Home Tooth pain Inhalation method of administration. Inhalation route

Tooth pain

Inhalation method of administration. Inhalation route

CHAPTER 26 TECHNIQUES OF DRUG ADMINISTRATION

The enteral route of drug administration, including oral and rectal, is of greatest importance in pediatric practice. In addition, without compromising the integrity of the skin medicines can be introduced into the body through inhalation, by application to the skin and mucous membranes, as well as medicinal electrophoresis (see section “Techniques for performing simple physiotherapeutic procedures”).

Administration of drugs by mouth. Children receive medications by mouth in the form of tablets, powders, capsules, solutions, emulsions, etc. Difficulties in taking medications by mouth include a possible negative reaction from the child, the presence of medications with an unpleasant odor or taste, tablets or pills big size. It is best for children to take medications by mouth in solution or suspension; When taking drugs in dry form, you have to crush them and dilute them with milk or syrup.

Do not mix several medications in one spoon.

For children infancy It is better to administer the entire prescribed dose of liquid medicine not at once, but in parts, in several spoons, being careful not to spill it.

The dose of the administered drug is determined by the doctor. There are doses prescribed for one dose - one-time, during the day - daily, for a course of treatment - course. The drug is prescribed per 1 kg of body weight or per 1 m2 of body surface, per 1 year of a child’s life. To eliminate possible errors and overdose, you need to know the approximate calculation of single dosages of medicines for children depending on age:

up to one year - 1/12 - 1/24 doses;

1 year - 1/12;

2 years - 1/8; 4 years - 1/6; 6 years - 1/4;

7 years - 1/3; 12-14 years -1/2;

15-16 years old - 3/4 of the adult dose.

Sublingual, medications are usually prescribed fast action. Moreover, these can be various dosage forms: tablets, capsules, solutions. Drugs taken under the tongue are not destroyed by enzymes of the digestive tract and quickly enter the bloodstream, bypassing the liver. Traditionally, validol and nitroglycerin tablets are given under the tongue if the child has a cardiovascular disease. You can apply 3-5 drops of valocardine solution to a piece of sugar and ask the child to hold this piece under the tongue without swallowing until completely dissolved.

Rectal administration of suppositories. The technique for inserting suppositories into the rectum in children is not fundamentally different from that in adults. A suppository with a medicine is inserted into the rectum usually in the morning (after spontaneous bowel movement or after a cleansing enema) or at night. It is necessary to explain to the child and/or his parents the technique of administering the suppository and provide general information about the drug. If there are other patients in the ward, then the sick child must be fenced off with a screen. Help or place the child on his side with his knees bent. Gloves are worn before the procedure. The child is asked to relax and lie down. Next, tearing the contour packaging along the notch, remove the suppository. Before using the suppository, you should moisten it with water at room temperature, which facilitates administration and further resorption. Spread the buttocks with one hand and insert the suppository into the anus with the other. After inserting the suppository, the child is asked to lie down in a position that is comfortable for him, preferably on his side, and lie down for 20 minutes. Next, the nurse takes off the gloves, removes the screen, fills out documentation about the procedure performed, and then monitors the child’s well-being and the presence of bowel movements for several hours.

Inhalations. In pediatric practice, treatment by inhalation of liquid and solid medicines sprayed into the air is widely used. There are steam inhalations, heat-moist inhalations, oil inhalations, and aerosols of medicines. Inhalations cause primarily local impact on mucous membranes respiratory tract, and the effect is largely determined by the degree of dispersion (grinding) of aerosols.

Types of inhalers. The effectiveness of treatment depends on the correct choice of drug delivery vehicle, taking into account the child’s age and clinical picture. With the correct combination of the drug and the method of its administration, the greatest therapeutic effect is achieved.

Inhalations are carried out using aerosol inhalers (AI-1, AI-2), steam inhalers (IP-2), metered-dose aerosol inhalers (MDI), universal inhalers designed for heat-moisture inhalations with solutions of liquid and powdery substances (“Aerosol” U-G, “Aerosol” U-2), ultrasonic aerosol devices (UZI-1, UZI-3, UZI-4, “Fog” and nebulizers various types), electric aerosol devices (“Electroaerosol”-G, GEI-1). Using aerosol inhalers, you can inhale medications, alkaline solutions, oils, and herbal infusions. The steam inhaler is equipped with a heat regulator to heat the aerosols to body temperature. In ultrasonic inhalers, the crushing of the drug is carried out by ultrasonic vibrations, the air flow is regulated at a speed of 2-20 l/min, the optimal aerosol temperature is 33-38 ° C. The choice of drug for inhalation is determined by medical indications (secretolytics, bronchodilators, anti-inflammatory drugs, etc.). In a medical facility, inhalations are carried out in a specially equipped room.

Metered inhalation technique. For inhalation of b2-agonist bronchodilators and inhaled glucocorticoids into the respiratory tract, portable MDIs are usually used. To obtain the optimal effect, strict adherence to the technique of using the inhaler is required. The child usually performs inhalation independently, for which he undergoes special training. Sequence of the procedure:

Remove the cap from the inhaler, holding the canister upside down;

Shake the inhaler before use;

Exhale;

Slightly tilting your head back, wrap your lips around the mouthpiece of the inhaler;

Take a deep breath while pressing the bottom of the inhaler;

At the height of inhalation, hold your breath (it is recommended not to exhale for 8-10 seconds after inhalation so that the drug settles on the walls of the bronchi);

Exhale slowly.

Main condition correct application MDI - synchronization of inhalation and pressing on the balloon (hand-lung maneuver).

When performing inhalations, the mouth and nose are closed with a socket, the bottle with the medicinal substance is positioned strictly perpendicularly, bottom up (Fig. 71). Children sometimes find it difficult to follow all instructions for using the inhaler correctly.

Rice. 71.Application of portable inhaler:

A - general form inhaler: 1 - damper; 2 - inhaler; 3 - reservoir; b - inhaler in action

Repeated inhalation is carried out after 1-2 minutes.

Most common mistakes committed when using MDI:

Forgetting to shake the inhaler before use;

The inhaler is held incorrectly (the canister should be positioned bottom up);

When performing inhalation, the head is tilted forward;

The child does not hold his breath at the height of inspiration;

Inhalation and pressing on the can occur asynchronously, and desynchronization of breathing and spraying occurs in 20-45% of observations;

Repeated inhalations are done without the required interval of 1-2 minutes.

Difficulties in performing the forced inhalation maneuver and synchronously pressing the inhaler canister can be overcome if you use a new type of inhaler - “ Easy breath» or a breath-activated inhaler. At the same time, the efficiency correct use with an inhaler increases by 2 times, especially in children.

Inhalation technique using the “Light Breathing” inhaler:

Open the inhaler cap;

Take a breath;

Close the inhaler lid.

Repeated inhalation begins with opening the inhaler cap. To activate the inhaler, you only need to open its cap and inhale the medicine. Exhalation before and after inhalation, holding your breath after inhalation are also necessary.

Let's pay attention to what you don't need to do:

1) shake the can;

2) place your finger on the grille of the upper part of the inhaler;

3) press the bottom of the inhaler synchronously with inhalation (there is no “hand-lung” maneuver).

An inhalation-activated inhaler has a serious advantage - simplicity of inhalation technique with reliable delivery of medicine to the bronchi. In children, the additional use of a spacer (equipped with a chamber valve) is recommended - a device that facilitates the use of the inhaler, reduces systemic absorption, and for inhaled corticosteroids, the number of side effects. Before using the spacer, you must ensure that it is compatible with your inhaler.

Prolonged inhalation technique. Another type of inhalation is prolonged. It can be difficult for children to correctly follow all the necessary recommendations, which determines the need for constant monitoring. The inhaler system is preliminarily set up. Before the procedure, the sick baby is usually wrapped or covered with a blanket, or held on his lap, holding his hands if necessary. The mouthpiece of the sprayer is applied to the mouth and nose area. The child’s cry is not an obstacle to the procedure; on the contrary, during the cry the child inhales the aerosol deeper. Older children wrap their lips around the mouthpiece of the nebulizer and inhale the medicinal mixture. Inhalation time is 5-10 minutes. Use

disposable replacement mouthpieces. If they are absent, after inhalation the mouthpiece is washed and sterilized.

Inhalations are usually carried out 1-1.5 hours after eating or physical activity. At severe symptoms for rhinitis and sinusitis, before the inhalation procedure, it is advisable to prescribe vasoconstrictors intranasally. The child should breathe deeply and evenly, taking a deep breath through the mouth, then hold the breath for 1-2 seconds and exhale completely through the nose. After inhalation, it is not recommended to drink, eat or talk for 1 hour, with the exception of inhalation hormonal drugs when, on the contrary, after the procedure you should rinse your mouth with water at room temperature. The course of treatment is 6-8-15 procedures.

Most typical mistakes when performing a prolonged aerosol therapy technique:

Failure to comply with prescriptions - reducing the duration of the procedure, temperature regime and etc.;

Unclear information to parents and the child about the rules of conduct during and after the procedure;

Combination various procedures in a number of sick children;

Switching the nurse's attention to something else during the procedure.

Children under 5 years of age must perform inhalations under the strict supervision of adults due to the almost obligatory errors in the technique of performing the procedure. The medical professional should take into account international data that in half of the cases patients do not fully comply with the recommendations.

To ensure the comfort of the procedure, inhalations are carried out at an air temperature of 18-20 ° C in a well-ventilated room. Failure to comply with the last rule often causes various allergic reactions among staff.

You should monitor the temperature of the aerosol, especially when inhaling an infant, as well as if the patient has bronchial hyperreactivity. At the optimal temperature (35-38 ° C), inhalates are well absorbed, the function ciliated epithelium is not violated. Hot inhalations (above 40 °C) suppress the function of the ciliated epithelium. Cold inhalations (below 25 °C) cause irritation of the mucous membrane of the respiratory tract and provoke an attack of reflex cough. As for the duration of the course of treatment, long-term inhalation even makes no difference.

high aerosols (more than 30 inhalations) can have a damaging effect on the aeration and surfactant system, cause swelling of the alveolar epithelium, and disrupt microcirculation processes.

A necessary condition for the safety of aerosol therapy is thorough disinfection of the equipment and all its parts, the use of individual masks and disposable mouthpieces, and their mandatory disinfection. To prevent nosocomial infections, the inhalation unit should be disassembled, washed and chemically disinfected after every 3-4 inhalations.

Aerosol devices should not become a source of nosocomial infections!

You cannot use faulty aerosol devices - in these cases, the characteristics of the aerosols do not correspond to the passport ones. In devices with pneumatic sprayers, the valves most often malfunction, the membrane is damaged, or the nozzle nozzle is clogged. In ultrasonic inhalers, effective spraying is often hampered by the formation of air bubbles in the contact medium at the boundary of the aqueous medium and incorrect calculation of the volume of sprayed liquid. A common malfunction of electric aerosol sprayers is the lack of electrification of particles.

There may be an underestimation of the interaction of drugs included in the composition. In this regard, it is prohibited to use inhalation drugs that are insoluble in water, for example, propolis, diazolin, sulfonamides, petroleum jelly or preparations prepared on its basis. Used in inhalations vegetable oils(eucalyptus, sea buckthorn, mint, etc.), are able to almost completely break down and be absorbed in the lungs. They, unlike petroleum jelly, have antiseptic, expectorant and odor-removing effects, and actively influence metabolism and reparative processes.

The effectiveness of inhalation depends on compatibility with other procedures. Previous physiotherapeutic effects, as a rule, contribute to the retention of drugs in the respiratory tract; the administration of therapeutic physical factors after inhalation accelerates the removal of the drug from the lungs.

In recent decades, pediatric practice has had to abandon inhalations of antibiotics, vitamins, ephedrine, menthol oil and many herbal infusions. This is due to both their low effectiveness and side effects on the health of medical personnel.

Fusafungin, which has unique antibacterial and anti-inflammatory properties, is of particular concern in pediatrics. The aerosol drug Bioparox (fusafungin) is produced in the form of a metered aerosol of 20 ml/400 doses and is used for children starting from 30 months (2.5 years) with acute respiratory infections of bacterial origin, complicated by sinusitis, pharyngitis, laryngotracheitis: on day 4 inhalations through the mouth and /or 4 inhalations in each nasal passage. Duration of treatment is 8-10 days.

Nebulizer therapy is considered the best way to deliver drugs to the respiratory tract. Nebulizer or compressor inhaler- a device for converting a liquid medicinal substance into a fine aerosol, which is carried out under the influence of ultrasound (ultrasonic nebulizer) or gas from an electric compressor or cylinder (jet nebulizer) (Fig. 72, a). In the solution supplied by a compressor, the drug is sprayed in the form of a wet aerosol with a particle diameter of 2-5 microns.

Nebulizer inhalations are possible in children usually from 1.5-2 years of age and do not require special coordination of breathing. To perform the procedure, the inhaler system is set up, the sick child is wrapped in a blanket and held on his knees, placing the mouthpiece of the nebulizer to the mouth and nose. Older children wrap their lips around the mouthpiece of the nebulizer and inhale the medicinal mixture. Use disposable mouthpieces. The technique for performing ultrasonic inhalation is the same as for prolonged inhalation (Fig. 72, b).

Rice. 72.Nebulizer therapy: a- ultrasonic inhalation

Rice. 72.Nebulizer therapy (end): b- type of modern jet nebulizers

Bronchodilators for nebulizer therapy are presented R 2 ~adrenergic agonists, anticholinergics and combination drugs. In the form of nebulas, the main bronchodilators for the treatment of bronchial asthma in children are used: salbutamol (Ventolin-nebulas, sterinebsalamol, salgim), fenoterol (Berotec), ipratropium bromide (Atrovent). Preparations of salbutamol and fenoterol contain 1 mg of the drug, ipratropium bromide - 250 mg in 1 ml of solution. Schemes for taking drugs through nebulizers:

1) 3 inhalations for 5-10 minutes with an interval of 20 minutes, then every 4-6 hours until the attack stops;

2) continuous inhalation of the drug into daily dose 0.5-0.8 mg/kg (rarely used in domestic practice).

For tonsillitis, pharyngitis, bronchitis of bacterial origin, pneumonia, cystic fibrosis through nebulizers in Lately According to indications, mucolytics or drugs to thin the sputum were administered: ambroxol hydrochloride (lazolvan, ambrobene), acetylcysteine (ACC, mucomyst, fluimucil), bromhexine (bisolvone). These drugs break the polymer bonds in the components of sputum, reducing its viscosity and mucus production, but in large doses they can lead to bronchospasm and reflex cough. Thus, fluimucil inhalations are used in a dose of 300 mg (1 ampoule) 1-2 times a day for 5-10 days. For the same purpose, inhalation administration of physiological ras-

tvor (0.9% sodium chloride solution) or even mineral water such as “Moskovskaya”, “Polyana Kvasova”, “Borjomi”. Prescribe 2-3 ml ( mineral water must first be degassed) 3-4 times a day.

For nebulizer therapy special indications use antibacterial agents - antituberculosis and antifungal drugs wide range actions, as well as antiseptics. Nebulizer therapy with antibiotics is possible only after identifying the sensitivity of the pathogenic microflora and the absence of increased individual sensitivity. The course of treatment is 7-10 days. With aerosol therapy antibacterial drugs A trial inhalation is carried out in half a single dose. With normal tolerability, repeated inhalation includes the full dose of the drug, but lower than with parenteral administration. Most often, inhalations are carried out with a 4% solution of gentamicin (2 ml of ready-made solution), amikacin (2 ml or 100 mg in solution), 10% isoniazid solution (diluted in a 1:1 ratio, 2 ml 1-2 times a day), amphotericin B (25,000- 50,000 units per inhalation 1-2 times a day).

The disadvantages of nebulizer therapy remain its high cost, the need for frequent cleaning of devices, and the small amount of drugs produced in the form of nebulizer solutions.

Devices for inhalation therapy bronchial asthma in children. They are represented by pressurized metered-dose inhalers (PDIs), breath-activated MDIs, powder inhalers (PDIs) and nebulizers. MDIs are best used with additional special spacers, which are a plastic tube with an inhaler attachment and a mouthpiece. Cyclohalers and diskhalers are used to deliver dry powder into the respiratory tract.

A suitable device is selected individually for a sick child:

For children under 4 years of age, it is better to use a DID plus a spacer or nebulizer with face masks;

At the age of 4 to 6 years, use a DAID plus a spacer with a mouthpiece, a PI or, if necessary, a nebulizer with a face mask;

In children over 6 years of age, if difficulties arise in using a DAID, it is necessary to use a DAID with a spacer that activates

inhaled MDI, PI or nebulizer. The use of PIs requires respiratory effort, which makes them difficult to use during severe attacks; for severe asthma attacks, it is recommended to use a DAI

with a spacer or nebulizer. For ease of drug delivery into the respiratory tract, we have developed various means Specifically, the medicine is injected into a spacer from an inhaler and then gradually inhaled by the child. A spacer must be used for the administration of bronchodilators (salbutamol), as well as inhalation of corticosteroids (Fig. 73).

Rice. 73.Sequence of spacer use

The advantages of using a spacer are as follows:

No irritation to the respiratory tract;

The inhalation technique is simplified, since there is no need to synchronize inhalation with the moment of drug administration, which is especially difficult for children;

Less medication is retained in the mouth and pharynx;

The medicine penetrates into the respiratory tract much deeper than without the use of a spacer.

Inhalers for administering powder forms of drugs. They have a number of advantages - they can be used without a carrier substance (freon), which irritates the mucous membranes. Large quantities of the drug can be administered this way; Strict control of the doses of the drug taken is possible, thereby preventing overdose. The most common types of inhalers are: dischaler, aerolizer, spinhaler, inhaler, etc.

For a dischaler, medications placed in discs (ventolin, flixotide) are used (Fig. 74), for an aerolyzer - capsules (formoterol, etc.) (Fig. 75).

Rice. 74. Diskhaler

Rice. 75.Aerolizer application:

a - removing the cap; b - turning the mouthpiece (opening the container); c - filling the capsule; g - reverse rotation of the mouthpiece (closing the container); d - pressing the button to release the powder from the capsule; e - “Aerolyzer” in action

For inhalation delivery of formoterol (Foradil), a special type of inhaler is used - an aerolyzer, which has a number of features:

Low resistance (less effort required when inhaling);

Quite high pulmonary deposition of the drug;

No coordination of inhalation with device activation is required;

The completeness of inhalation is controlled by taste sensations and the degree of emptying of the capsule.

The "Spinhalera" type nebulizer is intended for inhalation of Intal (cromolyn sodium), produced in capsules. A capsule containing the powder is inserted into the propeller yellow end down. Very important correct technique performing inhalation. It requires the child to actively inhale forcefully through the Spinhaler and briefly hold the air before exhaling. A necessary requirement is to inhale with your head thrown back, since otherwise up to 90% of the drug remains in the throat. The effect of using intal as an antiallergic drug appears only if all the rules for inhaling the drug are observed.

The rules for using Spinhaler are as follows:

1. Take a deep breath.

2.Tilt your head back slightly.

3.Place your lips tightly around the mouthpiece of the inhaler and take a deep, sharp breath.

4.Hold your breath for 10 seconds.

5.In order for the capsule to be completely emptied, you need to inhale as described in steps 1-4, up to 4 times.

6.After inhalation, you need to examine the child’s oral cavity. If a lot of powder has settled on the tongue and mucous membrane of the mouth, it means that there were errors during inhalation (weak inhalation, the head is not thrown back, the Spinhaler is clogged with powder and requires cleaning).

The inhaler, like the aerolyzer, is designed to inhale powder from a capsule; the principles of their operation are similar.

Administration of drugs through the skin and mucous membranes. For this purpose they are used various techniques: rubbing, lubricating, using ointment, wet-dry dressings, introducing medications into the nose, ear, conjunctival sac.

Rubbing in medicines usually carried out in healthy skin, but with such skin diseases like scabies, nesting

alopecia (baldness), etc., possibly in the affected areas of the skin. When rubbing the medicine into the scalp area, the hair is first shaved.

The rubbing technique is as follows: before starting the procedure, thoroughly wash your hands with soap, put on gloves, apply a small amount of the medicinal substance to the skin, distribute it evenly over the surface, then rub it in with circular and longitudinal movements of your fingers until the skin surface feels dry.

Lubrication- applying ointment, paste, or mash to the affected areas of the skin. The ointment is applied to the skin using a spatula or gauze pad and carefully distributed in an even layer. The paste is also applied to the skin. When applying the paste to scalp hair is shaved off beforehand. The mash must be shaken before lubricating. The medicinal suspension is applied to the affected areas of the skin with a cotton or gauze swab.

Ointment dressings applied if prolonged exposure to the drug is necessary. A small amount of ointment is applied to a gauze pad or directly to the affected area, covered with compress paper, then with cotton wool. Then the bandage is tightly fixed with a bandage.

Wet-dry dressings used in children for acute inflammatory diseases skin accompanied by weeping (eczema, etc.). Sterile gauze napkins, folded in 8-10 layers, are moistened with a medicinal solution, wrung out and applied to the inflamed area of skin, covered with compress paper and bandaged. Cotton wool is usually not added to slow down the drying rate. If the bandage has dried out and does not come off on its own from the damaged skin, it must be soaked with the same medicinal solution that was used previously.

Putting drops into the nose. The drug is applied to the nasal mucosa in drops using a pipette. Before administering the drops, the child’s nose is cleared of mucus and crusts: for children early age- using a cotton wick, and older children blow their nose, freeing the right and left nasal passages in turn.

It is more convenient for a child to instill drops with the assistance of an assistant. The assistant (mother) holds the child in a semi-lying position, fixing the arms and, if necessary, the legs of the child. For an older child, drops can be administered while he or she is lying down

or sitting with your head thrown back. The medicine is drawn into a pipette or an individual dropper bottle is used (for example, “Pinosol”), the tip of the child’s nose is fixed or slightly raised, the head is tilted to the side: when the medicine is administered into the right nasal passage, it is tilted to the left, and vice versa. Trying not to touch the nasal mucosa with the pipette, inject 2-3 drops of the drug. Leave the child's head in the same position for 1-2 minutes to ensure uniform distribution of the drug throughout the mucous membrane. Next, drops are administered in the same sequence into the other nasal passage.

Attention! An isotonic solution of sodium chloride can be prepared ex tempore, including at home: add table salt to a glass of water (200 ml) on the tip of a table knife.

Less commonly, the drug is administered into the nose using insufflator(powder blower). The procedure must first be explained to the child and his parents. At the moment of insufflation, it is necessary that the child first hold his breath if possible, and then “suck” part of the powder into his nose. Nurse clarifies the child’s well-being and removes the remaining powder from the nose with a napkin.

Putting drops into the ear. Before introducing drops into the external ear canal medicinal solution preheated to body temperature. Clean the external auditory canal with a cotton swab and place the child on his side with the affected ear facing up. Prepare the pipette. Drops are instilled after straightening the external auditory canal, for which purpose in a young child with the left hand auricle pull it down a little, for older children - down and to the side. Usually 5-6 drops of medicinal solution are administered. After instillation, the patient’s position must be maintained for 10-20 minutes. In the future, they observe the child and ask about his well-being.

Putting drops into the eyes. Drops into the conjunctival sac of the eye are often prescribed to newborns and infants. To perform the procedure, you need to prepare a pipette, sterile cotton balls, and eye drops. It is advisable to make sure once again that the bottle of medicine is children's eye drops. The pipette must be washed and sterilized by boiling before use. It is necessary to ensure that the medicinal solution drawn into the glass end of the pipette does not fall into the rubber container. The pipette should be kept strictly vertical when filling. With your left hand you need to pull the lower eyelid or if the child

reflexively squeezed the eyelids, spread them, with the right hand, pressing on the rubber balloon, introduce 1-2 drops of the medicinal solution into the conjunctival sac (Fig. 76, a). Often, drops can be placed into the eyes only with the participation of an assistant, who holds the child’s head in the required position and fixes the arms and legs. Then the child is asked to close his eyes, blot the edges of the eyelids with a ball from the outside to the inner corner of the eye. All steps are repeated if there is a need to drop drops into the other eye.

Rice. 76.Instilling drops into the eye (a) and placing the ointment behind the eyelid (b). Explanation in the text

After use, pipettes must be cleaned, disinfected and sterilized. Eye drops are available with a pipette attachment.

Putting the ointment into the conjunctival sac. This normal procedure for inflammatory diseases of the conjunctiva. The ointment can be administered directly from the tube or using a special glass rod, one end of which is flattened in the form of a spatula (Fig. 76, b). Before use, the glass rod is sterilized by boiling. An assistant helps to stabilize a young child. Using a glass rod, take a small amount (about the size of a pea) of eye ointment and inject it into the outer corner of the conjunctival sac, and in case of diseases of the eyelids, apply it to the diseased area. After this, the child’s eyes are closed and the eyelids are lightly massaged. The child should be given a clean cotton ball to remove ointment leaking from under closed eyelids. If necessary, apply the ointment to the lower eyelid of the other eye, repeat all steps.

The use of ear phytocandles and phytofunnels. Relatively new method treatment and prevention of ENT diseases (rhinitis, otitis, sinusitis, etc.), as well as removal sulfur plugs. The composition of classic ear phytofunnels includes beeswax and essential oils(cinnamon, eucalyptus, clove, lavender); The composition of the children's phytofunnel contains only beeswax. The “No drops” protective sleeve ensures safety; the absence of essential oils in children's forms reduces the risk of allergic reactions.

The procedure is performed with the child lying on his side. The auricle is massaged. Next one end ear candle(phytofunnels) are brought to the lighter, and after the fire flares up, the opposite free edge is inserted into the external auditory canal of the sick child. The burning candle is fixed in strict vertical position and is maintained throughout the entire procedure. Warm air coming from a burning candle provides gentle heating of tissues, a complex effect - analgesic and anti-inflammatory effects. When the flame reaches a special mark, the candle is extinguished in water (a glass of water is prepared in advance). After warming up, the auricle is wiped with a cotton swab on a stick, then a dry cotton swab is inserted into the external auditory canal. If necessary, repeat the procedure on the other side.

General care for children: Zaprudnov A.M., Grigoriev K.I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.

(pocket inhaler, spacer, nebulizer).

Inhalation method administer medicinal substances for both local and systemic effects: gaseous (oxygen, nitrous oxide); vapors of volatile liquids (ether, fluorotane); aerosols (a suspension of tiny particles of solutions).

Use pocket inhaler Can be done in a sitting or standing position.

Sequence of using a pocket inhaler:

1.Remove the protective cap from the mouthpiece of the aerosol can.

2.Turn the can upside down and shake it well.

3.Ask the patient to exhale deeply.

4. Explain to the patient that he must tightly clasp the mouthpiece with his lips and take a deep breath, while simultaneously pressing the valve of the can; After inhaling, the patient should hold his breath for a few seconds.

5.After this, ask the patient to remove the mouthpiece from the mouth and exhale slowly.

After inhaling glucorticoids, the patient should rinse their mouth with water to prevent the development of oral candidiasis.

Spacer is a reservoir - an adapter from the inhaler to the mouth, where the drug particles are suspended for 3-10 seconds. Benefits of using a spacer: reduced risk of local side effects; the possibility of preventing systemic exposure to the drug, because non-exhaled particles settle on the walls of the spacer, and not in the oral cavity; possibility of prescribing high doses of drugs.

Nebulizer– a device for converting a solution of a medicinal substance into an aerosol under the influence of a compressor or ultrasound to deliver the drug directly to the bronchi. For inhalation, use a face mask or mouthpiece.

Advantages of using a nebulizer: the ability to continuously supply the drug for a certain time; no need to synchronize inhalation with the arrival of the aerosol, which makes it possible to use it when treating children and elderly patients, as well as during an attack of suffocation; the possibility of using high doses of the drug with minimal side effects.

35.Insertion of a gas outlet tube.

Target: removal of gases from the intestines during flatulence.

Necessary equipment: sterile exhaust tube, spatula, Vaseline, tray, vessel, oilcloth, diaper, napkins, gloves, container with disinfectant solution.

Procedure to complete:

1. Prepare for the procedure: wash your hands, put on a mask and gloves.

2.Ask the patient to lie on his left side and pull his legs towards his stomach.

3. Place an oilcloth under the patient’s buttocks and lay a diaper on it.

4. Place a vessel filled one third with water on a chair next to the patient.

5.Lubricate the rounded end of the tube with Vaseline for 20–30 cm, using a spatula.

6. Bend the tube in the middle, clamping the free end ring finger and little finger right hand and gripping the rounded end like a writing pen.

7.Spread your buttocks and lungs rotational movements carefully insert into the tube to a depth of 20–30 cm.

8. Lower the free end of the tube into the vessel and cover the patient with a blanket.

9.After an hour, carefully remove gas outlet pipe from the anus.

10.Place the gas outlet tube in a container with a disinfectant solution.

11. Toilet the anus (wipe with a damp cloth).

36.Rules for applying an arterial tourniquet. Execution order:

1.A tourniquet is applied above the bleeding site through a pad.

2. Stretch the tourniquet and circle it around the limb 2-3 times, secure the free ends of the tourniquet.

3.Check the correct application of the tourniquet by the cessation of bleeding, disappearance of the pulse, and pallor of the limb.

4. Make a note about the date and time the tourniquet was applied. Place a note under the tourniquet.

5.A tourniquet is applied for 30 minutes - 1 hour. After 30 minutes, the tourniquet must be loosened for 3–5 minutes, at this time the bleeding vessel should be pressed with a finger, then the tourniquet should be tightened again, slightly shifting the tourniquets, for another 30 minutes.

37. Finger pressure of the arteries (carotid, subclavian, axillary, brachial, femoral).

Finger pressure of the arteries is used in cases where it is necessary to urgently stop bleeding, but applying a tourniquet is not possible.

1. The carotid artery is pressed against the transverse process of the 6th cervical vertebra at the level of the middle of the sternocleidomastoid muscle.

2. The subclavian artery is pressed to the first rib in the supraclavicular fossa outward from the place of attachment of the sternocleidomastoid muscle to the manubrium of the sternum.

3. The axillary artery is pressed to the head humerus in depth armpit, bend the victim’s arm at the elbow joint and place the palm behind the head.

4.The brachial artery is pressed against the inner surface of the humerus at the inner edge of the biceps muscle.

5. The femoral artery is pressed against the horizontal branch of the pubic bone midway between the anterior superior iliac spine and the symphysis.
38. Taking a swab from the nose and throat.

A sterile metal swab is used (a cotton swab attached to a wire and passed through a stopper into a sterile test tube). For culture, they take discharge from ulcers or plaque from the tonsils.

To take a nasal swab brush without touching outer surface nose, insert first into one nasal passage, and then into the other, and take material for sowing. After taking swabs, they should be sent immediately to the laboratory, indicating the patient's name, age, room number, department name, date, name of the material and purpose of the study.

Taking a swab from the throat.

1. Lay out the necessary equipment (sterile swab in a test tube with a stopper, spatula), put on gloves.

2.Sit the patient in front of the light source and ask him to open his mouth wide.

3.Press the root of the patient’s tongue with a spatula.

4. Remove the swab from the test tube by the outer part of the test tube and, without touching the mucous membrane of the oral cavity, pass the swab along the arches and palatine tonsils.

5. Without touching the outer surface of the test tube, insert the swab with the material for inoculation into the test tube.

6.Fill out the form and send the test tube to the laboratory.

Indirect cardiac massage is rhythmic pressure on the victim’s sternum to restore blood circulation. Before performing a cardiac massage, you can perform one or two precordial blows with a fist on the sternum in the area of the border of the middle and lower thirds of the middle force with an arm swing from a distance of 20-30 cm from the surface of the body.

For indirect massage of the heart, stand on the side (preferably on the left) of the victim and place your straightened arms on the lower third of the sternum (two to three transverse fingers above the xiphoid process of the sternum) so that the hands placed on top of each other at an angle of 90 o form a cross. Fingers should not touch chest the victim. The hands should not be torn off from the chest and moved to the side. Apply pressure with quick thrusts to a depth of 4–5 cm, using not only the efforts of your hands, but also your body weight. The rate of indirect cardiac massage is 100 compressions per minute.
40. Pre-sterilization treatment of instruments.

Used reusable instruments are subject to pre-sterilization treatment, which is carried out in 2 stages:

Disinfection;

Cleaning.

Disinfection carried out with the aim of destroying pathogenic and conditionally pathogenic microorganisms (except for spore forms of bacteria).

1% of products from a batch of one name processed in one work shift (but not less than 3 pieces) are subject to control.

42. Sterilization quality control.

1.Physical control method– instrument readings (control of temperature, pressure, processing time).

2.Chemical method– use indicators.

3.Biological method– use biotests with spore cultures of microbes.

To control the sterility of products, they are inoculated on nutrient media. If the products have big sizes or dimensions, then swabs are made from the product under strictly aseptic conditions, followed by inoculation of these swabs on nutrient media.
43.Routine cleaning of premises.

Wet cleaning of premises (cleaning floors, furniture, equipment, window sills, doors) should be carried out at least 2 times a day using detergents and disinfectants permitted for use in accordance with the established procedure.

Before you start disinfect furniture, equipment, taps, door handles, floors. Disinfection is carried out by wiping or irrigation. After cleaning using the wiping method, turn on the bactericidal lamp for 30 minutes.

After finishing work in the office, furniture, equipment, doors, door handles are treated with a rag moistened with a disinfectant solution, top part radiator, wash the floor. The bactericidal lamp is turned on for 30 minutes.

Marked cleaning equipment is disinfected in a disinfectant solution after cleaning, after which the rags are rinsed and dried.

44. Composition emergency first aid kit(Anti-HIV first aid kit) (in accordance with SP 3.1.5.2826 - 10).

70% ethanol 100 ml;

5% alcohol solution of iodine;

Bactericidal adhesive plaster;

Sterile dressing material (medical gauze napkins 14x16 - 2 packs, bandage - 1 pc.);

Scissors;

Disposable cup;

eye pipettes in a case – 4 pcs.
express test – 2 pcs. (located in the treatment room)

The first aid kit should be stored in a labeled metal container (along with approved instructions for its use in emergency situations).
45. First aid kit “Anti-HIV” (in accordance with SP 3.1.5.2826 - 10).

70% ethyl alcohol;

5% alcohol solution of iodine;

Patch;

Sterile dressing material;

Scissors;

Latex gloves.

The first aid kit should be stored in a labeled metal container (along with approved instructions for its use in emergency situations).

46. Prevention of HIV infection when the patient’s biological fluid gets on skin hands and mucous membranes of the oropharynx, nose and eyes of the nurse.

In accordance with SP 3.1.5.2826 - 10:

Treat gloved hands with a napkin moistened with a disinfectant, then wash under running water, remove gloves, wash hands and treat with skin antiseptic;
if the skin of the hands is contaminated with blood, serum, or patient secretions, treat the area with 70% alcohol, wash with soap and water and re-treat with 70% alcohol;
if the patient’s biological fluid gets on the mucous membranes of the oropharynx, immediately rinse the mouth and throat with 70% alcohol or water;
when hit biological fluids the patient in the nose, the nurse must rinse the nasal mucosa with water;
If biological fluids get into your eyes, rinse them with plenty of water, do not rub them;
in case of cuts and punctures - immediately remove gloves, wash hands with soap and running water, treat with 70% alcohol, 5% alcohol solution iodine;
if the patient’s blood and biological fluids get on a gown or clothing, remove work clothes and immerse in a disinfectant solution;
Start taking antiretroviral drugs as soon as possible.

About the emergency that occurred medical worker must inform the head of the department and make an entry in the emergency log.

Literature

Andreeva T.A. General nursing care: tutorial M: RIOR, 2005.
Davlitsarova K.E., Mironova S.N. Manipulation technology Forum, M. 2005.
Zalikina L.S. Nursing MIA 2008
Mukhin N.A., Moiseev V.S. Propaedeutics of internal diseases GEOTAR - Media, M. 2009.
Mukhina S.A., Tarnovskaya I.I. General nursing M.: Medicine 2011.
Oslopov V., N., Bogoyavlenskaya O.V. General care for patients in the therapeutic clinic GEOTAR - Media M. 2009.
Pautkin Yu.F. Elements of general nursing care M.: RUDN publishing house, 2003.
SP 3.1.5.2826 – 10 Prevention of HIV infection. 2011
SanPin 2.1.3.2630 – 10 Sanitary and epidemiological requirements for organizations engaged in medical activities.
SanPin 2.1.7.2790 -10 Sanitary and epidemiological requirements for the management of medical waste.

For various diseases of the respiratory tract and lungs, drugs are administered directly into the respiratory tract. In this case, the medicinal substance is administered by inhalation - inhalation (lat. inhalatum - breathe). When administering drugs into the respiratory tract, you can

produce local, resorptive and reflex effects.

Medicinal substances with both local and systemic effects are administered by inhalation:

Gaseous substances (oxygen, nitrous oxide);

Vapors of volatile liquids (ether, fluorotane);

Aerosols (a suspension of tiny particles of solutions).

bronchi. After vigorous shaking, the inhaler should be turned upside down. Having exhaled deeply, at the very beginning of the inhalation the patient presses the canister (with the inhaler in the mouth or using a spacer - see below), then continuing to inhale as deeply as possible. At the height of inhalation, you should hold your breath for a few seconds (so that the particles of the drug settle on the walls of the bronchi) and then calmly exhale.

Spacer is a special chamber-adapter from the inhaler to the mouth, where the drug particles are suspended for 3-10 s (Fig. 11-1). The patient can make the simplest spacer himself from a sheet of paper rolled up into a tube, about 7 cm long.

The advantages of using a spacer are as follows.

Reduced risk of local side effects: for example, cough and oral candidiasis with inhaled use of glucocorticoids.

The ability to prevent systemic exposure to the drug (its absorption), since non-inhaled particles settle on the walls of the spacer and not in the oral cavity.

Possibility of prescribing high doses of drugs during attacks of bronchial asthma.

Nebulizer. In the treatment of bronchial asthma and chronic airway obstruction, a nebulizer (lat. nebula - fog) - a device for converting a solution of a medicinal substance into an aerosol for delivering the drug with air or oxygen directly into the bronchi of the patient (Fig. 11-2). The formation of an aerosol is carried out under the influence of compressed air through a compressor (compressor nebulizer), which turns the liquid drug into a foggy cloud and supplies it with air or oxygen, or under

influence of ultrasound (ultrasonic nebulizer). To inhale the aerosol, use a face mask or mouthpiece; the patient does not make any effort.

The benefits of using a nebulizer are as follows.

Possibility of continuous supply of the drug for a certain time.

There is no need to synchronize inhalation with the supply of aerosol, which allows the nebulizer to be widely used in the treatment of children and elderly patients, as well as in severe asthma attacks, when the use of metered aerosols is problematic.

Possibility of using high doses of the drug with minimal side effects.

Steam inhalations.

In the treatment of catarrhal inflammation of the upper respiratory tract and sore throats, it has long been used. steam inhalations using a simple inhaler.

A stream of steam generated in a heated water tank is ejected through the horizontal tube of the nebulizer and rarefies the air under the vertical elbow, as a result of which the medicinal solution from

cup rises through a vertical tube and is broken into tiny particles by steam.

Steam with drug particles enters a glass tube, which the patient takes into his mouth and breathes through it (inhaling through the mouth and exhaling through the nose) for 5-10 minutes. At home, instead of an inhaler, you can use a kettle, into the spout of which you insert a paper or plastic

a tube; inhalation is carried out through the mouth. Herbal infusions, 3% sodium bicarbonate solution ( baking soda) and/or natural mineral water "Borjomi".

IN steam inhaler The drug particles are quite large, and therefore they settle on the mucous membrane of the upper respiratory tract, without reaching the lungs. To obtain an aerosol with smaller particles (reaching the alveoli), inhalers are used with complex spray devices, but based on the same principle of a spray angle. To form an aerosol, instead of steam, air or oxygen is used, which is pumped into the horizontal tube of the sprayer under different pressure, and along the vertical

The tube raises a medicine (for example, a solution of benzylpenicillin), which the patient inhales for a certain time until he receives the dose prescribed to him.

In some cases, the “chamber” method is used inhalation administration medicinal substance - when a whole group of patients inhales a drug sprayed in the inhalation room.

Wet wipe

Equipment: oilcloth, diaper, kidney-shaped tray, warm water, 6% table vinegar or alcohol, large napkin or towel, replacement underwear and bed linen, gloves.

Establish a friendly, confidential relationship.
Wash your hands, dry them, put on gloves.
Place an oilcloth with a diaper under the patient.
Pour warm water into the tray (you can add a tablespoon table vinegar per 1 liter of water or alcohol).
Expose the patient's upper body.
Wet a napkin or part of a towel by squeezing it lightly.
Wipe the patient in the following sequence: face, neck, arms, back, chest.
Wipe the patient's body with the dry end of the towel in the same sequence and cover with a sheet.
Wipe your stomach, thighs, and legs in the same way.
Trim your fingernails (if necessary).
Change underwear and bed linen (if necessary).
Remove gloves.
Wash and dry your hands.

Installation of mustard plasters

Goal: achieve analgesic and anti-inflammatory effect.

Equipment: mustard plasters, tray with water (temperature 40-45°C), tray for waste material, towel, gauze napkins, thermometer for measuring water temperature, clock.

Preparation for the procedure

Examine the patient’s skin at the site where the mustard plasters were placed. Make sure that there are no contraindications: skin diseases, tumors of various etiologies, allergic reactions to essential oils, hyperthermia.
Check the quality of mustard plasters. Before use, you should check the expiration date: suitable mustard plaster has a pungent smell of mustard oil and does not crumble.
Measure the temperature of the water for wetting the mustard plasters (temperature 40-45°C). Cannot be used for mustard procedures hot water, since it destroys the mustard enzyme and mustard oil will not be released.

Executing the procedure

Soak mustard plaster in water for 5 seconds each.
Shake off and apply the mustard plaster to the desired area of skin, mustard side down, and place a towel on top.

Places for placing mustard plasters:

A) circular – on the chest area, except mammary gland, nipples;

B) collar - on the area of the upper shoulder girdle with hypertensive crisis;

C) on the heart area - for pain in the heart in women - around the mammary gland, in men - except for the nipples, as well as at the site of pain projection (usually on the sternum area).

3. Cover the patient with a blanket.

4. Keep mustard plasters for 10-15 minutes.

End of the procedure

Remove the mustard plasters and throw them into a waste tray. At hypersensitivity(appearance of an unbearable burning sensation in the first or second minutes).
Wipe the patient's skin with a damp, warm gauze cloth and wipe dry. Exclude allergic reaction and if it is absent, gauze moistened with water and wrung out should be placed between the mustard plasters and the skin. It is strictly forbidden to place mustard plasters on paper, as this will lose the direct irritant effect of mustard oil on the skin.
Help put on underwear and put them in a comfortable position.
Cover the patient, recommend bed rest (30-60 minutes).

Oxygen therapy (supply of humidified oxygen from an oxygen cushion)

Goal: increasing oxygen in tissues.

Equipment: oxygen cushion containing 100% oxygen, funnel (mouthpiece); gauze napkin folded in 4 layers; container with disinfectant solution (3% chloramine solution); drinking water or defoamer (antifomsilan 10% or ethyl alcohol 96%).

Preparation for the procedure

Fill the pillow with oxygen from an oxygen cylinder:

Connect the rubber tube of the cushion to the oxygen cylinder reducer;

Open the valve on the pillow tube, then on the cylinder.

Fill the pillow with oxygen;

Bury the valve on the cylinder, then on the pillow;

Disconnect the rubber tube from the cylinder reducer;

Connect the mouthpiece to the pillow tube.

2. Moisten a cloth in water or defoamer. The defoamer is 20% ethyl alcohol or antifomsilane.

3. Wrap the mouthpiece (funnel) with a damp gauze cloth.

4. Remove mucus from the patient’s mouth and nose with a swab (or electric suction) before the procedure. The airways must be cleared.

Executing the procedure

Hold the mouthpiece (funnel) to the patient's mouth and open the valve on the pillow. The patient inhales the oxygen mixture through a mouthpiece (funnel) and inhales through the nose. In order to reduce the loss of oxygen during exhalation, its supply is temporarily stopped by squeezing the tube with your fingers or turning the tap on the tube.

(If the patient inhales through the nose, then the exit is through the mouth!)

Adjust the oxygen supply rate (4-5 liters per minute). Feed an oxygen mixture containing 80-100% oxygen for 15 minutes, if necessary, repeat the procedure after 10-15 minutes.
Press down on the pillow and roll it up from the opposite end until the oxygen is completely released.
Change the oxygen pillow.

End of the procedure

Remove the oxygen cushion, disconnect the mouthpiece (funnel). Monitor the patient's condition.
Place the napkin and mouthpiece (funnel) into the disinfectant solution. At home, you can boil it in a 2% solution of baking soda, or wipe the mouthpiece with 70% alcohol.

Diet No. 11

Indications: tuberculosis of the lungs, bones, lymph nodes, joints with a mild exacerbation or its subsidence, with reduced body weight; exhaustion after infectious diseases, operations, injuries; in all cases - in the absence of damage to the digestive organs. Options for diet No. 11 have been developed, taking into account the localization and nature of the tuberculosis process, the state of the digestive organs, and the presence of complications.

Purpose of purpose: improving the nutritional state of the body, increasing its defenses, enhancing recovery processes in the affected organ.

general characteristics: a diet of high energy value with a predominant increase in the content of proteins, vitamins, minerals (calcium, iron, etc.), a moderate increase in the amount of fats and carbohydrates. Cooking and food temperature are normal.

Chemical composition and energy value: proteins 110–130 g (60% animal), fats 100–120 g (20–25% vegetable), carbohydrates 400–450 g; energy value 12.6-14.2 MJ (3000-3400 kcal); sodium chloride 15 g, free liquid 1.5 l.

Diet: 5 times a day; kefir at night.

Excluded foods and dishes: very fatty meats and poultry, lamb, beef and cooking fats; spicy and fatty sauces, cakes and pastries with a lot of cream.

Tests for the topic "»

1. What is the name of deep, noisy, rare breathing?

a) Cheyne Stokes breathing

b) Biot's respiration

c) stridor breathing

d) Kussmaul breathing

2. What is emphysema?

a) increased airiness of the alveoli

b) decreased elasticity of alveolar tissue

c) both

3. Explain why the patient’s neck veins swell during an attack of unproductive cough:

a) pressure in the pulmonary circulation increases

b) acute right ventricular heart failure develops

c) acute left ventricular heart failure develops

d) disruption of venous flow to the heart

as a result of increased intrathoracic pressure

e) relative tricuspid valve insufficiency develops

4. Explain why the patient “puffs” during an attack of unproductive cough:

a) this leads to the activation of additional respiratory muscles and easier exhalation

b) this leads to an increase in intrapulmonary pressure and a decrease in the manifestations of the mechanism of early expiratory bronchial closure

c) this leads to improved sputum discharge

d) it helps reduce bronchospasm

d) this bad habit patients who want to attract the attention of others

5. WHAT PULMONARY PATHOLOGY CAN BE ACCOMPANIED BY INCREASED CHEST RESISTANCE?

a) pneumonia

b) pleurisy

V) Chronical bronchitis

6. WHAT PULMONARY PATHOLOGY IS CHARACTERISTIC WITH INSPIRATIONAL DYSPNEA?

a) pneumonia

b) bronchial asthma

c) pleurisy

7. WHAT PULMONARY PATHOLOGY IS CHARACTERISTIC WITH EXPIRATORY DYSPNEA?

a) pleurisy

b) bronchial asthma

c) pneumonia

8. WHAT PULMONARY PATHOLOGY IS "RUSTY Sputum" CHARACTERISTIC?

a) bronchitis

b) focal pneumonia

V) lobar pneumonia

9. NATURE OF SMUTUM IN PATIENTS WITH BRONCHIAL ASTHMA?

a) in the form of “raspberry jelly”

b) foamy sputum

c) colorless, viscous

10. WHAT PULMONARY PATHOLOGY CAN BE OBSERVED BY A BARREL-SHAPED CHEST?

a) chronic bronchitis

b) pneumonia

c) pleurisy

11. HOW CAN THE SKIN COLOR CHANGE IN A PULMONARY PATIENT?

a) hyperemia

b) diffuse cyanosis

c) acrocyanosis

12. WHAT IS THE NORMAL BREATHING RATE?

a) 30-40 breaths per minute

b) 12-20 breaths per minute

c) 6-8 breaths per minute

13. SELECT COMPLAINTS CHARACTERISTIC FOR LUNG DISEASES:

a) hyperesthesia

b) cough

d) sputum discharge

d) increase in temperature

e) convulsions

g) difficulty breathing

h) shortness of breath

14. WHY IS IT NECESSARY TO TURN THE PATIENT’S HEAD UP WHEN PERFORMING ARTIFICIAL RESPIRATION?

A) For the convenience of providing medical care.

B) To create a good seal between the resuscitator’s mouth and the patient’s mouth (nose).

B) To ensure airway patency.

D) In order to create better conditions for blood circulation.

D) For the convenience of the patient.

15. HOW TO CHECK THE CORRECTNESS OF ARTIFICIAL RESPIRATION?

A) During the artificial respiration a pulse should appear.

B) During artificial inhalation, the chest should expand, and during passive exhalation, it should collapse.

B) During artificial inhalation, “inflating” of the patient’s cheeks is observed.

D) During artificial respiration, the color of the skin changes.

D) All of the above are true.

16. ALL MEASURES ARE INDICATED FOR PULMONARY BLEEDING EXCEPT:

A) ensuring complete rest for the patient;

B) giving a semi-sitting position with an inclination to the painful side;

B) applying a heating pad to the sore side of the chest;

D) applying an ice pack to the sore side of the chest;

D) administration of hemostatic drugs.

17. FOR GENERAL ANALYSIS THE following ARE SENT:

A) daily sputum;

B) sputum collected within 3 days by flotation;

B) fresh morning sputum collected in a clean spittoon;

D) fresh morning sputum collected in a Petri dish with a nutrient medium;

D) evening sputum.

Sample answersto the topic " Observation and care of patients with respiratory diseases »

1. d 2. c 3. d 4. b 5. b, c 6. a, c 7. b 8. c

9. c 10.a 11. b 12. b 13. b, d, e, g, h 14. c 15. b 16. c 17. c

Final control tests.

(situational tasks)

Task No. 1.

Patient K., 41 years old, a mechanic, was admitted to the department. Complaints of cough with a small amount of mucopurulent sputum, more in the morning. The patient has had a cough for 4 years. A year ago I suffered from pneumonia.

He has been smoking 20-25 cigarettes a day since the age of 20.

A) Damage to the pleura

Task №2

Patient L., 36 years old, worker, was admitted to the department. Complaints of cough with sputum production with an unpleasant putrefactive odor (about 250-300 ml per day). The cough worsens when the patient lies on the right side.

Upon examination, positive symptoms of “drum fingers” and “watch glasses” were revealed.

WHAT IS THE MOST LIKELY LOCATION AND NATURE OF THE PATHOLOGICAL PROCESS IN THE LUNG?

A) Damage to the pleura

B) Chronic inflammatory process in the bronchi

B) Purulent inflammatory process in the bronchi (bronchiectasis) or in the lung (abscess)

D) Isolated damage to the alveoli

D) Inflammatory damage to the alveoli and bronchi (bronchopneumonia)

Task №3

Patient 0., 32 years old, assembler, was admitted to the department. Complaints of severe pain in the right half of the chest, worsening with deep inspiration, and an increase in body temperature to 37.9 °C. The patient lies on the right side, the right half of the chest lags behind in the act of breathing.

WHAT IS THE MOST LIKELY LOCATION AND NATURE OF THE PATHOLOGICAL PROCESS IN THE LUNG?

A) Damage to the pleura

B) Chronic inflammatory process in the bronchi

B) Purulent inflammatory process in the bronchi (bronchiectasis) or in the lung (abscess)

D) Isolated damage to the alveoli

D) Inflammatory damage to the alveoli and bronchi (bronchopneumonia)

Task №4

Patient T., aged 50, engineer, was admitted to the department. Complaints of pain in the right half of the chest, aggravated by breathing, a quiet dry cough, accompanied by pain in the right half of the chest, an increase in body temperature to 37.5 ° C. Forced position - the patient lies on the right side, pressing the right half of the chest with his hand .

WHAT IS THE MOST LIKELY LOCATION AND NATURE OF THE PATHOLOGICAL PROCESS IN THE LUNG?

A) Damage to the pleura

B) Chronic inflammatory process in the bronchi

B) Purulent inflammatory process in the bronchi (bronchiectasis) or in the lung (abscess)

D) Isolated damage to the alveoli

D) Inflammatory damage to the alveoli and bronchi (bronchopneumonia)

Problem #5

Patient S, 49 years old, accountant, was admitted to the department.

He complains of an attack of suffocation that occurred 2 hours ago at home, a cough with a small amount of viscous glassy sputum.

INSPECTION: The condition is serious. The position is forced: the patient sits in bed, leaning on it with his hands. The chest is emphysematous. Number breathing movements- 14 per minute, exhalation is very difficult. Severe diffuse cyanosis and swelling of the neck veins are noted.

B) Spasm of small bronchi

Problem #6

Patient N., 56 years old, worker, was admitted to the department. Complaints of shortness of breath that occurs when physical activity(climbing stairs, brisk walking). No other complaints. Shortness of breath has been bothering the patient for 5-6 years. INSPECTION: Condition is satisfactory. Position active. The chest is emphysematous. Breathing is symmetrical.

WHAT IS THE MOST LIKELY CAUSE OF DYSPNOE?

A) Reduction of the respiratory surface of the lungs (lobar inflammatory compaction, atelectasis)

B) Decreased elasticity of the lungs due to emphysema

B) Spasm of small bronchi

D) Mechanical obstruction in the upper respiratory tract (larynx)

D) Mechanical obstruction in the trachea or large bronchus

Problem No. 7

Patient K., 34 years old, teacher, was admitted to the department.

Complaints of shortness of breath at rest, aggravated by physical activity, an increase in temperature to 37.9 °C, a cough with a small amount of “rusty” sputum, and pain in the right half of the chest associated with breathing. On examination, diffuse cyanosis and herpes are noted. The right half of the chest lags behind in the act of breathing. The number of respiratory movements is 36 per minute.

WHAT IS THE MOST LIKELY CAUSE OF DYSPNOE?

A) Reduction of the respiratory surface of the lungs (lobar inflammatory compaction, atelectasis)

B) Decreased elasticity of the lungs due to emphysema

B) Spasm of small bronchi

D) Mechanical obstruction in the upper respiratory tract (larynx)

D) Mechanical obstruction in the trachea or large bronchus

Task №8

Patient R., 68 years old, was taken to the clinic with complaints of bleeding from the mouth. The patient sits in bed, restless. Pallor of the skin is noted. The cough produces a moderate amount of scarlet, foamy blood. Reaction bleeding alkaline.

WHAT SYMPTOM DOES THE PATIENT HAVE?

Situational task No. 9

The victim is motionless and does not respond to calls. There is no visible breathing. Pulse on the radial and carotid arteries not determined. Take action!

Sample answers to problems:

1. B

2. IN

3. A

4. A

5. IN

6. B

7. A

8. Pulmonary hemorrhage

9. Lack of breathing and blood circulation indicates that the wounded person is dead.

14. List of topics on UIRS:

1. Types of oxygen therapy.

2. Types of inhalers and their use.

15. Literature:

Mandatory:

1. Grebnev A.L. , Sheptulin A.A., Khokhlov A.M. Fundamentals of general nursing. M.: Publishing house "Medicine" 2006

2. Oslopov V.N., Bogoyavlensky O.V. General patient care in a therapeutic clinic. –M.: GOETAR-MED. 1999

Additional:

3. Basikhina T.S., Konopleva E.L., Kulakova T.S. and etc. / Educational and methodological manual in Fundamentals of Nursing. GOU VUNMC Moscow – 2003

4. Grebenev A.L. Propaedeutics of internal diseases. - M.: Medicine, 2002

Methodological developments for students:

Lt;question1> What factors contribute to the occurrence of wind erosion? arid climate, increased wind conditions soil waterlogging

The measuring instrument is not subject to verification. What method is applicable to control its metrological characteristics?"6

Pharmacology: lecture notes Valeria Nikolaevna Malevannaya

2. Routes of administration medicinal substances

There are enteral and parenteral routes of administration of drugs. Enteral route– administration of the drug orally through the mouth ( per os), or orally; under the tongue ( sub lingua), or sublingually; into the rectum ( per rectum), or rectally.

Taking the drug by mouth. Advantages: ease of use; comparative safety, absence of complications inherent in parenteral administration.

Disadvantages: slow development therapeutic action, Availability individual differences in the speed and completeness of absorption, the effect of food and other drugs on absorption, destruction in the lumen of the stomach and intestines (insulin, oxytocin) or when passing through the liver.

Medicines are taken orally in the form of solutions, powders, tablets, capsules and pills.

Application under the tongue (sublingual). The medicine gets into big circle blood circulation, bypassing gastrointestinal tract and liver, starting to act after a short time.

Introduction into the rectum (rectally). A higher concentration of drugs is created than with oral administration.

Suppositories (suppositories) and liquids are administered using enemas. Disadvantages of this method: fluctuations in the speed and completeness of absorption of drugs, characteristic of each individual, inconvenience of use, psychological difficulties.

Parenteral route- This different kinds injections; inhalation; electrophoresis; superficial application of drugs to the skin and mucous membranes.

Intravenous administration (IV). Medicines are administered in the form of aqueous solutions.

Advantages: rapid entry into the blood; if a side effect occurs, it is possible to quickly stop the effect; the possibility of using substances that are destroyed and not absorbed from the gastrointestinal tract. Disadvantages: with long-term intravenous administration along the vein, pain and vascular thrombosis may occur, as well as the risk of infection with hepatitis B viruses and human immunodeficiency.

Intra-arterial administration (i.a.). It is used in cases of diseases of certain organs (liver, blood vessels of the limb), creating a high concentration of the drug only in the corresponding organ.

Intramuscular administration (IM). Aqueous, oily solutions and suspensions of medicinal substances are administered. Therapeutic effect occurs within 10–30 minutes. The volume of the administered substance should not exceed 10 ml.

Disadvantages: the possibility of the formation of local soreness and even abscesses, the danger of accidentally getting the needle into a blood vessel.

Subcutaneous administration. Aqueous and oil solutions are introduced. Solutions of irritating substances that can cause tissue necrosis should not be injected subcutaneously.

Inhalation. Gases (volatile anesthetics), powders (sodium cromoglycate), and aerosols are administered in this way. By inhaling the aerosol, a high concentration of the drug substance is achieved in the bronchi with minimal systemic effect.

Intrathecal administration. The medicine is injected directly into the subarachnoid space. Application: spinal anesthesia or the need to create a high concentration of a substance directly in the central nervous system.

Local application. To obtain a local effect, medications are applied to the surface of the skin or mucous membranes.

Electrophoresis is based on the transfer of medicinal substances from the surface of the skin to deep-lying tissues using galvanic current.

From the book Handbook of Nursing author Aishat Kizirovna Dzhambekova

From the book Latin for Doctors author A. I. Shtun

From the book Pharmacology: lecture notes author

Section 3 Use of medicinal substances Rules for prescribing, storing and distributing medicinal products B successful treatment patients must be observed correct dosage and intervals between the administration of drugs. Prescription of drugs is carried out daily by the senior

From the book Latin for Doctors: Lecture Notes author A. I. Shtun

Methods of administering medicinal substances You can apply the medicine externally through the skin and mucous membranes, by inhalation through the respiratory tract, orally through the mouth or rectum and by injection (parenterally) intradermally, subcutaneously, intramuscularly,

From the book Pharmacology author Valeria Nikolaevna Malevannaya

35. Trivial names of medicinal substances Some chemical compounds used as medicinal substances retain the same traditional semi-systematic names that they received in chemical nomenclature (salicylic acid,

From the book Bronchial asthma. Available about health author Pavel Alexandrovich Fadeev

1. Types of action of medicinal substances Pharmacodynamics deals with the study of the effect that medicinal substances have on the body. The action of a substance at the site of its administration before absorption into the general bloodstream is called local action, and the reaction

From the book Pocket Guide to Essential Medicines author author unknown

5. Absorption and distribution of medicinal substances Absorption of a medicinal substance is the process of its entry from the site of administration into the bloodstream, depending not only on the route of administration, but also on the solubility of the medicinal substance in tissues, speed

From the book Eco-Friendly Food: Natural, Natural, Living! by Lyubava Live

7. Side effect medicinal substances The following types of side effects and complications caused by drugs are distinguished: 1) side effects associated with the pharmacological activity of drugs; 2) toxic complications caused by

From the book Directory of Essential Medicines author Elena Yurievna Khramova

1. Trivial names of medicinal substances Some chemical compounds used as medicinal substances retain the same traditional semi-systematic names that they received in chemical nomenclature (salicylic acid,

From the author's book

5. Routes of administration of medicinal substances There are enteral and parenteral routes of administration of medicinal substances. Enteral route - administration of the drug orally through the mouth (peros), or orally; under the tongue (sub lingua), or sublingually; into the rectum (per rectum), or

From the author's book

6. Mechanism of action of drugs, doses of drugs The basis of the action of most drugs is the process of influencing physiological systems organism, expressed by changes in the rate of flow natural processes. Possible

From the author's book

Routes of drug administration exist various ways delivery of medications to the affected organ: through the gastrointestinal tract (taking tablets, etc.), intravenously, intramuscularly, etc. For bronchial asthma, the optimal way

From the author's book

Chapter 1. Routes of administration, doses, rules for taking medicines Methods and routes of administration of medicines What happens to the medicine in the body? Why is such a quantity needed? dosage forms? Why can’t everything be produced in the form of tablets or, for example,

From the author's book

Methods and routes of drug administration What happens to the drug in the body? Why are so many dosage forms needed? Why can’t everything be produced in the form of tablets or, for example, syrups? This section is dedicated to answering these questions.

From the author's book

Routes of entry of toxic substances into the human body There are three main ways of entry of toxins into the human body:? orally (through the mouth);? inhalation (through the respiratory system);? cutaneously (through

From the author's book

Routes of administration Most brief classification divides all drugs depending on the route of their administration into enteral and parenteral, i.e. administered through the gastrointestinal tract or by injection, respectively. There are several main

Inhalation method of administering medicinal substances - section Medicine, When Various Diseases Airways And Lungs Use Drug Administration...

Balloon metered aerosol preparations currently used most often. When using such a canister, the patient must inhale while sitting or standing, tilting his head back slightly so that the airways straighten and the drug reaches the bronchi. After vigorous shaking, the inhaler should be turned upside down. Having exhaled deeply, at the very beginning of the inhalation the patient presses the canister (with the inhaler in the mouth or using a spacer - see below), then continuing to inhale as deeply as possible. At the height of inhalation, you should hold your breath for a few seconds (so that the particles of the drug settle on the walls of the bronchi) and then calmly exhale.

Reduced risk of local side effects: for example, cough and oral candidiasis with inhaled use of glucocorticoids.

The ability to prevent systemic exposure to the drug (its absorption), since non-inhaled particles settle on the walls of the spacer and not in the oral cavity.

Possibility of prescribing high doses of drugs during attacks of bronchial asthma.

Nebulizer. In the treatment of bronchial asthma and chronic airway obstruction, a nebulizer (lat. nebula - fog) - a device for converting a solution of a medicinal substance into an aerosol for delivering the drug with air or oxygen directly into the bronchi of the patient (Fig. 11-2). The formation of an aerosol is carried out under the influence of compressed air through a compressor (compressor nebulizer), which turns the liquid drug into a misty cloud and delivers it along with air or oxygen, or under the influence of ultrasound (ultrasonic nebulizer). To inhale the aerosol, use a face mask or mouthpiece; the patient does not make any effort.

The benefits of using a nebulizer are as follows.

Possibility of continuous supply of the drug for a certain time.

There is no need to synchronize inhalation with the arrival of an aerosol, which allows the widespread use of a nebulizer in the treatment of children and elderly patients, as well as in severe asthma attacks, when the use of metered aerosols is problematic.

Possibility of using high doses of the drug with minimal side effects.

End of work -

This topic belongs to the section:

Methods of using medicines

External use of medications is designed mainly for their local action through intact skin, they are absorbed only.. administration of medications into the ears.. medications are instilled into the ears with a pipette, see the ear care section in the chapter oil solutions of medicinal substances..

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All topics in this section:

Methods of using medicines
In modern practical medicine there is not a single area in which it has not been successfully used

General rules for the use of medicines
A nurse, without the knowledge of a doctor, has no right to prescribe or replace one medication with another. If a drug is given to a patient by mistake or its dose is exceeded, the nurse will

Cutaneous administration of drugs
Medicines are applied to the skin in the form of ointments, emulsions, solutions, tinctures, mash, powders, pastes. There are several ways to apply the drug to the skin. Lubrication (shir

Local application of drugs to the conjunctiva of the eyes
When treating eye lesions, solutions of various medicinal substances and ointments are used (see the “Eye Care” section in Chapter 6). The purpose of application is local impact. It is necessary to be careful under

Intranasal use
Medicines are used in the nose (intranasally) in the form of powders, vapors (amyl nitrite, ammonia vapor), solutions and ointments. They have local, resorptive and reflex effects. Suction

Steam inhalations
In the treatment of catarrhal inflammation of the upper respiratory tract and sore throats, steam inhalations using a simple inhaler have long been used. A jet of steam generated in a heated water tank

Parenteral route of drug administration
Parenteral (Greek para - near, near, entern - intestines) is a method of introducing medicinal substances into the body, bypassing the digestive tract (Fig. 11-3). I distinguish

Intradermal injection
Intradermal injection is used for diagnostic purposes (allergic tests of Burnet, Mantoux, Casoni, etc.) and for local anesthesia(pinching). For diagnostic purposes, 0.1-1 ml of substance is administered

Subcutaneous injection
Subcutaneous injection is performed to a depth of 15 mm. The maximum effect of a subcutaneously administered drug is achieved on average 30 minutes after injection. The most convenient site

Intramuscular injection
Intramuscular injections should be carried out in certain places of the body where there is a significant layer muscle tissue and large vessels and nerve trunks do not pass close to the injection site. Most n

Intravenous injection
Venipuncture (Latin vena - vein, punctio - injection, puncture) - percutaneous insertion of a hollow needle into the lumen of a vein for the purpose of intravenous administration medicines, blood transfusions and blood

Infusion
Infusion, or infusion (Latin infusio - infusion), is the parenteral introduction into the body of a large volume of liquid. Intravenous drip infusion is performed to restore blood volume, detoxifier

Rules for prescribing and storing medicines
The procedure for prescribing and receiving medications by departments of a medical institution consists of the following stages. A selection of doctor's orders from medical records.

Rules for storing medicines
The head of the department is responsible for the storage and consumption of medicines, as well as for order at storage sites, compliance with the rules for issuing and prescribing medicines. Principle of storage of medicinal media

Rules for the storage and use of poisonous and narcotic drugs
Poisonous and narcotic medicines are stored in safes or iron cabinets. On inside cabinet (safe) doors are marked “Group A” and a list of poisonous and narcotic drugs is placed