and vegetable poisons.
· Vomiting with intestinal toxicosis with excacosis.
· Diagnostic study of washing water (for identifying poison, cytological research, discharge of pathogens of tuberculosis of respiratory and intestinal infections.
Contraindications:
· Remote (more than 2 hours) The terms of poisoning of migration actions (risk of perforation of the esophagus and stomach).
· Causes.
· Significant esophageal narrowings.
· Cardiovascular failure.
· Panish disease in the aggravation stage.
Possible complications:
· Aspiration of washing waters. (Observe the technique of manipulation, control the condition of the child).
· Heb brain edema. (In order to prevent water-salt disorders for the use of saline solutions).
· Traumatic damage to the mucous membranes of the esophagus and stomach. (Probe to enter without effort).
· Cooling of the child. (Wasping fluid is heated to 35 - 37 degrees).
Equipment:
· Sterile gastric probe.
· Sterile 20 gram syringe or sterile funnel.
· Tray or pelvis for draining washwater.
· Solution for washing the stomach (2% Sodium bicarbonate solution, potassium permanganate slot solution, potassium chloride isotonic solution, ringer solution, hemodhetus, water with a cook salt - 3 liters of water to take 1 tablespoon of cook salt and sodium bicarbonate) temperature 35 - 37 degrees.
Age: Approximate liquid volume:
Up to 1 month 200 ml
1 - 3 months 500 ml
3 - 12 months 1000 ml
2 -3 - year 2000 - 3000 ml
3 - 6 years 3000 - 5000 ml
7 - 10 years 6000 - 8000 ml
Older 10 years 10000 ml
· Sterile bank.
· Sterile gloves.
· Sterile vegetable oil.
· Sterile tweezers.
· Capacity with deucastor to disinfection of changing table
Used tools, gloves.
· Pelainka.
Algorithm of actions:
1. Wash hands. Treat the changing table by desorochor, to be applied to his pelleon.
2. The child's child in the early age.
3. Children of early age and older in severe condition laid on the side with a slightly frightened down face. The elders, if the condition allows the condition, the assistant sends to his knees, holding his legs with his crossed legs, locks his head with one hand for the forehead, the other worst hands. The child unconsciously intubated before the procedure.
4. Check sterile packaging with a gastric probe for tightness, watch the implementation period, handle the cropped edge, trim the edge with sterile scissors.
5. Wear sterile gloves.
6. Remove the probe from the package, take it a rounded end with a hole on the side wall between the large and index fingers, the opposite end to be fixed between 4 - and 5 fingers, the assistant pours the end of the probe with sterile vegetable oil.
7. Measure the probe (without touching the child) the distance from the nose to the navel, mark it with a sterile bandage.
8. Enter the probe through the bottom nasal stomach in the stomach, its free end is lowered into the tray.
Note: If the probe mistakenly hit the larynx, the child begins to cough and choke. The probe is extracted and introduced again.
9. On the free end of the probe to put on a syringe and, pulling out the piston, to extract the contents of the stomach, a small amount to put it into a sterile bank (for bacteriological research).
10. With the help of a syringe to enter the stomach fluid for washing, then, pulling away the piston, extract it from the stomach, release into the tray. You can not allow the full transition of the entire fluid from the syringe, because After the liquid, the air is saturated, which makes it difficult to remove the contents of the stomach in the future.
11. The washing continues to pure washing waters.
Note: If the amount of fluid output is less than input, introduce a plot probe or pull it higher (in the first case, the probe does not reach the bottom of the stomach, in the second - the probe is introduced too deeply and the fluid enters the intestine).
12. Recove the probe from the stomach, lower it into a container with a dezhestor, rinse with the help of a syringe and fill it with remorse, the disassembled syringe is lowered there.
13. Remove gloves, omit into another container with dezersor.
14. Pour the washing water with dry chlorine lime from the settlement of 200 g. , After 1 hour, pour into the sewer.
For children over 2 years old, we spend the manipulation in the "Sitting" position. The probe is introduced through the mouth. During washing, you need to control the condition of the child. The residual contents and wash waters of the stomach must be carefully studied, especially when suspicion of gastric bleeding. After the procedure, the next feeding should be skipped.
Indication:gas accumulation in the thick intestine
Equipment:1) Rubber Gloves
2) Kleenka, diaper
3) Towel
4) Gauge Tube (No. 1-6)
2) water container
3) Vaseline oil
1. Explain your mother goal and the course of the procedure.
2. Prepare equipment.
3. Handle hands with a hygienic way, put on apron and sterile rubber gloves.
4. Sit on the smooth surface of the loaf and diaper.
5. Take a gas feed tube, a blind end to lubricate with vaseline oil.
6. Put the baby on the left side with the legs pressed against the stomach (up to 6 months - on the back and lift the legs).
7. Slide the iodians with your fingers left and fix the child in this position.
8. After overpowing the free end of the gas feed tube, carefully, without applying efforts to introduce it into anus and move 1-2 cm towards the navel, then parallel to the spine.
9. The free end of the gas feed tube is omitted into a container with water.
10 . Assay the belly of a child with stroking circular motions towards a clockwise direction.
11. As the appearance of air bubbles in the container with water with a napkin, remove the gas pipe.
12. After defecation, the child should be sealed, dry the larch movements and lubricate the natural folds of oil. To wear.
13. Remove the loaf and diaper, put in the deeschor.
14. Remove the apron, put in deeschor.
15. Remove gloves, reset to the container. Wash the hands.
Note.The depth of the introduction of agazo tube depends on the age of the child (newborn 6-8 cm).
14. Algorithm of urine collection in young children
Indications:urinary tract infection, pyelonephritis, glomerulonephritis, dysmetabolic nephropathy.
Equipment:a) rubber gloves;
b) rubber circle wrapped by a diaper;
in the towel;
d) plate or tray - for girls, test tube - for boys;
e) oilcloth;
e) pure dry jar;
g) direction to the laboratory.
1. Explain the mother / relatives of the goal and the course of the procedure, to obtain consent.
2. Prepare the necessary equipment.
3. Cancel the direction in the clinical laboratory.
4. Handle hands with a hygienic way, wear sterile rubber gloves.
5. Before taking urine, we need to extend the toilet of the urinary bodies of the child.
6. For general clinical analysis, the morning freshly added urine is collected into clean dry glass dishes (the first and last drops are not collected).
7. On the dishes with urine glider label with the name of the surname, the initials of the child, the nature of the study (Nr., "general urine analysis").
8. The girl (age up to 1 year) is placed on the rubber circle, wrapped by a diaper, which is substituted with a tray or a plate.
9. We must follow the girl not slipping from the circle.
10.
11. In the boys, the penis is administered into a test tube, the edges of which are attached to the skin of the pubic strips of sticky plaster.
12. The legs should be wrapped in a diaper.
13. The collected urine is poured into clean dishes and sent to the laboratory.
14. Urban should be delivered to the laboratory no later than 1 hour after it is collected.
15. Remove gloves, reset to the Knutainer. Hand and dry your hands.
Urine collection algorithm in Nechiporenko
Indications:determination of the content of uniform elements in the urine (according to the results of the analysis, the presence or absence of a pathological process in the kidneys is estimated).
Equipment:a) pure, dry glass jar;
b) direction to the laboratory.
1. To shake the mother / relatives of the goal and the course of the procedure, to obtain consent.
2. Prepare the necessary equipment.
3. Write down the direction of the clinical laboratory.
4. Handle hands with a hygienic way, wear sterile rubber gloves, put on apron.
5. It is necessary to hold the toilet of the genitals.
6. Collect the middle portion of urine 5-10 ml into a clean light glass jar. The rest of the urine to lower in the toilet (pot).
7. After placing the direction, I urine to send to the laboratory.
8. Remove gloves, throw away into the container. Remove the apron.
9. Wash and dry your hands.
Purpose:gas removal from the intestines.
Indications: flatulence.
Contraindications:cracks in the area of \u200b\u200bthe rear pass, acute inflammatory or ulcerative processes in the field of colon or rear passage, malignant neoplasms of the rectum.
Equipment:a 40 cm long gas pipe, in diameter 15 mm, one end is slightly expanded, connecting glass tube, rubber tube, sterile vaseline, vessel, glove, gloves, shirma.
1. Extinguish the patient with a screen, put on the back, laying under it the oil.
2. Put the ship between the legs (pour some water into it).
3. Wash your hands, put on gloves.
4. Lubricate the rounded end of the tube with a sterile vaseline.
5. In the left hand, enter the buttocks, rightly enter the tube into the rectum to a depth of 20-30 cm (the outer end of the tube is lowering into the ship).
6. Stick the patient's sheet.
7. After an hour, remove the tube and process the anus with a napkin.
8. Remember the patient a convenient position, remove the screen and ship.
9. Spend disinfection of the tube, vessel and oilcloth after manipulation.
10. Remove the gloves, wash your hands.
Note:
It is impossible to keep the gas feed tube for more than 1 hour, as the intestine can be formed on the mucous membrane.
Measuring blood pressure
Purpose: Evaluation of the functional state of the cardiovascular system
Equipment: Tonometer, PhoneDoscope, Pen, Temperature sheet.
Medical Sister's Action Algorithm:
1. Inform the patient about the upcoming manipulation, the course of its implementation in 15 minutes.
2. Wash your hands.
3. Release the patient's hand from the clothes, placing it with the palm up, at the heart level.
4. Verify the cuff on the patient's shoulder. Two fingers should be placed between the cuff and the surface of the shoulder, and its lower edge should be 2.5 cm above the elbow yam.
5. The head of the phonenadoscope is placed at the bottom edge of the cuff over the projection of the shoulder artery in the area of \u200b\u200bthe elbow depression, slightly pressing the skin, but without applying for this effort.
6. Gradually, make the air of the pear in the tonometer cuffs until the pressure in the pressure gauge does not exceed 20-30 mm Hg. The level in which the pulsation of the shoulder artery ceases to determine.
7. Keeping the position of the phonenadoscope, open the valve and slowly start producing air from the cuff at a speed of 2-3 mm Hg.st. per second.
8. Remember on the tonometer scale. The appearance of the first tone is systolic pressure and stopping the loud last tone is a diastolic pressure.
9. Register the data obtained in the temperature sheet.
Covering the sterile table in the procedural office
Purpose:preservation of sterility of medical instrument, dressing material, linen.
Indications:preparation for the work of procedural and dressing rooms, operating room.
Equipment:bix with sterile linen, dressing material, gloves; Disinfecting solution for table processing, pure gloves.
Medical Sister's Action Algorithm:
1. Process the surface of the table with a 3% solution of chlorine twice with an interval of 15 minutes.
2. Check the type of laying, the date of sterilization on the Bix Tag and the presence of a signature of the employee who has conducted sterilization.
3. Slip the date, the time of opening the Bix and its signature.
4. Put the mask, wash your hands, treat with a hygienic way, put on sterile gloves.
5. Ask the assistant to open the sterilizer cover or click on the Pedal for the Bix Stands, check the sterilization indicators.
6. Sterile tweezers beat the corners of the diaper to the sides and close the edge of the bike.
7. Remove the sheet folded in four layers without touching the non-sterile surfaces (including its bathrobe), cover it the surface of the table so that the lower edge of the sheets hung is 20-30 cm below the table surface.
8. The two top layers of the sheets lift and fold the "harmonic" on the back surface of the table;
9. Remove the second sheet, folded fourly or twice, and put on two layers of the first sheets (the second sheet should hang 5 cm below the edge of the table);
10. Close the second sheet with two layers of the first sheet;
11. Fix with sterile breathaf 2 layers of the top sheet and 2 layers of the inner (at an eight-layer table) or 2 layers of the top sheet and 1 layer of the inner sheet (at the six-layer table).
12. Spread sterile material or tools on the inner surface of the second sheet, in the right neighboring corner - a sterile napkin and tweezers (mini-table);
13. Holding an adhesion in the hands, close the sterile table so that the upper layers cover the internal.
14. Attach the tag with the date, the time of covers and FI. Medical sister.
Additional information about the features of the technique.
Terms of preservation of sterile sterile tables:
Ø mini-table - 2 hours;
Ø in the procedural office - 6 hours;
Ø in the operating unit - 24 hours, if the tools from the table did not use;
Ø The sterile table is covered in the procedural office, in the dressing or in the operating room, in which bactericidal lamps before starting work are not less than 60 minutes;
Ø The sterile table should not remain open;
Ø Medical sister should not take a sterile table with hands, but only sterile tweezers, which should lie in the right corner of the sterile table.
If the sterile table is covered in the operating unit, the medical sister is pre-climbed into sterile clothing.
Using a pocket inhaler
Purpose:getting a local effect or overall impact
Medical Sister's Action Algorithm:
Rules for handling a canister (inhaler).
1. Remove the protective cap from the canopy and turn it upside down.
2. Shake a spray with an aerosol well well.
3. Make a deep exhalation.
3. Tightly graze mouthpiece lips.
4. Make a deep breath and simultaneously press the bottom of the plane (the doctor's dose is determined by the doctor).
5. Hold your breath for a few seconds, then slowly remove the mouthpiece from the mouth and make a slow exhalation through the nose.
6. After inhalation, put the protective cap on the canopy.
Stomach washing
Purpose:medical and diagnostic
Indications:poisoning - food, medicinal, alcoholic, etc.
Contraindications:ulcers, tumors, bleeding of the gastrointestinal tract, bronchial asthma, severe heart pathology.
Equipment:sterile thick probe, a length of 100-200 cm, on the blind end of 2 side oval holes at a distance 45, 55, 65 cm from the blind end of the label, a sterile rubber tube, a length of 70 cm, sterile connecting glass tube with a diameter of 8 mm, sterile funnel with a capacity of 1 l., Sterile Vaseline oil, basin for washing water, a bucket of clean water room temperature for 10-12 liters, a liter mug, rubber gloves, aprons.
Medical Sister's Action Algorithm:
1. Wash your hands, put on gloves.
2. Open the system for washing: probe, connecting tube, rubber tube, funnel.
2. Put on yourself and patient apron, put the patient on the chair with the back.
3. The blind end of the probe is treated with sterile vaseline oil or warm boiled water.
4. Put the blind end of the probe to the root of the patient's language, offer to make swallowing movements, deeply breathing through the nose.
5. As soon as the patient does a swallowing movement, slowly promote the probe into the esophagus.
6. By bringing the probe to the desired tag (the length of the administered probe: the growth of minus 100 cm), lower the funnel to the knee level of the patient.
7. Holding a funnel obliquely, pour 1 liter of water into it.
8. Slowly raise the funnel above the patient's head.
9. As soon as the water reaches the mouth of the funnel, lower it below the source position.
10. Pour the contents in the pension until the water goes through the connecting tube, but will remain in the rubber tube and on the bottom of the funnel.
12. Start filling the funnel again, repeating all actions, rinse up to "clean" waters.
13. Measure the amount of injected and selected fluid.
15. First portion of washing waters direct to the laboratory.
16. Remove the probe with a napkin, ask about well-being.
Note:
If, when the patient's probe is introduced, cough began, he began to choke, immediately remove the probe, as he got into the trachea, and not in the esophagus.
Universal laying of bikx
Purpose:preparation of material for sterilization
Medical Sister's Action Algorithm:
1. Check the details of the bix on tightness, determining the lid closing density; Easy to move the belt.
2. Open the side openings of the BIKS.
3. Wipe the surface of the bix from the inside and outside the cloth moistened with 0.5% ammonia solution.
4. Unlock the bottom and walls of the bike sheet or a diaper.
5. In the bottom layer, put the dressing material vertically by sectors, to launch operating underwear vertically, in sectors and clockwise.
6. Place the sterility indicators in 3 levels in the bixes.
7. On top of the sheets (1st layer), put a bathrobe, mask, napkins, hand towel and control indicator.
8. Tightly close the bix cover and tie to his handle a tire from the cape, which specify the separation number, the number and name of the items located in the bikc.
Note. In one bix, heterogeneous material is placed in the form of a set at the rate of one operation.
Intensification of gas formation in the intestine in the violation of its motor function is the name of meteorism.
If the selection of gases from the intestine with the help of a cleansing enema is undesirable, and meteorism, despite the special diet, the reception of activated carbon, does not decrease, then the gas feed tube is injected. Its length is 40 cm, the inner diameter is 5-10 mm, the outer end is slightly expanded, and on the rounded part of the tube in the center and on the side wall there are holes.
Purpose: Gas removal from the intestine.
Indications: Meteorism.
Contraindications: intestinal bleeding, rectal loss, malignant rectal neoplasms, acute inflammatory or peptic processes in the colon area or rear passage.
The time of finding the tube should not exceed the 1st hour, in order to avoid the development of the complication: the straland of the rectum.
When performing the procedure, it is necessary to control the separation of gases and the patient well-being every 15 minutes, because Possible blockage of tube with wheel masses.
With the ineffectiveness of the procedure, repeat it after 30-60 minutes using another sterile gas feed tube.
Reached results and their rating:
The patient will not experience intestinal colic, discomfort in the intestine
The patient must be informed about the upcoming study. Information on the formulation of a gas-conductive tube reported to him by a medical personnel includes information about the purpose and course of this study. Written confirmation of the consent of the patient or his relatives (proxies) is not required for this procedure, since this service is not potentially dangerous to the patient's life and health.
Equipment:
1. Sterile soft rubber tube (40-50 cm, D 3-5 mm) with a rounded end.
2. Shirma (if the procedure is performed in the ward) - 1 pc.
3.Cold glue - 1 pc.
4. Disinfection container - 1 pc.
5. Warrant bag - 1 pc.
6. Lining ship - 1 pc.
7. Disinfectant.
8. Antiseptic - 1 single dose for hand processing.
9. Ointment - Vaseline 5
10. Gauze napkin (toilet paper) - 2 pcs.;
11. Some Sterile Gloves - 1 pair.
12. Apron moistureproof.
13. Liquid soap - in the absence of antiseptics for hand processing.
14. Dispenser with a disposable towel.
Algorithm of action
Preparation for the procedure:
1. To introduce yourself to the patient, explain the purpose and course of the upcoming procedure.
2. Extinguish the patient with shirma (if the procedure is performed in the multi-seat chamber).
3. Help the patient to lie closer to the edge of the bed on the left side, slightly bring the legs to the stomach, put the oilcloth under it. If the patient is contraindicated to the position on the side, the gas feed tube can be put in the lying position on the back.
4. Put a ship next to the patient with a small amount of water.
5. Wear apron, gloves.
6. The rounded end of the tube is lubricating a vaseline for 30 cm.
Procedure:
7. The rounded end of the tube take the right hand as a pen with a pen, and a free end to clamp 4 and 5 finger.
8. Slide the buttocks with 1-2 fingers of the left hand. With the right hand to introduce a gas feed tube to a depth of 15-30 cm, the first 3-4 cm in the direction of the navel, and the rest - parallel to the spine, so that the outer end spoke at least 10 cm.
9. Lower the free end of the tube into the vessel with water. Leave the tube in the intestine by 1-2 hours until the complete outrage of gases.
10. Cover the patient a sheet or blanket.
Ending procedures:
11. Extract the gas pipe to achieve the effect through a napkin moistened with a disinfectant. Place the tube into a container with a disinfectant.
12. Watch the patient's anal hole with a napkin (toilet paper) in the direction of the front-back (in women), put the napkin into the disinfection container.
13. Remove the ship, put the linen in the waterproof bag for transportation to the disinfection site.
14. Patient to put in a convenient position.
15. Remove the apron, reset gloves into disinfection containers.
16. Hand and dry your hands (using soap or antiseptics).
17. Make the appropriate record of the procedure performed in medical records.
Clear. Concept, species, goals
Enema
Types of enema
| Types of enema | Indications for the formulation | Solution, water | Liquid volume | Fluid temperature | Effect of action | |
| Cleaning | 8-10 | 1-1.5 L. | 20-28 14-16 37-40 | |||
| Siphon | 20-40 | Water | 8-10 L. | 30-37 | ||
| Hypertonic | 15-20 | 50-100 ml | 37-38 | |||
| Oil | 15-20 | 100-200 ml | 37-38 | |||
| Drug | 15-20 | 50-100 ml | 38-42 |
Objectives of the formulation of enema
 |
Clear. Concept, species, goals
Enema (Greek. KlySMA) - fluid in the lower sector of the fat intestine with therapeutic or diagnostic purposes. The fluid injected into the intestines, its volume and temperature affect the receptor apparatus of the intestinal wall. Water annoys the intestinal mucous membrane and thereby enhances the peristaltics.
The nature of the constipation determines the temperature of the water:
Indifferent (30-37) - does not affect the emptying function, the cleansing is due to the mechanical effects of water volume;
Cold (12-18) - increases the stimulation of the contractile activity of the intestine (increases the peristaltics);
Warm (38-40) is a suction (absorption) of the fluid and relaxes the smooth muscles of the intestine.
Types of enema
| Types of enema | Indications for the formulation | Depth of the administration of the tip, see | Solution, water | Liquid volume | Fluid temperature | Effect of action |
| Cleaning | 1.Cap. 2. Preparation for diagnostic research. 3. Preparation for surgery, childbirth. 4. Food poisoning. | 8-10 | Water ATONIO intestine spastic state of intestines | 1-1.5 L. | 20-28 14-16 37-40 | Emptying, after 5-10 minutes |
| Siphon | 1. Diagnosis and treatment of intestinal obstruction. 2. poisoning poisons, mushrooms, medicines. 3. The ineffectiveness of other types of enema. | 20-40 | Water | 8-10 L. | 30-37 | Diagnostic (disintellation) to pure washbasinwater |
| Hypertonic | 1. Atonic constipation. 2. Massive swelling. 3. Postoperative period. | 15-20 | Solutions: 10% sodium chloride solution; 20-30% solution of magnesium sulfate. | 50-100 ml | 37-38 | Emptying (loss), after 20-30 minutes. |
| Oil | 1. Spastic constipation. 2. "Persistent" constipation. 3. Postoperative period. | 15-20 | Vaseline oil, glycerin, vegetable oils: sunflower, sea buckthorn, richness. | 100-200 ml | 37-38 | Lucky, after 6-10 hours (overnight) |
| Drug | 1. Hyperthermia. 2. Inflammatory intestinal processes. 3. Facial syndrome. | 15-20 | Double oral dose of aqueous solution. | 50-100 ml | 38-42 | Medical: hypothermal, anti-inflammatory, anticonvulsant. |
Objectives of the formulation of enema
| |
Contraindications for setting the enema:
Acute inflammatory intestinal processes;
Bleeding from the organs of the digestive system;
Malignant neoplasms of the rectum;
The first days of the postoperative period on the organs of the digestive tract;
Cracks in the field of anus / loss of the rectum;
Pain in the stomach of unclear origin;
The first 3 days after transferred acute myocardial infarction.
The procedure for setting the enema is performed by a wardrobe sister. This is a dependent nursing intervention. The testimony and contraindications are determined by the doctor.
The algorithm for performing the manipulation of the "Staging of a gas-conductive tube"
Prepare:
Sourish gloves - 1 pair.
Gauge tube - 1 pc.
Kleenka - 1 square. m.
Spatula -1 pcs.
Vaseline - 5 ml.
Tray - 1 pc.
Water vessel.
Antiseptic solution - 1 single dose.
Liquid soap - in the absence of an antiseptics for hand processing.
Dispenser with a disposable towel.
Disinfectant container.
I. Preparation to the procedure:
1. To introduce yourself to the patient, explain the purpose and course of the upcoming procedure.
2. Extinguish the patient with shirma (if the procedure is performed in the multi-seat chamber).
3. Help the patient to lie closer to the edge of the bed on the side, slightly bring the legs to the stomach, put the oilcloth under it. If the patient is contraindicated to the position on the side, the gas feed tube can be put in the lying position on the back.
4. Put a ship next to the patient with a small amount of water.
5. Wear apron, gloves.
6. The rounded end of the tube is lubricating a vaseline for 30 cm.
II. Procedure:
1. Rounded end of the tube to take the right hand as a "pubescent pen", and a free end to clamp 4 and 5 finger.
2. Slide the buttocks with 1-2 fingers of the left hand. With the right hand to introduce a gas feed tube to a depth of 15-30 cm, the first 3-4 cm in the direction of the navel, and the rest - parallel to the spine, so that the outer end spoke at least 10 cm.
3. Lower the free end of the tube into the vessel with water. Leave the tube in the intestine by 1-2 hours until the complete outrage of gases.
4. Cover the patient a sheet or blanket.
III. Ending procedures:
1. Move the gas feed tube to achieve the effect through the napkin. Place the tube into a container with a disinfectant.
2. Over the patient's anal hole with a napkin (toilet paper) in the direction of the front-back (in women), place the napkin into the disinfection container.
3. Remove the ship, put the linen in the waterproof bag for transportation to the place of disinfection
4. Patient to put in a convenient position.
5. Remove the apron, reset gloves into disinfection containers.
6. Wash and dry hands (using soap or antiseptic).
7. Make the appropriate record of the procedure for medical documentation.
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