At various diseases respiratory tract and lungs use the administration of drugs directly into the respiratory tract. In this case, the medicinal substance is administered by inhalation - inhalation (Latin inhalatum - inhale). When drugs are administered into the respiratory tract, local, resorptive and reflex effects can be obtained.
Medicinal substances are administered by inhalation for both local and systemic effects:
Gaseous substances (oxygen, nitrous oxide);
Vapors of volatile liquids (ether, fluorotane);
Aerosols (a suspension of tiny particles of solutions).
For introduction medicines The following types of inhalers are used through the respiratory tract:
· electrical;
· inhaler cans;
· nebulizers: ultrasonic, compression, membrane;
· spacers.
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 jet of steam generated in a heated water tank is ejected through a horizontal spray tube and rarefies the air under the vertical elbow, as a result of which medicinal solution from the glass 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. 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 a medicine (for example, an antibiotic solution) rises through a vertical tube, 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 an inhalation room.
USING AN ELECTRIC INHALER
Target: therapeutic, preventive.
Indications: respiratory diseases, as prescribed by a doctor.
Contraindications: individual intolerance to the drug.
I. Preparation for the procedure:
1. Introduce yourself to the patient, explain the process and purpose of the procedure. Ensure that the patient has informed consent for the upcoming insertion procedure medicinal product and no allergy to this drug.
2. Check the name and expiration date of the medicine.
3. Wash your hands.
II. Performing the procedure:
4. Demonstrate the procedure to the patient using an inhalation canister without medication.
5. Make the patient sit.
6. Remove the protective cap from the mouthpiece of the can.
7. Turn the aerosol can upside down.
8. Shake the can.
9. Take a calm, deep breath.
10. Cover the mouthpiece tightly with your lips.
11. Take a deep breath and, at the same time as you inhale, press the bottom of the can.
12. Hold your breath for 5-10 seconds (hold your breath while counting to 10 without removing the mouthpiece from your mouth).
13. Remove the mouthpiece from the mouth.
14. Exhale calmly.
15. Rinse your mouth with boiled water.
III. End of the procedure:
16. Close the inhaler with the protective cap.
17. Wash your hands.
18. Make an appropriate entry about the procedure performed in the medical document.
USING A SPACER
(an auxiliary device that facilitates the inhalation technique and increases the amount of medicine entering the bronchi)
Target:
1. Medicinal (facilitates the use of the inhaler, especially in children and old age)
2. Prevention of complications during treatment with ICS (cavity candidiasis)
Indications: Respiratory diseases (BA, COB, bronchospastic syndrome) as prescribed by a doctor.
Contraindications: No.
Equipment:
1. Inhaler (salbutamol, berodual, ICS).
2. Spacer (or inhaler with a built-in spacer)
Algorithm for using a spacer.
I. Preparation for the procedure:
1. Offer/help the patient take a position: standing or sitting with his head slightly thrown back.
2. Wash your hands.
II Performing the procedure:
3. Shake the inhaler vigorously.
4. Holding the inhaler in vertical position, remove the protective cap from it.
5. Place the spacer tightly onto the mouthpiece of the inhaler.
6. Take a deep breath.
7. Cover the mouthpiece of the spacer tightly with your lips.
8. Press the bottom of the inhaler and then take several calm breaths.
III End of procedure:
10. Disconnect the spacer from the inhaler.
11. Place the protective cap on the mouthpiece of the inhaler.
12. Wash the spacer in a soapy solution and then with boiled water.
The technology is simple medical services
APPLICATION OF MEDICINES THROUGH A NEBULIZER
Target: Therapeutic.
Indications: Respiratory diseases (BA, COPD, bronchospastic syndrome, acute bronchitis, pneumonia) as prescribed by a doctor.
Contraindications: No.
Equipment:
1. Nebulizer.
2. Medicine (salbutamol, berodual, lazolvan, flixotide, etc.).
Algorithm for using medications through a nebulizer.
I. Preparation for the procedure:
1. Introduce yourself to the patient, explain the process and purpose of the procedure. Make sure that the patient has informed consent for the upcoming procedure.
2. Check the name and expiration date of the medicine.
3. Offer/help the patient take a sitting position, leaning back in a chair (in a comfortable position).
4. Wash your hands.
5. Prepare the nebulizer for inhalation (connect to mains power, pour the dose of medicine prescribed by the doctor into the reservoir, attach the desired inhalation nozzle)
II Performing the procedure:
6. Invite the patient to put the mouthpiece in his mouth (or put on an inhalation mask).
7. Turn on the nebulizer and offer the patient to breathe calmly using a mouthpiece or mask.
III End of procedure:
8. Turn off the nebulizer from the network.
9. Remove the mouthpiece from the mouth.
10. Treat the nebulizer parts in accordance with the requirements of Sanitary Epidemiology. regime
Note: A nebulizer is a device for administering medications to the upper and lower respiratory tract in the form of a stream of finely dispersed mixture containing a medicinal solution.
Technology for performing a simple medical service
PICFLOW METRY
Target:
1. Assessment of the severity of asthma, COB.
2. Prediction of exacerbations bronchial asthma
3. Determination of reversibility of bronchial obstruction
4. Evaluation of treatment effectiveness
Indications: Respiratory diseases: asthma, COB.
Contraindications: No.
Equipment:
1. Peak flow meter.
2. Table of age norms of PEF for men and women
3. Self-control diary.
External use of medicinal substances
External route of administration - the effect of drugs is predominantly local on the skin and mucous membranes, in the eyes, nose, ears, and through the respiratory tract.
Dosage forms : ointments, emulsions, liniments, lotions, jellies, gels, foams, pastes, solutions, mash, powders, tinctures, aerosols.
Methods of external administration of drugs:
- inhalation;
- applying ointments to the skin: lubricating the skin, applying ointment to the wound surface;
- rubbing ointments;
- application of patches;
- use of powders;
- insertion of drugs into the vagina(vaginal method administration of drugs (per vaginal). They use suppositories, douching solutions, tampons with medications, etc.);
- instillation of drops into the eyes, nose, ear.
Advantages: accessibility, variety dosage forms and ways of using them.
Flaws: The method is designed primarily for local impact, since only fat-soluble substances are absorbed through intact skin.
The external method includes inhalation route administration of the drug, i.e. inhalation of the drug (at inhalation height). In this case, the medicine acts on the mucous membrane respiratory system. Stationary, portable, and pocket inhalers are used for inhalation. or home appliances. Inhalations are often used for diseases of the upper respiratory tract, for example, laryngitis (inflammation of the larynx), as well as bronchitis, bronchial asthma. Sometimes used for local anesthesia(pain relief) of the mucous membrane of the larynx, trachea and bronchi. Aerosols, gaseous substances (nitrous oxide, oxygen), vapors of volatile liquids (ether, fluorothane) are introduced.
Advantages inhalation route introduction
: - act directly in place pathological process in the respiratory tract; - the medicine enters the lesion, bypassing the liver, unchanged, which causes its high concentration in the blood.
Disadvantages of the inhalation route of administration: - in case of a sharp violation of bronchial obstruction, the medicine does not penetrate well into the pathological focus; - irritant effect of the drug on the mucous membrane of the respiratory tract.
Pocket inhalers are used to treat an attack of bronchial asthma. A nurse is teaching a client how to use a personal inhaler.
Use of a pocket-sized individual inhaler
1. Establish a trusting relationship with the patient, explain the process and purpose of the manipulation, obtain consent to perform
2. Sanitize your hands at a social level, wear gloves.
3. Remove the protective cap from the can by turning the can upside down.
4. Shake the aerosol can well.
5. Take a deep breath.
6. Cover the mouthpiece of the can with your lips, tilt your head back slightly.
7. Take a deep breath and at the same time press firmly on the bottom of the can: at this moment a dose of aerosol is dispensed.
8. Hold your breath for 5-10 seconds, then remove the mouthpiece of the canister from your mouth and exhale slowly through your nose.
9. After inhalation, put the protective cap on the can.
10. Remember: the deeper the aerosol dose is administered, the more effective it is.
More effective inhalations inhalations carried out with the help of nebulizers. They form an aerosol - a suspension of small particles of a medicinal substance in the air (“nebula” - fog, cloud; lat.). A nebulizer is a narrower subsection of inhalers. Using a nebulizer, you can more accurately influence certain parts of the respiratory system (upper, middle or lower), selecting the device depending on the particle size of the resulting aerosol. Nebulizers differ in technical design - they are compression and ultrasonic.
REMEMBER!
When using the medicine on the skin you must:
Inspect the place where the medicine was applied, make sure there is no redness, rash, swelling, or weeping;
Treat with warm water or skin antiseptic;
Dry with a towel or gauze pads.
Skin lubrication procedure
Goals: as a rule, skin disinfection, local exposure of the drug to the skin.
Indications: dryness skin, skin diseases.
Equipment: ointment, sterile glass rod or spatula, skin antiseptic, sterile gloves, containers with disinfectant solution for care items and gloves.
Purpose: therapeutic, educational.
Indications: diseases of the cardiovascular and respiratory systems.
Equipment: 2 pocket inhalers: one - used, the second - with a medicinal substance.
| Stages | Rationale |
| I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully. Clarify how to address him if the nurse sees the patient for the first time | Establishing contact with the patient! |
| 2. Explain to the patient the purpose and sequence of the procedure | Psychological preparation for the upcoming procedure |
| 3. Obtain the patient’s consent to the procedure | Respect for patient rights |
| 4. Prepare 2 inhalers, make sure the medicine corresponds to what the doctor prescribed, check the expiration date | Elimination of erroneous administration of medicinal drugs |
| 5. Wash and dry your hands | Prevention of nosocomial infection |
| II. Performing the procedure 1. To teach the patient how to perform the procedure, use an inhalation canister without medication. Sit the patient down, but if his condition allows it, it is better for him to be in a standing position, since the respiratory excursion is more effective | Formation of knowledge and skills. Ensuring propulsion efficiency |
| 2. Remove the protective cap from the inhaler | Preparation for the procedure |
| 3. Turn the aerosol can upside down and shake it | |
| 4. Ask the patient to exhale deeply | Ensuring that the drug reaches the respiratory tract as deeply as possible |
| 5. Ask the patient to tilt his head back slightly. Insert the mouthpiece of the inhaler into the patient's mouth. Ask the patient to wrap their lips tightly around the mouthpiece | Security better access medicinal substance. Reduce loss of funds |
| 6. Ask the patient to take a deep breath through his mouth, while simultaneously pressing on the bottom of the can, and hold his breath for 5-10 s | Administration of a drug into the respiratory tract. Ensuring achievement therapeutic effect |
| 7. Remove the inhaler mouthpiece from the patient’s mouth. Ask the patient to exhale calmly. Turn the can upside down and close it with the protective cap. | Completion of the procedure. Ensuring efficient storage |
| 8. Monitor the patient’s independent performance of the procedure with an active inhaler | Control of formed knowledge and skills |
| III. End of the procedure 1. Disinfect the mouthpiece of the used inhaler. Wash and dry your hands | |
| Ensuring continuity of nursing care |
INTRODUCTION TO THE PATIENT A SUPPOSITORY WITH LAXATIVE EFFECT
Purpose: therapeutic.
Indications: doctor's prescription.
Equipment: gloves, suppository, oilcloth, diaper, toilet paper, screen, disinfectant
| 4. Prepare the necessary equipment | |
| 5. Wash and dry your hands. Put on gloves | Prevention nosocomial infection |
| P. Performing the procedure 1. Take the package of suppositories from the refrigerator, read the name, cut one candle from the tape | |
| 2. Separate the patient with a screen (if there are other patients in the room) | Respect for human rights |
| 3. Help the patient lie on his side and bend his knees | Compliance with the rules of drug administration |
| 4. Open the package with the suppository. If the packaging is soft, then do not remove the suppository from the shell! | Preventing candle melting |
| 5. Ask the patient to relax. Spread the patient's buttocks with one hand, and with the other, insert a suppository into the anus, pushing it past the external sphincter of the rectum. The shell remains in the nurse's hand | Ensuring the effectiveness of the procedure |
| 6. Invite the patient to lie down in a position that is comfortable for him. Remove screen | Providing physiological comfort. Compliance with the rules for administering a suppository |
| 7. Ask the patient how he is feeling | Determining the patient's response to the procedure |
| III. Completion of the procedure 1. Remove gloves and soak them in a disinfectant solution and then dispose of them. Wash and dry your hands | Ensuring infection safety |
| 2. Make an entry in medical documents about the procedure and the patient’s reaction to it | |
| 3. Ask the patient after a few hours if he had a bowel movement | Evaluation of the effectiveness of the procedure |
| 4. Record the result | Ensuring continuity of nursing care |
SET OF MEDICINE FROM AMPOULE
Purpose: to perform an injection.
Indications: injection methods of administering medicinal solutions.
Equipment: assembled sterile syringe, sterile tray, container for used material, sterile tweezers, prescription notebook procedural nurse, medications in ampoules, nail files, packs with sterile dressings, alcohol 70°, sterile gloves.
| Stages | Rationale |
| 1. Wash and dry your hands, put on gloves | Ensuring infection safety of patients and staff |
| 2. Take the ampoule, carefully read the name of the medicinal solution, dose, expiration date. Check with doctor's prescription | Prevention of erroneous drug administration |
| 3. Move the medicinal solution from the narrow part of the ampoule to the wide one. To do this, you need to take the ampoule by the bottom with one hand, and lightly strike the narrow end of the ampoule with the fingers of the other. | |
| 4. File the ampoule in the center of its narrow part | Preventing nurse finger injuries |
| 5. Treat the cut area with a cotton ball moistened with alcohol and break off the end of the ampoule in the opposite direction. Dispose of the ball and fragments into a waste container. | |
| 6. Take the syringe into right hand so that the divisions are visible. Grab the opened ampoule between the II and III fingers with your left hand so that the opened part is facing inside the palm. Insert the needle into the ampoule. Intercept the syringe I, IV, V with the fingers of your left hand | Security effective implementation procedures |
| 7. Move your right hand onto the piston and draw in the required amount of solution. Make sure that the cut of the needle is constantly immersed in the solution | Elimination of drug loss |
| 8. Remove the ampoule from the needle and place it in a non-sterile tray | Ensuring patient infection safety |
| 9. Change the needle. If the needle is for single use, put a cap on it. Force the air out of the syringe into the cap. | Checking the patency of the needle |
| 10. Place a syringe and sterile cotton balls moistened with alcohol in a sterile tray. Cover everything with a sterile napkin if the syringe is reusable. Note: the syringe can be placed in a craft bag or packaging from a disposable syringe | Ensuring infection safety |
CULTIVATION OF ANTIBIOTICS
The inhalation route of drug administration is through the respiratory tract, including intranasally. Medicines, both local and systemic action: gaseous (nitrous oxide, oxygen), vapors of volatile liquids (ether, fluorotane), aerosols (suspensions of the smallest particles of solutions). Usually, medications that cause constriction of the blood vessels in the mucous membrane and thereby eliminate nasal congestion are administered into the nose (in the form of drops or aerosols).
Advantages of the inhalation route of administration:
- act directly at the site of the pathological process in the respiratory tract;
- the medicine enters the lesion, bypassing the liver, unchanged, which causes its high concentration in the blood.
Disadvantages of the inhalation route of administration:
- in case of a sharp violation of bronchial obstruction, the medicine does not penetrate well into the pathological focus;
- irritant effect of the drug on the mucous membrane of the respiratory tract.
IN medical practice Steam, heat-moisture, and oil inhalations, carried out using special devices, are widely used. Inhalation of drugs is also carried out using pocket inhalers.
Familiarize the patient with the rules for handling the inhaler:
1. Remove the protective cap from the can and turn it upside down.
2. Shake the aerosol can well.
3. Grasp the mouthpiece with your lips.
4. Take a deep breath, at the height of which you press the bottom of the can: at this moment a dose of aerosol is “dispensed”.
5. Hold your breath for a few seconds, then remove the mouthpiece from your mouth and exhale slowly.
6. After inhalation, put a protective cap on the canister.
Ice pack.
· ice in the tray.
· container with water (14-16°C),
· towel
1. Explain to the patient the course of the upcoming procedure, obtain consent for the procedure.
2. Fill the bubble with finely crushed ice, add water, displace the air, and screw on the cap. Check the seal by turning the bottle upside down.
II. Performing the procedure:
1. Wrap an ice pack in a towel and place it on the desired area of the body.
2. After 20-30 minutes, be sure to remove the bubble and take a break for 10-15 minutes.
III. End of the procedure:
1. Remove the ice bubble, empty the water and disinfect the bubble. Ask the patient how he is feeling.
2. Wash and dry your hands (using soap or hand sanitizer).
3. Make a note about the manipulation on the patient’s follow-up sheet.
NOTE: As the ice in the bubble melts, the water is drained and pieces of ice are added. You cannot freeze a bubble filled with water in the freezer, because... this can lead to frostbite.
Warmer
(dry heat) causes relaxation of smooth muscles, increases blood circulation internal organs, has an analgesic and absorbable effect. The effect of using a heating pad depends not so much on the temperature of the heating pad, but on the duration of exposure.
Indications:
1. Spasmodic pain.
2. The first period of fever.
3. Second day after injury.
4. Warming the body when cooling.
Contraindications:
1. Vague abdominal pain.
2. Spicy inflammatory processes V
3. The first day after the injury.
4. Skin damage.
5. Bleeding of any etiology.
6. Infected wounds.
7. Malignant neoplasms.
I. Preparation for the procedure:
1. Prepare equipment:
· rubber heating pad.
· diaper,
· hot water(60°C).
2. Explain to the patient the course of the upcoming procedure, clarify the patient’s understanding of the course of the upcoming procedure, and obtain his consent.
3. Pour hot water into the heating pad.
4. Force the air out of the heating pad.
5. Tighten the plug.
6. Check the tightness of the heating pad by turning it upside down.
7. Wrap the heating pad in a diaper.
II. Performing the procedure:
1. Place the heating pad on the desired body surface.
2. After 5 minutes, check for overheating of the tissues.
3. After 20 minutes, remove the heating pad (do not keep it on for more than 20 minutes continuously). When using the heating pad for a long time, take a break of 15-20 minutes every 20 minutes.
III. End of the procedure:
1. Examine the patient's skin (there should be slight redness on the skin).
2. Remove and disinfect the heating pad.
3. Ask the patient how he is feeling.
4. Wash and dry your hands (using soap or hand sanitizer).
5. Make a note about the manipulation on the patient’s follow-up sheet.
