Download 4. Collecting of sputum

Ministry of Health of Republic of Belarus
Education establishment
«The Gomel State medical university»
Chair of Internal Disease №1 with Endocrinology Course
It is discussed at the meeting of chair 30.08.2016
Protocol № ___________
METHODICAL REVIEW
for practical training of foreign students of the 1st course
Subject:
«Supervision and hygienic care of patients
with function break of respiratory system»
Theme 6 (Lesson 10)
Time: 3 hours
Chief of chair______________
1. Training and educational goals, motivation for theme learning,
requirements of initial level of knowledge
1.1 Aim of training: Explore the features of monitoring and care of patients
with impaired respiratory function, when you cough, hemoptysis, pulmonary
hemorrhage, sputum collection rules for general clinical and bacteriological
examination, rules processing, disinfection and storage of spittoons.
1.2 Requirements to initial level of knowledge: during the training the student
should
To know:
1. The main complaint in respiratory diseases.
2. The rules of sputum collection for general clinical and bacteriological
examination.
3. The rules of disinfection and storage of spittoons.
4. Features of monitoring and care of patients with cough, hemoptysis,
pulmonary hemorrhage, asphyxia.
5. Rules pocket inhaler.
6. The concept of instrumental methods of investigation of the respiratory
(spirography, bronchoscopy, bronchography, pneumotachometry, peak flow).
To be able to:
1. Perform sputum collection for general clinical and bacteriological
examination.
2. Carry out disinfection spittoons.
3. Provide first aid to patients with cough, hemoptysis, pulmonary hemorrhage,
asphyxia.
4. To teach the patient to use the rules of pocket inhaler.
5. Conduct training patients for instrumental studies of the respiratory.
2. Material equipment of training
1. Spittoon.
2. Pocket inhaler.
3. Checklist from related subjects
1. Anatomy of the upper and lower respiratory tract.
2. The normal physiology of the respiratory system.
4. Questions on an occupation subject:
Lesson № 10
1. The main complaint of respiratory diseases.
2. Signs of respiratory function, their assessment. Help the patient with shortness
of breath, attacks of breathlessness.
3. Features of observation and taking care when there are coughing, sputum
production.
4. Collecting of sputum (for general analysis, for the presence of mycobacterium
tuberculosis, atypical cells, flotation method, fluorescence microscopy method).
5. Methods of disinfection care items: processing and distribution of individual
spittoons sputum in somatic hospitals and antitubercular health facilities.
6. Features of observation and care of patients with hemoptysis, pulmonary
hemorrhage, pain in the chest.
7. Oxygen therapy. Working safely with oxygen devices.
8. The concept of instrumental methods of investigation of the respiratory
(spirography, bronchoscopy, bronchography, pneumotachometry, peak flow).
Preparing patients for instrumental studies of the respiratory system.
5. Materials for self-preparation:
Lesson №10
1. The main complaint of respiratory diseases.
Respiratory diseases are studied by internal diseases section - pulmonology.
Pulmonology (from the Latin «pulmo» - light;.. From the Greek «logos»
teaching) is a section of Internal Medicine that studies the pathology of the respiratory
system and develop methods of prevention, diagnosis and treatment of diseases of the
respiratory system.
Complaints of patients with respiratory diseases can be divided into two groups:
1) Local report:
- Violation of nasal breathing, runny nose, smell disturbances, dry nose,
- Nosebleeds,
- Voice changes,
- Pain and other unpleasant sensations in the throat,
- Cough,
- Sputum,
- Hemoptysis,
- Shortness of breath, breathlessness
- Choking,
- Pain in the chest.
2) general (nonspecific) complaints:
- Fever,
- Weakness,
- Decreased performance,
- Sweating,
- Loss of appetite, and others.
Observation and care of the sick with respiratory diseases should be carried out
in two directions.
General measures are measures to monitor and care needed by patients with any
disease of various organs and systems: monitoring of the general state of the patient, a
thermometer, monitor the pulse and blood pressure, the filling temperature blank,
ensuring the personal hygiene of the patient, vessel supply, etc.
Special events are event of monitoring and taking care, to help patients with
symptoms characteristic of the respiratory diseases, - shortness of breath, cough,
hemoptysis, chest pain, fever and others.
2. Signs of respiratory function, their assessment. Help the patient with
shortness of breath, attacks of breathlessness.
Violations of respiratory function occur during the diseases of the respiratory
system and it characterized by lesions of the small bronchi (bronchial asthma, chronic
obstructive pulmonary disease) and alveoli (pneumonia - pneumonia).
In clinic of internal medicine is widely practiced study of respiratory function,
which is judged more often by studying pulmonary ventilation, although this function
is supported and the diffusion of gases through the alveolar-capillary membrane,
pulmonary blood flow, nerve regulation, etc.
Pulmonary ventilation estimated respiratory rate, tidal volume, minute volume
of respiration, the maximum pulmonary ventilation and other spirographic indicators.
Clinically, disorders of respiratory function are manifested by shortness of
breath, choking, and breathing frequency change rate, the appearance of cyanosis
(bluish coloration of the skin), and others.
Shortness of breath or dyspnea (from the Greek "dys" -. The difficulty violation
"rnoe" - breathing) is the frequency of the violation, the rhythm and depth of breathing
or increased work of the respiratory muscles, exercise, as a rule, subjective feelings of
lack of air, or breathing difficulties. It should be remembered that the shortness of
breath can be a proper lung and heart, and other neurogenic origin.
There are 2 types of changes in respiratory rate.
Tahypnea is rapid shallow breathing (more than 20 per minute). Tahypnea is
most frequently observed in lesions of the lung (eg, pneumonia - pneumonia), fever,
blood disorders (eg, with a decrease in hemoglobin - anemia). During hysteria
respiratory rate may reach 60-80 min.
Bradypnea is an abnormal decrease in breathing (less than 12 per minute); it is
observed in brain diseases and its membranes (brain hemorrhage, brain tumor),
prolonged and severe hypoxia (eg, due to heart failure).
Depending on the phase of the respiratory disorders are the following types of
dyspnea:
- Inspiratory dyspnea, it is difficult inhalation.
- Expiratory dyspnea, it is difficult exhalation.
- Mixed shortness of breath, are hampered both phases of respiration.
Normal breathing is a rhythmic process. Pathological conditions can observe
violations of the respiratory rhythm (so-called "periodic breathing").
Cheyne-Stokes respiration is breathing in which breathing pauses after first
appears superficial rare breathing, which gradually increases in depth and frequency, it
is very noisy, then gradually decreases and ends with a pause, during which the patient
may be disoriented or lose consciousness. A pause can last from a few to 30 seconds.
Breathing Biota is a rhythmic periods of deep breaths alternate around at regular
intervals with prolonged respiratory pauses. A pause may also vary from a few to 30
seconds.
Kussmaul breathing is deep breathing with a rare noisy inhalation and
exhalation power; it is observed at a deep coma caused by diabetes and renal failure
(uremia)
Actions of nurse when a patient has breathlessness
When the patient's shortness of breath or choking nurse should immediately
inform the doctor his observations of nature dyspnea, respiratory rate, and to take
measures to facilitate the patient's condition.
1. Create environment around the patient calm, reassure him and others.
2. Help the patient take the sublime (half upright) position, lifting the head end
of the bed and put it under his head and back cushions.
3. Release the patient from hindering clothing and heavy blankets.
4. Provide fresh air into the room (the window open).
5. With appropriate prescribing physician to give the patient a pocket inhaler
and explain how to use it.
Suffocation is pronounced shortness of breath.
Asthma is a paroxysmal dyspnea. There are 2 kinds of it: bronchial and heart. At
the heart of bronchial asthma is a spasm of the small bronchi, and heart is acute
weakness (lack of) most of the left ventricle.
Rules pocket inhaler
(Aerosol, spinhalerom, spacer)
In various diseases of the respiratory tract and lungs are the introduction of
drugs directly to the respiratory tract. In this pharmaceuticals-vennoe substance is
administered by inhalation of its - inhalation (from the Latin «inhalatum» -. Inhale).
By inhalation drugs are administered, both local and systemic effects:
- Gaseous substances (oxygen, nitrous oxide);
- A pair of volatile liquids (ether, halothane);
- Aerosol (a suspension of tiny particles of solutions).
Inhaled forms as the anti-inflammatory and bronchodilators are the most modern
and safe method for the treatment of asthma and chronic obstructive pulmonary
disease.
It is important to remember that the drug's effectiveness depends on whether it is
properly applied.
Types of handheld inhalers
There are several types of handheld inhalers: an inhaler for inhalation of
aerosols and an inhaler for inhaling powdered medicament, which is called
spinhalerom. additional device may be used when using the aerosol inhaler which is
called a spacer.
The spacer is designed to delay
drug big size droplets which can not
achieve the small branches of the
bronchial tree, and therefore, the drug will
not have a bronchodilatory effect on
muscles under their bronchiolar spasm.
Terms of use aerosol inhaler (spray)
1. Remove the cartridge cap by turning balon upside down.
2. Shake the aerosol.
3. Make a deep exhalation.
4. Cover the balloon mouthpiece lips, his head slightly
thrown back.
5. Take a deep inhalation and press firmly to the bottom
of the can in the same time: at this moment it will get a dose of
aerosol.
6. Hold your breath for 5-10 seconds, then remove the
cartridge from the mouth and make a slow exhale.
7. After inhalation spray should be put on the protective
cap.
Remember: it is more effective when a dose aerosol is
inhalated deeper.
Spinhaler using
1. Making spinhaler position as shown in Fig. 6.1.
2. Three components of spinhaler: body with a sliding tube, propeller, the
mouthpiece with a steel rod (Figure 6.2.).
3. Insert the capsule with a powdered medicine in a special place on the
propeller colored end push it down (Fig. 6.3.).
4. Screw housing on the mouthpiece (Fig. 6.4.).
5. Slide the tube body down (Fig. 6.5.).
6. Lift up the receiver (Fig. 6.6). That action finalized that spinhaler is ready
for use.
7. Make full exhalation (Fig. 6.7.).
8. Insert the mouthpiece into your mouth, take a deep breath and strong
through spinhaler that the powder from the capsule has reached the lungs (Fig. 6.8),
hold your breath for a few seconds by removing spinhaler breath, exhale into the
environment, but not in spinhaler.
9. Repeat three or four times the steps in paragraphs 7 and 8.
10. Remove the used capsule and put spinhaler into the box to make it clean and
dry.
Twice a week, you need to disassemble spinhaler.
Wash it’s three parts in warm tap water and dry it in a warm place to gather and
put in a box.
Particular attention should be paid to clean the propeller channel, which includes
a metal rod die at piercing the capsule during the advance of the tube body down.
3. Features of observation and taking care when there are coughing,
sputum production.
Cough is a complex reflex act, caused by irritation of the respiratory tract
receptors, but sometimes the pleura and even the external auditory canal receptors. It is
a resounding pushing forced exhalation, can be voluntary and involuntary.
There are dry cough, that is, without sputum and wet cough (productive), if it is
accompanied by sputum.
The cough reflex occurs when stimulation of airway receptors by various factors
- mucus, foreign body, bronchospasm, dry mucous membranes of the respiratory tract
or structural changes. The physiological role of cough is to purify the airways of
secretions and substances introduced into them from the outside. Cough is a push of a
sudden sharp exhalation against a closed glottis, the subsequent sudden opening where
the air along with the phlegm and other foreign bodies with the power emitted through
the mouth. As a manifestation of the disease cough tends to be painful, persistent,
often painful, with sputum and the appearance in it of various contaminants.
According to the frequency and nature of the occurrence of the following types
of cough:
- Single - for example, when inhaled foreign body;
- Paroxysmal - bronchial asthma, obstructive bronchitis, in smokers;
- Convulsive is paroxysmal cough with fast successive shocks is interrupted
noisy breath, sometimes accompanied by vomiting (whooping cough);
- Spasmodic is resistant dry cough accompanied by a spasm of the larynx
(laryngeal nerve during stimulation are usually pathological process in the
mediastinum);
- Acute - in acute viral or bacterial infection;
- Chronic - chronic respiratory diseases, chronic heart failure.
With strong painful cough may develop complications: syncope, break
emphysematous (dilated, swollen) lung areas with the development of pneumothorax
(accumulation of air in the pleural cavity), pathological fractures of the ribs in the
presence of osteoporosis and metastatic tumors in the ribs.
Nursing dry cough includes first treating the underlying disease. Recommend
plenty of warm alkaline water – for example, mineral water "Borjomi", diluted half
with hot milk.
Sputum (lat. «Sputum») is secreted by coughing pathologically altered secretion
of the mucous membranes of the trachea, bronchi, with an admixture of saliva and
secretions of the mucous membrane of the nasal cavity and paranasal sinuses.
Characteristics of sputum - the quantity, color, odor, consistency (liquid, thick,
sticky), inclusion (blood, pus, and other impurities) - depending on the disease and,
together with the results of other laboratory and instrumental methods of research are
in great importance in the diagnosis of diseases of the respiratory system and other
organs.
Daily number of sputum may vary from a few milli-liters with chronic
bronchitis to 1-1.5 liters with bronchiectasis (bronchiectasis), breakthrough abscess
(purulent fusion) lung bronchus, gangrene (putrid melting) of the lung.
By the nature of the following types of sputum
Mucous expectoration (sputum mucosum) - sputum, colorless, transparent,
viscous, essentially free of cellular elements.
Serous sputum (sputum serosum) - frothy sputum liquid, released in pulmonary
edema.
Purulent sputum (sputum purulentum) - sputum contains pus (sloecharacterized, in particular, to break the lung abscess in the bronchial lumen).
Putrid phlegm (sputum putridum) - purulent sputum with a putrid odor.
Bloody sputum (sputum sanguinolentum) - sputum contains blood impurity (say,
for example, bleeding from the walls of the airways in lung cancer).
"Rusty" phlegm (sputum rubiginosum) - bloody sputum, contains inclusions of
brown (rusty) color, resulting from the decomposition of hemoglobin (there is, for
example, pneumonia, tuberculosis).
Pearl sputum - phlegm contains rounded opalescent inclusion consisting of
abnormal cells and detritus (observe, for example, squamous cell carcinoma of the
bronchi). Detritus (from the Latin «detritus» -. Worn) - a product of the disintegration
of tissues.
Three-layered sputum - phlegm profuse, purulent separating by settling into
three layers: the top - gray foam, medium - watery, transparent, bottom - dirty graygreen color, containing pus and necrotic tissue residues (watch with gangrene of light).
In the presence of the patient's sputum nurse should ensure the observation of
cleanliness and timeliness emptying spittoons. For better sputum discharge is
necessary to help the patient find a posture in which the sputum is best allocated. This
posture is called drainage and apply it several times a day. Make sure that the patient
is regularly taking the position of the drain, such as angioedema (Quincke Heinrich,
Quincke H., 1842-1922, a German physician), promoting the separation of sputum,
several times a day for 20-30 minutes. This procedure is called postural drainage.
Postural drainage (from the Latin «positura» - position;.. From the French «drainage» dehumidification) - drainage by giving the patient a situation in which the fluid
(sputum) flows off by gravity.
Giving the patient drain position
Objective: facilitating expectoration in bronchitis, lung abscess, bronchiectasis,
etc.
Preparation for the procedure: Fill the tank sputum (spittoon) disinfectant (0.2%
solution "Hlorotsid" or 0,3% solution "Hlordez" or 0,3% solution "Hlormiks") to a
third of its volume and put the spittoon next to sick, so he was easy to reach it.
Option 1
From the starting position at the back of the patient is gradually rotated about its
body axis at 360 °. Turning the patient to 45 °, each time asking him to take a deep
breath and cough when a good opportunity to give him cough.
The procedure should be repeated 3-6 times.
Option 2 (Muslim prayer pose)
The patient must get on your knees and lean forward. Thereafter, the patient is
asked to repeat tilt 6-8 times to pause for 1 minute, then again repeated 6-8 times the
slope (of not more than 6 cycles).
Follows this procedure to the patient spent 5-6 times a day.
Option 3
Explain to the patient that he needs 6-8 times alternately (lying on the right, then
on the left side) hangs his head and arms out of bed (slippers search position under the
bed).
Keep an eye to the procedure the patient is carried out 5-6 times a day.
Option 4 (the Quincke position)
The foot end of the bed on which the patient lies, raised by 20-30 cm above the
head end of the level.
This procedure is performed several times for 20-30 minutes with a break of 1015 minutes.
After the procedure, postural drainage should help the patient to take a
comfortable position to carry out disinfection of sputum and flushing and make a
record in the history of the implementation of the procedure and the patient's response
to it.
If none of the drainage provisions of sputum does not depart, then it considered
ineffective.
To improve blood and lymph circulation in the chest patient shows her massage,
and for improving the ventilation of the lungs - breathing exercises. The room in which
the patient does not aerate at least 4 times a day and the air temperature is maintained
within 18-22 ° C. It is necessary to monitor the implementation of the patient doctor's
instructions. The patient should be provided with sufficient amount of liquid - in order
to prevent the formation of kidney stones with antibiotics and other drugs.
4. Collecting of sputum (for general analysis, for the presence of
mycobacterium tuberculosis, atypical cells, flotation method, fluorescence
microscopy method).
Sputum is a pathological secretion released from the airway by coughing.
Sputum examination is of great diagnostic value.
There are the following main methods of sputum:
1. General sputum analysis:
- Determine the quantity, color, odor, texture, nature of sputum;
- Microscopic examination of sputum is carried out in order to detect
accumulations of cellular elements, Charcot-Leyden crystals, elastic fibers, Kurshmana
spirals elements neoplasms (abnormal cells), etc.
Charcot-Leyden crystals are the formation of the protein products as a result of
the collapse of eosinophils. Finding them in the sputum is characteristic of asthma.
Spirals Kurshmana are formation of white filaments consisting of mucus, often found
in asthma.
2. Bacteriological examination of sputum:
- Identification in the sputum microflora and determination of its sensitivity to
antibiotics;
- Analysis of sputum for the presence of Mycobacterium tuberculosis (sputum
collection is the same as for the overall analysis).
To collect sputum, the patient should at 8 o'clock in the morning on an empty
stomach to brush your teeth and rinse your mouth thoroughly with boiled water. Then
he should take a few deep breaths and wait for the urge to cough, then cough up
phlegm (in a volume of 3-5 mL) in a pre-issued him a clean, dry graduated jar and
close the lid. For the purpose of sputum bacteriological examination give a sterile
container; In this case, the patient should be warned that it does not touch the edges of
the dishes with your hands or mouth. After collecting sputum patient should be kept in
a container with sputum sanitary room in a special box.
Taking sputum for investigation of the sensitivity of microorganisms to
antibiotics.
On the eve of the bacteriological laboratory studies provide a sterile petri dish or
the spittoon. Sputum is going in the morning on an empty stomach. Before collecting
the patient is brushing her teeth and mouth rinses. The first portion of sputum was not
going into the spittoon, and spits. Follow the sputum collected in sterile spittoon and
closes the lid.
Detection of Mycobacterium tuberculosis by using the flotation method.
General sputum analysis is not always possible to identify Mycobacterium
tuberculosis, even when overt clinical manifestations of tuberculosis. In such cases,
carry out a special examination of sputum using the flotation method (floating). The
volume of sputum for research should not be less than 100 ml, for a larger volume of
more chances to identify mycobacteria. In this regard, the right amount of sputum
should be collected within 2-3 days. That it has not deteriorated, it must be stored in
the refrigerator technical. In the laboratory, the collected sputum was poured into
narrow-necked bottle of 200 ml, was added an equal amount of 0.5% sodium
hydroxide solution, shake, put in a water bath at a temperature of 55-56 ° C. Make it to
dissolve mucus lumps and especially the so-called "lentils" in which most often are
bacteria. After homogenization sputum added 1-1.5 ml benzene or toluene, and
distilled water to 200 ml, shake. When defending gasoline rises and collects in the
neck of the bottle, dragging the-sticks-tuberculosis. This top layer is removed with a
pipette drop by drop, and is laminated to a warmed glass slide. After staining ZiehlNielsen drug examine under a microscope.
In recent years, to improve the detection of tubercle bacilli widely used method
for fluorescent microscopy. The innovation of this method is that the smears prepared
luminescent composition is further coated, and then observed under the microscope
with UV light. With this technology the TB bacillus shine brightly on a blue
background.
When collecting sputum for abnormal cells (cancer cells) nurse should
immediately deliver the material to the laboratory, since tumor cells are rapidly
destroyed.
5. Methods of disinfection care items: processing and distribution of
individual spittoons sputum in somatic hospitals and antitubercular health
facilities.
Rules for patient with sputum
In order to prevent contamination of surrounding nurse should educate the
patient, sputum, the following rules of conduct:
- Coughing in close proximity to healthy people;
- Cover your mouth with your hand or handkerchief when coughing;
- Not to spit phlegm on the floor, as dries, it can turn into dust particles and
infect others;
- Collect sputum in a special spittoon with a tight lid on the bottom of which a
small amount of disinfectant should be poured (bp 0.3% solution "Hlorotsid").
Processing, disinfection and storage of spittoons
Spittoons must be emptied daily, noting the number of pre sputum per day at
temperatures sheet. For disinfection of the spittoon phlegm 1/3 filled with a 2%
solution of chlorine bleach, and for tuberculosis patients - 5% solution of chlorine
bleach. Sputum after disinfection is drained into the sewer system, and sputum,
collected from patients with tuberculosis, mixed with sawdust and burned in special
furnaces. Spittoon disinfected after use in a 3% solution of bleach (60 minutes), and
tuberculosis - 5% solution of bleach (240 minutes). Thereafter spittoon washed with
running water, dried and put on a shelf for storage net spittoons.
Be sure to inspect the sputum. When in her veins the blood is necessary to
inform the doctor immediately.
6. Features of observation and care of patients with hemoptysis, pulmonary
hemorrhage, pain in the chest.
Hemoptysis (Greek «haemoptoe».) is the allocation of blood or sputum mixed
with blood from the airway by coughing. Blood can be uniformly distributed in the
sputum (e.g., sputum as a "raspberry jelly" lung cancer) or individual streaks. In lobar
pneumonia sputum may be "rusty". The source of the bleeding can be a system of
vessels of the pulmonary artery or bronchial vessels. In the so-called "false" sources
appear hemoptysis bleeding gums and blood leaking for epistaxis.
Hemoptysis may occur in diseases of the lungs, accompanied by the collapse of
the lung tissue with involvement in the pulmonary vascular collapse of the zone and
the violation of the integrity of the vascular wall (bronchiectasis, lung abscess,
tuberculosis, lung cancer), the pathology of the cardiovascular system - the vices of the
left atrioventricular orifice (mitral stenosis), pulmonary embolism, chest trauma,
autoimmune diseases.
Hemoptysis is an indication for emergency hospitalization, since the appearance
of blood in the sputum can not exclude the possibility of pulmonary hemorrhage.
Allocation through the respiratory tract a considerable amount of blood (from a
cough or a continuous stream) is called pulmonary hemorrhage.
Massive called pulmonary hemorrhage of more than 240 ml of blood isolated
within 24-48 hours. Massive bleeding is a direct threat to the life of the patient.
Pulmonary hemorrhage often leads to blood flow into other regions of the lungs and
the development of aspiration pneumonia.
It is necessary to distinguish pulmonary hemorrhage from gastric:
- In pulmonary bleeding blood has red color, foamy, not clotting, has an alkaline
reaction, is released when coughing.
- With gastric bleeding released blood is usually dark, it looks like "coffee
grounds" because of the interaction with the acidic gastric juice and the formation of
hydrochloric hematin; blood is acidic, is mixed with food stands vomiting.
Caring for patients with hemoptysis provides for complete rest. It is necessary to
help the patient to take a comfortable position in bed half-sitting with a slope to the
affected side in order to avoid getting blood in the healthy lung. On the patient side of
the chest put an ice pack. Ice also give swallowing that leads to reflex spasm of blood
vessels and reduce blood supply to the lungs. With a strong cough, bleeding
reinforcing appoint antitussives. High temperatures can lead to pulmonary
hemorrhage, so food is given only cold semisolid form. You can not take a hot bath or
shower. Prior to examination by a doctor the patient should not move or talk.
When hemoptysis and the threat of pulmonary bleeding patient is strictly
contraindicated staging cans, mustard plasters, warmers and hot packs to the chest.
If the patient is unable to rinse mouth by himself, nurse takes sterile napkins,
pulls on a spatula and gently clean the mouth, removing the remains of bloody sputum.
In diseases of the respiratory pain syndrome is most often associated with
involvement in the pathological process of the pleura (pleural effusion,
pleuropneumonia, pneumothorax, etc.). Pleural pain provoked by respiratory
movements, due to which the patients are trying to breathe shallow.
Care of patients with pleural pain is to give the patient a comfortable, limiting
respiratory motion position (patient side), performing as intended doctors just
physiotherapy.
When the patient's body temperature above 38o C, any physical therapy
treatments are contraindicated.
It should be prescribed by a doctor to ensure patient taking pain medications and
drugs which reduce coughing.
In the presence of patients with exudative pleurisy - inflammation of the pleura
with propotevanie fluid (effusion) in the pleural cavity - on doctor's prescription he
carried pleural puncture, in this case it is necessary to prepare the patient for the
procedure and assist the doctor during it.
7. Oxygen therapy. Working safely with oxygen devices.
In severe dyspnea patient oxygen therapy should be carried out (from the Latin
«oxygenium» - oxygen,. From the Greek «therapeia» - treatment.) - The use of oxygen
for medical purposes.
The indications for oxygen therapy is acute or chronic respiratory failure
accompanied by cyanosis (a bluish tint of the skin and mucous membranes),
tachycardia (palpitations), a decrease in the partial pressure of oxygen in the blood.
Cyanosis is bluish coloration of the skin.
When poor circulation cyanosis expressed in the most remote areas of the body
from the heart, namely, the fingers and toes, tip of the nose, lips, ears. This distribution
is called acrocyanosis (peripheral cyanosis, cold). Its appearance is dependent on the
content increase in venous blood of reduced hemoglobin in blood due to excess
absorption of oxygen during deceleration tissue blood flow.
When respiratory failure cyanosis becomes prevalent - central (diffuse warm)
cyanosis. The reason for it is the lack of oxygen due to insufficient blood
arterialization in the pulmonary circulation.
Oxygen therapy is used for oxygen mixture containing from 40 to 80% oxygen;
if pulmonary edema is also used anti-foaming agents (50-96% ethyl alcohol solution or
10% alcohol solution antifomsilana silicone compounds).
There are the following ways of supplying oxygen
1. Submission of oxygen through nasal catheters - oxygen is stored in a special
room in the cylinder of compressed oxygen on metal tubes system, held in the chamber
(the so-called centralized oxygen supply).
2. Oxygen through a mask. When overlaying on the face mask should cover the
mouth and nose. The mask has an inspiratory and expiratory channels. The tube is
connected to the inhalation channel breathing bag of thin rubber in which oxygen is
stored during exhalation, and oxygen is actively sucked lungs during inhalation.
3. Oxygen through a ventilator. In this case, oxygen supply is performed through
the endotracheal tube.
4. Hyperbaric oxygen therapy, or oksigenobarotherapy (from the Greek «barys»
-. Heavy) is a therapeutic and preventive method of oxygen saturation of the body
under high pressure. Sessions of hyperbaric oxygenation is carried out in a special
pressure chamber. The chamber is a hermetically sealed room, which can be created
artificially increased air pressure (gas). Dimensions of hyperbaric chambers and
equipment allow for a longer stay in the chamber one or more patients.
Safely during oxygen therapy
Oxygen therapy, regardless of the methods may only be used medical oxygen.
According to current government standards medical oxygen must contain 99% oxygen
and 1% nitrogen have any other gaseous impurities (carbon dioxide, methane,
hydrogen sulphide). Organoleptic - a colorless gas, odorless and tasteless. Medical
oxygen tanks have a capacity of 40 liters and contain oxygen gas under a pressure of
150 atm.
Due to the fact that oxygen stored in cylinders under high pressure, all persons
related to the use, storage and transport of oxygen and, above all, physicians should be
aware of the basic security requirements and rules associated with these procedures.
Cylinders, which are filled with medical oxygen must be painted blue and have
an inscription in black paint "oxygen" and the letter "M". . Because oxygen can not be
used under a pressure of 2-3 atm, the balloon is attached to a special device - reducer pressure reduction. Oxygen cylinders in compliance with certain safety precautions to
handle. At the same time, careless handling can lead to undesirable consequences
(explosion and so on. D.).
When using an oxygen cylinder must be remembered that the compressed
oxygen gas in contact with oils, fats, oil, actively takes them into the mix, causing fire
or explosion. Smoking in the room where you store cylinders, it is strictly prohibited.
The container must be protected against knocks and bumps. Store it in an upright
position and attach to the wall in a cool place. At the opening of the cylinder valve is
not recommended to get to face him as a strong jet of oxygen getting to the mucous
membrane of eyes can cause burns and eye damage. The fire-fighting purposes in
every room where there are oxygen tanks, fire extinguishers should be to avoid
accidents. Oxygen cylinders should be stored only in designated areas for this purpose,
in which smoking is prohibited. It is impossible to place oxygen cylinders away from
heat and light sources.
When working with an oxygen cylinder can not lubricate the hand cream.
Before a session of hyperbaric oxygenation is necessary to ensure there are no makeup on the patient's face.
8. The concept of instrumental methods of investigation of the respiratory
(spirography, bronchoscopy, bronchography, pneumotachometry, peak flow).
Preparing patients for instrumental studies of the respiratory system.
Spirography is a method designed for the study of respiratory function. With
this method, you can define the basic parameters of breathing: tidal volume (ML), the
reserve volume inspiratory and expiratory (police department), vital capacity (VC), the
respiratory minute volume, forced vital capacity (FVC) maximum ventilation (MVV),
backup breathing. Based on the analysis of the parameters can ultimately judge the
presence or absence of the patient's symptoms of respiratory failure and its varieties
(obstructive or restrictive). A study carried out by a special device - spirograph. The
patient is seated on a chair in front of the machine. In the mouth the patient takes a
specially treated sterile rubber mouthpiece and nose superimposed on a special
terminal, creates a closed-loop system, all of the exhaled air is drawn into the unit.
Enables tape drive-ism fur and moving tape of paper using recorded curve spirogram
as oscillations. After the recording is made spirogram analysis and calculated the basic
tidal volumes, which are compared with the proper values.
Preparation of spirograph work: rubber mouthpieces after use are soaked in a
0.5% solution of bleach for 2 hours then sterilized by boiling for 45 minutes.
Currently contemporary spirographs equipped with computer software and
spirograms after recording their analysis is carried out automatically.
Peak flow is method of measurement of peak expiratory flow (PEF) during
forced exhalation after full inspiration as possible using a special portable device
pikfluometr, whose scale is graduated in liters per minute (L / min) or liters per second
(l / s). These devices allow patients at home (ambulatory) conditions independently
monitor the status of bronchial passability (PSV determined at different times of the
day before and after bronchodilator). Indicators of patient PEF compared with normal
data which is calculated depending on height, gender and patient’s edge. Normally, the
PSV of more than 90% of the predicted value. Each patient should be informed of its
proper values of PSV, which is determined by the table of standard values of PSV, and
personal best PEF. In case of violation of bronchial patency PSV significantly below
normal.
Pneumonic tahy meter is a method of research of breathing mechanics, based on
the speed measurement inhaled and exhaled air. Graphic recording speed and volume
of inhaled and exhaled air using a pneumotahograph device, and the record itself is
called pnevmotahogramm. Pneumonic tahy meter is a simple method to roughly
determine whether the patient signs of obstructive and restrictive respiratory failure on
speed characteristics of inhalation and exhalation.
Structurally, the peak flow meter is a metal tube, which put on a removable
treated with sterile plastic tips and patient alternately makes the most energetic
inhalation and exhalation. Passing through a metal pipe air enters the recording unit
block, which is determined by the rate of air flow of inhalation and exhalation.
Preparation of a peak flow meter: removable plastic tips (mouthpieces) are
soaked in 0.5% solution hloromin 2 hours, rinsed with distilled water and cleaned with
alcohol.
Bronchoscopy is a modern method for using the flexible fibreoptic inspect the
mucous membrane of the trachea and bronchi branching, and if necessary to take to
study the washings of the bronchi and pieces of tissue for biopsy. Fibreoptic working
part consists of a flexible glass fiber fabric, in which an image of the internal structures
of the respiratory tract is carried out by optical fibers to the eyepiece-endoscopist
doctor. Due to the flexibility of working part of modern bronchoscopy allow to inspect
the bronchi clearance to level 4-5. A special biopsy channel brushes are introduced
into the bronchoscope and biopsy forceps, which made fence biopsy material.
Bronchography is radiographic method using a contrast agent which allows to
identify deformation or constriction on the contrary, extension (bronchiectasis)
bronchi.
After anesthesia of the upper airway into the trachea and then central bronchus
right or left sterile rubber catheter is inserted, and through it - the contrast medium
that fills the bronchi. After that, the X-ray light.
6. LITERATURE
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Oslopov, OV Epiphany. - M .: GEOTAR - Media 2008.
2. Fundamentals of nursing: Ouch. Benefit / LV Roman'kov [et al.]. - Minsk:
Elaida, 2012. - 200 p.
3. Basics of therapeutic care patients: Ouch. Benefit / KN Sokolov [et al.]. Grodno, 2016. - 252 p.
4. comb, AL .. Bases of general nursing: Textbook. / AL Comb, AA Sheptulin. M .: Medicine, 1991. - 256 p.
5. Murashko VV .. General nursing: Textbook. / VV Murashko, EG Shuganov,
AV Panchenko- M .: Medicine, 1998. - 224 p.
6. Mukhina, SA General nursing. / SA Mukhina, II Tarnovskaya. - M .:
Medicine, 1989. - 326 p.
Head of the department of Internal Diseases No.1
with Endocrinology Course,
PhD, assist. of Professor
E.G. Malaeva