Assist the nurse in performing nursing probing procedures. Algorithms for performing nursing manipulations

STATE AUTONOMOUS EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION IN THE NOVOSIBIRSK REGION

"KUPINSKY MEDICAL TECHNIQUE"

METHODOLOGICAL DEVELOPMENT

FOR INDEPENDENT WORK

according to the professional module:

“Performing work in the junior profession nurse for patient care"

Section: PM3.Rendering medical services within the limits of their powers.

MDK 07.01. Technology of medical services.

Topic: “Technology of execution probe manipulations as one of the types

medical services"

Specialty: 060101 General Medicine

(in-depth training)

Specialties 060501 “Nursing”

(basic training).

Kupino

2014

Considered at the meeting

Subject-cycle commission of professional modules

Protocol No.___ "__" ________________2014

Chairman

Skitovich N.V.

Kupino

2014

Explanatory note

to the methodological development for the professional module “Performing work in the profession of a junior nurse caring for patients on the topic: “Technology for performing probe manipulations as one of the types of medical services.

Toolkit designed for independent work of students in order to develop skills and knowledge on the topic: “Technology for performing probe manipulations as one of the types of medical services.

« Methodological development compiled in accordance with the requirements for skills according to the Federal State Educational Standard of the III generation, for use on practical lesson within the framework of specialty 060101 “General Medicine” (advanced training) specialty 060501 “Nursing” (basic training).

In accordance with the Federal State Educational Standard, after studying this topic, the student must

be able to:

Collect information about the patient's health status.

Identify the patient's problems related to his health condition.

Provide a safe hospital environment for the patient, their environment and staff.

Conduct current and general cleaning premises using various disinfectants.

know:

Technologies for performing medical services.

Factors affecting the safety of patients and staff.

Basics of prevention of nosocomial infections.

Methodological development consists of: Explanatory note, presentation of new material, independent work of students.

Topic: Technology for performing probe manipulations as one of the types of medical services.

The patient must be pitied, the patient must be cherished,

You need to work near the patient.

The student must know:

Types of probes;

Purposes of probe procedures;

Types of irritants gastric secretion;

The student must be able to:

Assist the patient with vomiting;

Flush the patient's stomach;

Take gastric lavage water for examination;

Carry out gastric and duodenal intubation.

Dyspepsia– indigestion. Clinical signs dyspepsia: belching, heartburn, nausea, vomiting, abdominal discomfort. Vomiting is a complex reflex act when the vomiting center is excited, followed by the involuntary release of stomach contents through the esophagus, pharynx, and sometimes the nasal passages.

Vomit may be of central or peripheral origin (food, chemical, drug poisoning) brings relief to the patient, and gastric lavage helps detoxify the body. In this case, vomiting is a protective-adaptive reaction of the human body, caused by rarefaction of the gastric mucosa. Nausea can be a precursor to vomiting, more often with stomach diseases. In seriously ill patients and patients in unconscious, vomit may get into Airways, there is a possible threat of asphyxia and the development of pneumonia.

During vomiting, harmful chemicals or poor quality food are removed from the stomach, and the person experiences relief. Vomit contains remnants of undigested food and has an acidic odor.

Vomiting of central origin(disorder cerebral circulation) or reflex nature (myocardial infarction) does not alleviate the patient’s condition.

Vomit color " coffee grounds " - a sign of gastric bleeding. Clinical signs of acute blood loss: weakness, dizziness, darkening of the eyes, shortness of breath, nausea, thirst, fainting. The patient has pale skin, cold extremities, rapid pulse, and low blood pressure. In this case, the nurse should urgently call a doctor. Independent nursing interventions: place the patient on his back, place an ice pack on the epigastric area, and exclude food and liquid intake.

Nursing interventions for vomiting.

Prepare: waterproof napkin/towel, gloves, container for collecting vomit, glass of water, container with disinfectant.

Patient position: sitting.

Sequencing:

1. Wash and dry your hands and put on gloves.

2. Place a napkin/towel on the patient’s chest.

3. Place the basin on the floor at the patient’s feet.

4. Support the patient's forehead and shoulders.

5. Give water to rinse the mouth after each act of vomiting.

6. Dry your face.

7. Leave the vomit until the doctor arrives; if necessary, send it to the laboratory.

8.Remove gloves, place in disinfectant, wash and dry hands.

9. Provide the patient with a comfortable position.

Rice. 1 Patient care for vomiting:

a - patient’s sitting position;
b - patient’s position lying down.

1. turn your head to the side to prevent aspiration of vomit from the respiratory tract.

2. remove the pillow, remove dentures.

3. put the diaper on your chest.

4. Place a kidney-shaped tray near your mouth.

5. Aspirate the contents of the oral cavity with a bulb.

6. Carry out oral hygiene for the patient with an antiseptic (soda solution, furatsilin).

Nursing observations of a patient with vomiting require a medical assessment of the clinical situation. When diagnosing food poisoning, the nurse performs a gastric intubation procedure.

Goals of probe procedures:

Therapeutic – detoxification – stopping the absorption of toxic substances and removing them from the stomach;

Diagnostic – laboratory – sampling of stomach/intestinal contents for research.

Therapeutic probe procedures

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

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

Probes are distinguished by

Purpose

Type of material

Diameter

Gastric

duodenal

polymer (disposable)

rubber (reusable)

thin (gastric, duodenal)

average

thick (stomach)

Duodenal tube at the working end has olive to overcome the pylorus of the stomach when passing from the stomach to twelve duodenum during the probing procedure.

Sensing ( French explore) - instrumental examination of hollow and tubular organs, canals, wounds using probes.

Contraindications:

1) esophageal and gastric bleeding

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

3) pronounced cardiovascular pathology

Gastric lavage– removal of food residues, gases, mucus or toxic substances.

Indications are determined by the doctor. The procedure is carried out using probe and probe-free methods.

Target:

medicinal– cessation of exposure to toxic substances and their evacuation from the body;

diagnostic– detection of chemicals, microorganisms and their toxins in wash water.

The most effective is the probe method of washing based on the principle of communicating vessels (siphon method). Liquid is injected into the stomach repeatedly in fractional portions through a system of two communicating vessels: the stomach and the funnel, connected by the outer end of the probe. The procedure is repeated until " clean water”, until all the contents of the stomach are removed from it with water. Clinical diagnosis confirm laboratory research gastric lavage waters.

Gastric lavage system: funnel with a capacity of 0.5 - 1 l, two thick gastric tube, connected by glass adapters. Rinsing is carried out with water at room temperature (warm water enhances absorption).

The depth of insertion of the probe into the patient is determined:

measuring the distance: earlobe – incisors – xiphoid process

or according to the formula: height in cm – 100 .

When inserting the probe, the patient makes swallowing movements. If you feel the urge to feel nauseous/vomiting, you should squeeze the probe with your teeth and take deep breaths to suppress the gag reflex.

Features of gastric lavage for an unconscious patient: the nurse inserts a nasogastric tube into the patient after tracheal intubation performed by a doctor, and rinses the stomach cavity with water using a Janet syringe.

If it is difficult to insert a probe, use a probeless method of gastric lavage.

Gastric lavage with a thick probe

Prepare: a tray with a system for gastric lavage, a container with water at room temperature 8 - 10 liters, a container for rinsing water, waterproof wipes, gloves, a towel, a container with disinfectant.

Patient position: sitting. Provide personal hygiene with waterproof wipes and place a container for rinsing water at your feet.

Sequencing:

1. wash and dry your hands.

2. cover the patient’s chest with a napkin.

3. wear gloves.

4. take the probe and determine the insertion.

5. pour over the working end of the probe boiled water to ensure sliding.

6. ask the patient to open his mouth, place the end of the probe behind the root of the tongue and offer to make swallowing movements.

7. insert the probe into the stomach.

8. Attach the funnel to the probe, lower it to the level of the stomach and hold it slightly inclined.

9. Fill the funnel with water and slowly raise it until the water reaches the mouth.

10. Lower the funnel to the level of the patient’s knees, drain the contents into the prepared container. Repeat rinsing several times until the waters are clear.

11. Disconnect the funnel and dump it into the disinfectant.

12. Wrap the probe in a napkin and remove it, place it in a container.

13. ensure hygiene oral cavity, faces.

14. remove gloves, throw into disinfectant, wash and dry hands.

15. ensure a comfortable position for the patient.

1. collect and send vomit as prescribed by a doctor for laboratory diagnostics.

2. issue a referral to the laboratory.

Tubeless method of gastric lavage

Outside the hospital, gastric lavage is acceptable in a natural way. Prepare 2 – 3 liters of water. They stimulate the gag reflex by irritating the root of the tongue mechanically (with a spatula, finger). The procedure is repeated several times until the “clean wash waters” are obtained. This promotes detoxification - stopping the effects of toxic substances and removing them from the body.

Diagnostic probe procedures

Study of gastric secretory function

Probing of the stomach is carried out for diagnostic purposes to assess its secretory and motor function. The doctor determines the indications. Contraindications: acute gastrointestinal conditions, abdominal cavity, heart, respiratory tract, brain.

The gastric contents are first removed on an empty stomach, basal secretion is obtained, and then, after the introduction of irritants of the gastric glands, stimulated secretion is obtained.

Gastric secretion stimulants:

enteral - cabbage broth;

parenteral – 0.025% pentagastrin solution;

0.1% histamine solution.

2–3 days before the examination:

Eliminate gas-forming and secretion-stimulating foods from your diet.

Choose a magazine or book to distract yourself and relieve emotional stress during a long procedure (more than 2 hours).

Light dinner the night before the test.

On the day of the study:

Monitor physiological functions.

Prepare a towel.

Determine height and body weight to guide the depth of probe insertion and determine the dose of parenteral irritant.

Avoid intake of food and liquids, medications, and smoking.

The presence of prostheses (dental, limbs) and possible allergic reactions are taken into account.

During the study, they explain how to breathe and be an active helper.

The patient is examined early in the morning (at 7–8 am) on an empty stomach in the functional diagnostics room.

Fractional gastric intubation

Prepare: a thin gastric tube in a package, gloves, a gastric secretion irritant (enteral, parenteral), laboratory glassware, a 20.0 syringe for aspiration of gastric contents, a tray, a 2.0 syringe for a parenteral secretion stimulator, a Janet syringe with cabbage broth, a clamp, napkins, towel, boiled water, container with disinfectant, laboratory referral form.

Patient position: sitting.

Sequencing:

Leporsky method Veretenov method

Novikova - meat eater

Wash and dry your hands.

Open the package with the probe.

Wear gloves.

Remove the probe from the package and determine the insertion depth.

Pour boiled water over it to ensure gliding and insert into the stomach.

Remove gastric contents on an empty stomach into a container with a 20.0 syringe (portion 1).

Use a Janet syringe to administer 200.0 ml of cabbage broth - an enteral irritant (T = 38C).

Within 1 hour, extract portions 2,3,4,5 with an interval of 15 minutes between portions (basal secretion).

After 10 minutes, use a syringe to extract 10 ml of gastric contents (portion 2).

Introduce a parenteral irritant subcutaneously, taking into account body weight.

After 15 minutes, remove the rest of the contents of the test breakfast (serving 3).

Within 1 hour with an interval of 15 minutes, extract sequentially portions 4, 5, 6, 7 (stimulated secretion).

Remove portions 6, 7, 8, 9 every 15 minutes within 1 hour (stimulated secretion).

Send five portions 1, 2, 3, 4, 5, 6, 7 to the laboratory (servings 2 and 3 contain cabbage broth).

Send all 9 portions to the laboratory.

Dump into container.

Wash and dry your hands.

Provide direction and send biomaterial to the clinical laboratory.

Place the clamp on distal end probe to accumulate gastric contents at the desired time interval.

Insurance Company

№ insurance policy

Branch Chamber

Direction

to a clinical laboratory

Petrov Nikolay Ivanovich

Gastric juice

date

Signature

m / With

Duodenal sounding

Probing of the duodenum is carried out to diagnose diseases of the duodenum, gallbladder, biliary tract and pancreas.

The doctor determines the indications.

Portion A - contents of the duodenum, pancreas, bile.

Portion B - contents of the gallbladder;

Portion C is the contents of the hepatic ducts.

One of the stimulants is used to stimulate the gallbladder and obtain bladder contents:

25%,33% magnesium sulfate solution,

40% glucose solution,

When diabetes mellitus- a solution of sorbitol or xylitol.

Performing duodenal intubation.

Patient preparation is similar to preparation for fractional intubation of the stomach.

Prepare: packaged duodenal tube, gallbladder irritant (38C), rack with labeled test tubes, tray, syringe 20.0, auxiliary container, clamp, towel, heating pad, roller, boiled water, gloves, container with disinfectant, laboratory referral form .

Patient position: sitting.

Sequencing:

Wash and dry your hands.

Place a towel on the patient's chest and tilt his head slightly forward.

Open the package with the probe.

Wear gloves.

Remove the probe from the package and determine the insertion depth:

1) earlobe – incisors – xiphoid process – mark

№ 1(stomach level);

2) earlobe – incisors + distance to the navel – mark No. 2 (level 12 – duodenum).

Pour boiled water over the probe and insert it into the stomach to the 1st mark.

Place a clamp on the free end.

Place the patient on the couch without a pillow on the right side, place a bolster or pillow under the pelvic area, and a heating pad under the right hypochondrium.

Continue swallowing the probe until the 2nd mark within 20-60 minutes.

Place a rack with test tubes below the level of the couch.

Remove the clamp, lower the free end of the probe into a container to collect cloudy stomach contents.

Place the probe in the test tube - the appearance of golden-yellow contents of an alkaline reaction - duodenal portion A.

Inject the gallbladder contraction stimulator with a syringe through the peripheral end of the probe and apply a clamp.

Move the probe to the next tube.

Remove the clamp after 5 - 10 minutes - the flow of dark olive contents - gallbladder bile - portion B.

Move the probe to the next test tube; the appearance of a golden-yellow transparent secretion indicates the contents of the hepatic ducts - portion C.

Wrap the probe in a napkin and slowly remove it.

Dump into container.

Remove gloves and throw into disinfectant.

Wash and dry your hands.

Ensure the patient's comfort.

Fill out a referral and send the test portions (A, B, C) to the clinical laboratory.

Document the execution of the manipulation.

While swallowing the probe into the stomach, the patient can not only sit, but also walk.

The duodenal contents of each portion are obtained in several tubes.

One portion at a time is sent to the laboratory - the most reliable ones.

Observe temperature regime(T 38C) irritant of bile secretion.

Rinse the mouth with water after removing the probe to relieve the patient of the bitter feeling.

Deliver duodenal portions to the clinical laboratory in a warm state for the purpose of identifying protozoa (for example, Giardia).

Exist various ways and methods for collecting gastric contents. Modern medical technology the proposed author's methods of Leporsky and Veretenov - Novikov - Myasoedov are relegated to the background.

Endoscopic examination stomach and duodenum - fibrogastroduodenoscopy (FGDS) - allows the doctor to immediately assess the functional and secretory activity of the stomach and duodenum, and, if necessary, perform a biopsy and drug treatment.

Independent work students.

Control questions

Definition of the concept of sensing.

Purposes of probe procedures.

Characteristics of vomiting of peripheral origin.

Characteristics of vomiting of central origin.

Clinical signs of acute blood loss.

Contraindications for probe manipulations.

Helping the patient with food poisoning.

Types of irritants of gastric secretion.

Preparing the patient for diagnostic probe procedures.

Portions of duodenal intubation.

Glossary of terms

Aspiration– penetration foreign bodies into the respiratory tract.

Targeted biopsy– taking a piece of organ tissue during an endoscopic examination.

Detoxification– stopping the absorption of toxic substances and removing them from the body.

Heartburn– a burning sensation behind the sternum or in the epigastric region.

Tracheal intubation– insertion of a tube into the trachea to restore its patency.

Nasogastric tube - a tube inserted through the nasal passage into the stomach to perform diagnostic and therapeutic procedures.

Belching– involuntary release of gases or small amounts of gastric contents from the stomach into the oral cavity.

Wash waters- a liquid obtained as a result of washing a hollow organ or body cavity; serve as material for diagnostic research.

Vomit– involuntary ejection of stomach contents through the mouth and nose.

Epigastrium (epigastrium)- the area of ​​the anterior wall of the abdomen, limited above by the diaphragm, below - by the level of the tenth ribs.

Complete the correct answer

The purpose of gastric probing in case of food poisoning: removal of gases, residues ______ , mucus, _____ .

In the stomach, the reaction of the environment (pH) is _________________ .

In case of severe food poisoning, it is necessary to carry out __________________ stomach.

Diagnostic probing is always performed on the patient in a state of ______________ .

Sliding of the probe during insertion is facilitated by processing of the working end ___________ .

The depth of insertion of the probe when examining the stomach is determined from ______ _______ before ______ ________ .

Solutions of pentagastrin and histamine - _____________ gastric secretion stimulants.

Cabbage broth - ______________ gastric secretion stimulant.

The first portions of gastric juice during fractional intubation characterize __________________ secretion.

When preparing for fractional intubation of the stomach, gas-forming and ___________________ gastric secretion products.

Vomiting - involuntary expulsion _________________ stomach through the mouth and nose.

The volume of water for tubeless gastric lavage is ____ – ____ .

The volume of water for tube gastric lavage is ____ – ____ liters

In case of food poisoning, gastric contents are directed to _____________________ laboratory.

The composition of the vomit is stated __________________________ .

Tube gastric lavage is based on the method ____________________ .

After vomiting, the nurse helps a seriously ill patient treat ________________ .

A harbinger of vomiting - ___________ .

Vomit the color of “coffee grounds” is a sign __________________________ .

During duodenal intubation, three portions are obtained:

A – contents ________________________ .

B – contents ________________________ .

C – contents ________________________ .

Option I

Indications for gastric lavage

A) alcohol poisoning

B) dehydration

B) food poisoning

D) drug poisoning

Possible contaminants in vomit

A) blood

B) specific

B) food

D) bile

When vomiting the color of "coffee grounds" the patient creates

A) peace

B) hunger

B) warmth

D) cold

Contraindications for gastric lavage

A) mushroom poisoning

B) stomach bleeding

B) burn of the esophagus

G) acute stomach

Amount of water for tubeless gastric lavage, l

A) 0.5

B) 2

B) 2.5

D) 3

Amount of water for tube gastric lavage, l

A) 12

B) 10

AT 8

D) 3

Water temperature for gastric lavage, °C

A) 20 – 22

B) 22 – 24

B) 26 – 28

D) 36 – 38

Purpose of gastric lavage

A) medicinal

B) preventive

B) rehabilitation

D) diagnostic

Clinical signs of dyspepsia

A) belching

B) convulsions

B) heartburn

D) nausea

Clinical manifestations acute blood loss

A) belching

B) weakness

B) dizziness

D) nausea

Option II

Components of a system for gastric lavage in a conscious person

A) gastric tubes

B) adapter

B) Janet's syringe

D) funnel

Parenteral gastric secretion stimulants

A) histamine

B) glucose

B) sorbitol

D) pentagastrin

Gallbladder stimulants

A) 40% glucose solution

B) 33% magnesium sulfate solution

B) 25% magnesium sulfate solution

D) 5% glucose solution

Composition of gastric juice

A) leukocytes

B) mucus

B) hydrochloric acid

D) pepsin

Portions of duodenal intubation

A) contents of the duodenum

B) gastric juice

B) cystic bile

D) contents of the liver ducts

Clinical picture penetration of the probe into the respiratory tract is characterized by

A) cough

B) turning blue

B) difficulty breathing

D) heart pain

Skin antiseptics for treating nurse gloves

A) chlorhexidine bigluconate

B) ethyl alcohol

B) furatsilin

D) lizafin

In the morning, on the day of diagnostic probing, the patient is prohibited

A) eat food

B) drink water

B) smoke

D) brush your teeth

During duodenal intubation, studies are carried out

A) gastric juice

B) pancreatic juice

B) duodenal juice

D) contents of the hepatic ducts

Gallbladder stimulator temperature, °C

A) 36

B) 37

B) 38

D) 39

Probe manipulations

Horizontally:

1. What needs to be done with the probe if an obstacle to the insertion of the probe is detected

3. Probing, which is carried out to examine the gallbladder

4. What kind of relationship is established with the patient before the procedure begins?

9. Which side is the patient placed on during probing?

13. What should the patient breathe through during insertion of the probe?

15. How should a patient come for probing

16. Studies of gastric secretion under physiological conditions

17. Flow of stomach contents into the oral cavity, followed by flow into the respiratory system

Vertically:

2. When caring for vomit, what kind of gloves should you wear?

5. What temperature should the water be for gastric lavage?

6. What is the patient wearing when lavaging the stomach?

7. Which paths should the probe not enter?

8. Which hand is used to take the probe?

10. What kind of gloves should a nurse have? sisters

11. What needs to be attached to the tube during gastric lavage

12. What needs to be done with used items at the end of the procedure

14. What kind of rest should be provided to the patient after gastric lavage?

18. How long should the patient swallow the tube?

Equipment
1. Bed linen set (2 pillowcases, duvet cover, sheet).
2. Gloves.
3. Bag for dirty laundry.

Preparation for the procedure
4. Explain to the patient the course of the upcoming procedure.
5. Prepare a set of clean linen.
6. Wash and dry your hands.
7. Wear gloves.

Executing the procedure
8. Lower the rails on one side of the bed.
9. Lower the head of the bed to a horizontal level (if the patient’s condition allows).
10. Raise the bed to required level(if this is not possible, change underwear, observing the biomechanics of the body).
11. Remove the duvet cover from the blanket, fold it and hang it on the back of the chair.
12. Make sure they are clean bed dress prepared by you, nearby.
13. Stand on the side of the bed opposite the one you will be making (on the side of the lowered rail).
14. Make sure that there are no small personal items of the patient on this side of the bed (if there are such items, ask where to put them).
15. Turn the patient on his side towards you.
16. Raise the side rail (the patient can support himself in a side position by holding the rail).
17. Return to the opposite side of the bed, lower the handrail.
18. Elevate the patient's head and remove the pillow (if there are drainage tubes, make sure they are not kinked).
19. Make sure there are no small items of the patient's belongings on this side of the bed.
20. Roll up the dirty sheet with a roller towards the patient’s back and slip this roller under his back (if the sheet is heavily soiled (with secretions, blood), put a diaper on it, so that the sheet does not come into contact with the contaminated area, the patient’s skin and the clean sheet).
21. Fold a clean sheet in half lengthwise and place its central fold in the center of the bed.
22. Fold the sheet towards you and tuck the sheet into the head of the bed using the “corner bevel” method.
23. Tuck the middle third, then the lower third of the sheet under the mattress, placing your hands palms up.
24. Make the roll of the rolled clean and dirty sheet as flat as possible.
25. Help the patient “roll” over these sheets towards you; make sure that the patient is lying comfortably, and if there are drainage tubes, they are not kinked.
26. Raise the side rail on the side of the bed where you were just working.
27. Go to the other side of the bed.
28. Replace the bedding on the other side of the bed.
29. Lower the side rail.
30. Roll up the dirty sheet and place it in a laundry bag.
31. Straighten a clean sheet and tuck it under the mattress, first its middle third, then the upper third, then the lower third, using the method in paragraph 1. 22, 23.
32. Help the patient turn on his back and lie in the middle of the bed.
33. Tuck the blanket into a clean duvet cover.
34. Adjust the blanket so that it hangs equally on both sides of the bed.
35. Tuck the edges of the blanket under the mattress.
36. Remove the dirty pillowcase and throw it into the laundry bag.
37. Turn a clean pillowcase inside out.
38. Grasp the pillow by its corners through the pillowcase.
39. Pull the pillowcase over the pillow.
40. Elevate the patient's head and shoulders and place a pillow under the patient's head.
41. Raise the side rail.
42. Create a fold in the blanket for the toes.

Completing the procedure
43. Remove gloves and place them in a disinfectant solution.
44. Wash and dry your hands.
45. Make sure the patient is lying comfortably.

Patient eye care

Equipment
1. Sterile tray
2. Sterile tweezers
3. Sterile gauze wipes - at least 12 pcs.
4. Gloves
5. Tray for waste material
6. Antiseptic solution for treating mucous membranes of the eyes

Preparation for the procedure
7. Clarify the patient’s understanding of the purpose and progress of the upcoming procedure and obtain his consent
8. Prepare everything you need

Equipment
9. Wash and dry your hands
10. Examine the mucous membranes of the patient’s eyes to identify purulent discharge
11. Wear gloves

Executing the procedure
12. Place at least 10 napkins into a sterile tray and moisten them with an antiseptic solution, squeeze out the excess on the edge of the tray
13. Take a napkin and wipe your eyelids and eyelashes with it from top to bottom or from the outer corner of the eye to the inner
14. Repeat the treatment 4-5 times, changing napkins and placing them in the waste tray
15. Wipe the remaining solution with a dry sterile cloth

Completing the procedure
16. Remove all used equipment and then disinfect it
17. Help the patient find a comfortable position
18. Place the wipes in a container with a disinfectant and then dispose of them
19. Remove gloves and place them in a disinfectant solution
20. Wash and dry your hands
21. Make an entry in medical card about the patient's reaction

Study of the arterial pulse on the radial artery

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparation for the procedure
4. Explain to the patient the purpose and progress of the study.
5. Obtain patient consent for the study.
6. Wash and dry your hands.

Executing the procedure
7. During the procedure, the patient can sit or lie (arms are relaxed, arms should not be suspended).
8. Press with 2, 3, 4 fingers (1 finger should be on the back of the hand) the radial arteries on both hands of the patient and feel the pulsation.
9. Determine the pulse rhythm for 30 seconds.
10. Select one comfortable hand for further examination of the pulse.
11. Take a watch or stopwatch and examine the pulsation of the artery for 30 seconds. Multiply by two (if the pulse is rhythmic). If the pulse is not rhythmic, count for 1 minute.
12. Press the artery harder than before to radius and determine the pulse voltage (if the pulsation disappears with moderate pressure, the voltage is good; if the pulsation does not weaken, the pulse is tense; if the pulsation has stopped completely, the voltage is weak).
13. Write down the result.

End of the procedure
14. Inform the patient the result of the study.
15. Help the patient find a comfortable position or stand up.
16. Wash and dry your hands.
17. Record the test results on a temperature sheet (or nursing care plan).

Blood pressure measurement technique

Equipment
1. Tonometer.
2. Phonendoscope.
3. Handle.
4. Paper.
5. Temperature sheet.
6. Alcohol napkin.

Preparation for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before it starts.
8. Clarify the patient’s understanding of the purpose of the study and obtain his consent.
9. Ask the patient to lie down or sit at the table.
10. Wash and dry your hands.

Performance
11. Help remove clothes from your arm.
12. Place the patient’s arm in an extended position, palm up, at the level of the heart, muscles relaxed.
13. Place the cuff 2.5 cm above the ulnar fossa (clothing should not compress the shoulder above the cuff).
14. Fasten the cuff so that two fingers pass between the cuff and the surface of the shoulder.
15. Check the position of the pressure gauge needle relative to the zero mark.
16. Find (by palpation) the pulse on radial artery, quickly pump air into the cuff until the pulse disappears, look at the scale and remember the pressure gauge readings, quickly release all the air from the cuff.
17. Find the place of pulsation of the brachial artery in the area of ​​the ulnar fossa and firmly place the stethoscope membrane on this place.
18. Close the valve on the bulb and pump air into the cuff. Inflate air until the pressure in the cuff, according to the tonometer readings, exceeds 30 mmHg. Art., the level at which the pulsation of the radial artery or Korotkoff sounds ceases to be detected.
19. Open the valve and slowly, at a speed of 2–3 mm Hg. per second, release air from the cuff. At the same time, use a stethoscope to listen to sounds on the brachial artery and monitor the readings on the pressure gauge scale.
20. When the first sounds appear above the brachial artery, note the level of systolic pressure.
21. Continuing to release air from the cuff, note the level of diastolic pressure, which corresponds to the moment of complete disappearance of sounds in the brachial artery.
22. Repeat the procedure after 2–3 minutes.

Completing the procedure
23. Round the measurement data to the nearest even number and write it as a fraction (systolic blood pressure in the numerator, diastolic blood pressure in the denominator).
24. Wipe the phonendoscope membrane with a cloth moistened with alcohol.
25. Write down the study data in the temperature sheet (protocol for the care plan, outpatient card).
26. Wash and dry your hands.

Determination of frequency, depth and rhythm of breathing

Equipment
1. Clock or stopwatch.
2. Temperature sheet.
3. Pen, paper.

Preparation for the procedure
4. Warn the patient that a pulse examination will be performed.
5. Obtain the patient’s consent to conduct the study.
6. Ask the patient to sit or lie down so that you can see the upper chest and/or abdomen.
7. Wash and dry your hands.

Executing the procedure
8. Take the patient’s hand as for examining the pulse, hold the patient’s hand on the wrist, place your hands (yours and the patient’s) on the chest (in women) or on the epigastric region (in men), simulating the examination of the pulse and count the respiratory movements as 30 seconds, multiplying the result by two.
9. Write down the result.
10. Help the patient take a position that is comfortable for him.

End of the procedure
11. Wash and dry your hands.
12. Write the result on the sheet nursing assessment and temperature sheet.

Measuring armpit temperature

Equipment
1. Clock
2. Medical maximum thermometer
3. Handle
4. Temperature sheet
5. Towel or napkin
6. Container with disinfectant solution

Preparation for the procedure
7. Warn the patient about the upcoming study 5 - 10 minutes before it starts
8. Clarify the patient’s understanding of the purpose of the study and obtain his consent
9. Wash and dry your hands
10. Make sure that the thermometer is intact and that the readings on the scale do not exceed 35°C. Otherwise, shake the thermometer so that the mercury column drops below 35 °C.

Performance
11. Inspect axillary area, if necessary, wipe dry with a napkin or ask the patient to do this. In the presence of hyperemia or local inflammatory processes, temperature measurements cannot be taken.
12. Place the thermometer reservoir in the axillary area so that it is in close contact with the patient’s body on all sides (press the shoulder to the chest).
13. Leave the thermometer for at least 10 minutes. The patient should lie in bed or sit.
14. Remove the thermometer. Assess the indicators by holding the thermometer horizontally at eye level.
15. Inform the patient of the results of thermometry.

Completing the procedure
16. Shake the thermometer so that the mercury column drops into the reservoir.
17. Immerse the thermometer in the disinfectant solution.
18. Wash and dry your hands.
19. Make a note of the temperature readings on the temperature sheet.

Algorithm for measuring height, weight and BMI

Equipment
1. Height meter.
2. Libra.
3. Gloves.
4. Disposable napkins.
5. Paper, pen

Preparation and carrying out the procedure
6. Explain to the patient the purpose and course of the upcoming procedure (learning to measure height, body weight and determine BMI) and obtain his consent.
7. Wash and dry your hands.
8. Prepare the stadiometer for use, raise the stadiometer bar above the expected height, place a napkin on the stadiometer platform (under the patient’s feet).
9. Ask the patient to take off his shoes and stand in the middle of the stadiometer platform so that he touches the vertical bar of the stadiometer with his heels, buttocks, interscapular area and the back of his head.
10. Position the patient’s head so that the tragus of the auricle and the outer corner of the orbit are on the same horizontal line.
11. Lower the stadiometer bar onto the patient’s head and determine the patient’s height on the scale along the lower edge of the bar.
12. Ask the patient to get off the stadiometer platform (if necessary, help him get off). Inform the patient about the measurement results and write down the result.
13. Explain to the patient about the need to measure body weight at the same time, on an empty stomach, after visiting the toilet.
14. Check the serviceability and accuracy of medical scales, set the balance (for mechanical scales) or turn it on (for electronic ones), place a napkin on the scale platform
15. Invite the patient to take off his shoes and help him stand in the middle of the scale, and determine the patient’s body weight.
16. Help the patient get off the scale, tell him the result of the body weight test, and write down the result.

End of the procedure
17. Put on gloves, remove the napkins from the stadiometer and scales and place them in a container with a disinfectant solution. Treat the surface of the stadiometer and scales with a disinfectant solution once or twice with an interval of 15 minutes in accordance with methodological instructions on the use of disinfectant.
18. Remove gloves and place them in a container with a disinfectant solution,
19. Wash and dry your hands.
20. Determine BMI (body mass index) -
body weight (in kg) height (in m 2) Index less than 18.5 - underweight; 18.5 - 24.9 - normal body weight; 25 - 29.9 - overweight; 30 - 34.9 - 1st degree obesity; 35 - 39.9 - II degree obesity; 40 and more - III degree obesity. Record the result.
21. Inform the patient’s BMI and write down the result.

Applying a warm compress

Equipment
1. Compress paper.
2. Vata.
3. Bandage.
4. Ethyl alcohol 45%, 30 - 50 ml.
5. Scissors.
b. Tray.

Preparation for the procedure
7. Clarify the patient’s understanding of the purpose and course of the upcoming procedure and obtain his consent.
8. It is convenient to sit or lay down the patient.
9. Wash and dry your hands.
10. Cut off the required piece with scissors (depending on the area of ​​application, a piece of bandage or gauze and fold it into 8 layers).
11. Cut a piece of compress paper: 2 cm larger than the prepared napkin around the perimeter.
12. Prepare a piece of cotton wool around the perimeter 2 cm larger than the compress paper.
13. Place the layers for the compress on the table, starting with the outer layer: below - cotton wool, then - compress paper.
14. Pour alcohol into the tray.
15. Moisten a napkin in it, lightly wring it out and place it on top of the compress paper.

Executing the procedure
16. Place all layers of the compress simultaneously on the desired area (knee joint) of the body.
17. Secure the compress with a bandage so that it fits tightly to the skin, but does not restrict movement.
18. Mark the time of application of the compress in the patient’s chart.
19. Remind the patient that the compress is applied for 6 - 8 hours, give the patient a comfortable position.
20. Wash and dry your hands.
21. 1.5 - 2 hours after applying the compress with your finger, without removing the bandage, check the moisture level of the napkin. Secure the compress with a bandage.
22. Wash and dry your hands.

Completing the procedure
23. Wash and dry your hands.
24. Remove the compress after the prescribed time of 6–8 hours.
25. Wipe the skin in the area of ​​the compress and apply a dry bandage.
26. Dispose of used material.
27. Wash and dry your hands.
28. Make a note in the medical record about the patient's reaction.

Installation of mustard plasters

Equipment
1. Mustard plasters.
2. Tray with water (40 - 45*C).
3. Towel.
4. Gauze napkins.
5. Clock.
6. Tray for waste material.

Preparation for the procedure
7. Explain to the patient the purpose and course of the upcoming procedure and
obtain his consent.
8. Help the patient find a comfortable position, lying on his back or stomach.
9. Wash and dry your hands.
11. Pour water at a temperature of 40 - 45*C into the tray.

Executing the procedure
12. Inspect skin patient at the site of mustard plasters.
13. Immerse mustard plasters one by one in water, allow excess water to drain, and place the side covered with mustard or the porous side on the patient’s skin.
14. Cover the patient with a towel and blanket.
15. After 5–10 minutes, remove the mustard plasters, placing them in the waste material tray.

End of the procedure
16. Wipe the patient’s skin with a damp, warm cloth and dry with a towel.
17. Place the used material, mustard plasters, napkin in the waste material tray, then dispose of it.
18. Cover and place the patient in a comfortable position, warn the patient that he must remain in bed for at least 20 - 30 minutes.
19. Wash and dry your hands.
20. Make a record of the procedure performed in the patient’s medical record.

Using a heating pad

Equipment
1. Hot water bottle.
2. Diaper or towel.
3. Jug of water T - 60-65°C.
4. Thermometer (water).

Preparation for the procedure
5. Explain to the patient the course of the upcoming procedure and obtain his consent to the procedure.
6. Wash and dry your hands.
7. Pour hot (T - 60–65°C) water into the heating pad, slightly squeeze it at the neck, releasing the air, and close it with a stopper.
8. Turn the heating pad upside down to check the flow of water and wrap it in some kind of swaddling cloth
with a towel.

Executing the procedure
9. Place the heating pad on the desired area of ​​the body for 20 minutes.

End of the procedure
11. Examine the patient’s skin in the area of ​​contact with the heating pad.
12. Pour out the water. Treat the heating pad with a rag generously moistened with a bactericidal disinfectant solution twice with an interval of 15 minutes.
13. Wash and dry your hands.
14. Make a note about the procedure and the patient’s reaction to it in the inpatient’s chart.

Setting up an ice pack

Equipment
1. Ice pack.
2. Diaper or towel.
3. Pieces of ice.
4. Jug of water T - 14 - 16 C.
5. Thermometer (water).

Preparation for the procedure
6. Explain to the patient the course of the upcoming procedure and obtain consent for the procedure.
7 Wash and dry your hands.
8. Place pieces of ice prepared in the freezer into a bubble and fill them with cold water (T - 14 - 16°C).
9. Place the bubble on a horizontal surface to displace air and screw on the lid.
10. Turn the ice pack upside down, check the seal and wrap it in a diaper or towel.

Executing the procedure
11. Place the bubble on the desired area of ​​the body for 20–30 minutes.
12. Remove the ice pack after 20 minutes (repeat steps 11–13).
13. As the ice melts, the water can be drained and pieces of ice added.
End of the procedure
14. Examine the patient’s skin in the area where the ice pack is applied.
15. At the end of the procedure, treat the drained water with a rag moistened with a bactericidal disinfectant solution twice with an interval of 15 minutes.
16. Wash and dry your hands.
17. Make a note about the procedure and the patient’s reaction to it in the inpatient’s chart.

Caring for a woman’s external genitalia and perineum

Equipment
1. A jug with warm (35–37°C) water.
2. Absorbent diaper.
3. Kidney-shaped tray.
4. Vessel.
5. Soft material.
6. Cortsang.
7. Container for discarding used material.
8. Screen.
9. Gloves.

Preparation for the procedure
10. Explain to the patient the purpose and progress of the study.
11. Obtain the patient’s consent to perform the manipulation.
12. Prepare the necessary equipment. Pour warm water into a jug. Place cotton swabs (napkins) and forceps into the tray.
13. Separate the patient with a screen (if necessary).
14. Wash and dry your hands.
15. Put on gloves.

Executing the procedure
16. Lower the head of the bed. Turn the patient to her side. Place an absorbent diaper under the patient.
17. Place the bedpan in close proximity to the patient’s buttocks. Turn her onto her back so that her perineum is above the opening of the vessel.
18. Help to find an optimally comfortable position for the procedure (Fowler’s position, legs slightly bent at the knees and apart).
19. Stand to the right of the patient (if the nurse is right-handed). Place a tray with tampons or napkins in close proximity to you. Secure the tampon (napkin) with a forceps.
20. Hold the jug in your left hand and the forceps in your right. Pour water onto the woman’s genitals, use tampons (changing them) to move from top to bottom, from the inguinal folds to the genitals, then to the anus, washing: a) with one tampon - the pubis; b) second - groin area right and left c) then the right and left labia (major) c) anal area, intergluteal fold Throw used tampons into a vessel.
21. Dry the patient’s pubis, inguinal folds, genitals and anal area with blotting movements using dry wipes in the same sequence and in the same direction as when washing, changing the wipes after each stage.
22. Turn the patient on her side. Remove the bedpan, oilcloth and diaper. Return the patient to the starting position, on her back. Place the oilcloth and diaper in a container for disposal.
23. Help the patient find a comfortable position. Cover her. Make sure she feels comfortable. Remove the screen.

End of the procedure
24. Empty the vessel of its contents and place it in a container with disinfectant.
25. Remove gloves and place them in a waste tray for subsequent disinfection and disposal.
26. Wash and dry your hands.
27. Make a record of the procedure and the patient’s reaction in the documentation.

Catheterization of a woman's bladder with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Sterile gloves.
3. Clean gloves - 2 pairs.
4. Medium sterile wipes - 5−6 pcs.

6. Jug with warm water (30–35°C).
7. Ship.


10. 10−30 ml of saline or sterile water, depending on the size of the catheter.
11. Antiseptic solution.

13. Urinal bag.

15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. Kontsang.
19. Container with disinfectant solution.

Preparation for the procedure
20. Clarify the patient’s understanding of the purpose and course of the upcoming procedure and obtain her consent.
21. Separate the patient with a screen (if the procedure is performed in the ward).
22. Place an absorbent diaper (or oilcloth and diaper) under the patient’s pelvis.
23. Help the patient take the position necessary for the procedure: lying on her back with her legs apart, bent at the knee joints.
24. Wash and dry your hands. Wear clean gloves.
25. Carry out hygienic treatment of the external genitalia, urethra, and perineum. Remove gloves and place them in a container with a disinfectant solution.
26. Wash and dry your hands.
27. Place large and medium sterile wipes into the tray using tweezers). Moisten medium napkins with an antiseptic solution.
28. Wear gloves.
29. Leave the tray between your legs. Spread the labia minora with your left hand (if you are right-handed).
30. Treat the entrance to the urethra with a napkin soaked in an antiseptic solution (hold it with your right hand).
31. Cover the entrance to the vagina and anus with a sterile napkin.
32. Remove gloves and place them in a container for used material.
33. Treat your hands with antiseptic.
34. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
35. Open the bottle with glycerin and pour it into the beaker
36. Open the package with the catheter, place the sterile catheter in the tray.
37. Wear sterile gloves.

Executing the procedure
38. Take the catheter at a distance of 5–6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
39. Lubricate the catheter with glycerin.
40. Insert the catheter into the urethral opening 10 cm or until urine appears (direct the urine into a clean tray).
41. Drain urine into a tray.
42. Fill the Foley catheter balloon with 10 - 30 ml of sterile saline or sterile water.

Completing the procedure
43. Connect the catheter to a container for collecting urine (urinal).
44. Attach the urine bag with a plaster to the thigh or to the edge of the bed.
45. Make sure that the tubes connecting the catheter and the container are not kinked.
46. ​​Remove the waterproof diaper (oilcloth and diaper).
47. Help the patient lie down comfortably and remove the screen.
48. Place the used material in a container with disinfectant. Solution.
49. Remove gloves and place them in a disinfectant solution.
50. Wash and dry your hands.
51. Make a record of the procedure performed.

Catheterization of a male bladder with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Sterile gloves.
3. Clean gloves, 2 pairs.
4. Medium sterile wipes 5-6 pcs.
5. Large sterile wipes - 2 pcs.
b. Jug with warm water (30 - 35°C).
7. Ship.
8. Bottle with sterile glycerin 5 ml.
9. Sterile syringe 20 ml - 1−2 pcs.
10. 10 - 30 ml of saline or sterile water depending on the size of the catheter.
11. Antiseptic solution.
12. Trays (clean and sterile).
13. Urinal bag.
14. Absorbent diaper or oilcloth with diaper.
15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. Container with disinfectant solution.

Preparation for the procedure
19. Explain to the patient the essence and course of the upcoming procedure and obtain his consent.
20. Protect the patient with a screen.
21. Place an absorbent diaper (or oilcloth and diaper) under the patient’s pelvis.
22. Help the patient take the required position: lying on his back with his legs apart, bent at the knee joints.
23. Wash and dry your hands. Wear clean gloves.
24. Carry out hygienic treatment of the external genitalia. Remove gloves.
25. Treat your hands with antiseptic.
26. Place large and medium sterile wipes into the tray using tweezers). Moisten medium napkins with an antiseptic solution.
27. Put on gloves.
28. Treat the head of the penis with a napkin soaked in antiseptic solution(hold it with your right hand).
29. Wrap the penis with sterile wipes (large)
30. Remove gloves and place them in a container with disinfectant. solution.
31. Treat your hands with antiseptic.
32. Place a clean tray between your legs.
33. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
34. Open the bottle with glycerin.
35. Open the catheter package and place the sterile catheter in the tray.
36. Wear sterile gloves.

Executing the procedure
37. Take the catheter at a distance of 5–6 cm from the side hole and hold it at the beginning with 1 and 2 fingers, the outer end with 4 and 5 fingers.
38. Lubricate the catheter with glycerin.
39. Insert the catheter into the urethra and gradually, intercepting the catheter, move it deeper into the urethra, and “pull” the penis upward, as if pulling it onto the catheter, applying a slight uniform force until urine appears (direct the urine into the tray).
40. Drain urine into a tray.
41. Fill the Foley catheter balloon with 10 - 30 ml of sterile saline or sterile water.

Completing the procedure
42. Connect the catheter to a container for collecting urine (urinal bag).
43. Attach the urine bag to your thigh or to the edge of the bed.
44. Make sure that the tubes connecting the catheter and the container are not kinked.
45. Remove the waterproof diaper (oilcloth and diaper).
46. ​​Help the patient lie down comfortably and remove the screen.
47. Place the used material in a container with disinfectant. Solution.
48. Remove gloves and place them in a disinfectant solution.
49. Wash and dry your hands.
50. Make a record of the procedure performed.

Cleansing enema

Equipment
1. Esmarch mug.
2. Water 1 -1.5 liters.
3. Sterile tip.
4. Vaseline.
5. Spatula.
6. Apron.
7. Taz.
8. Absorbent diaper.
9. Gloves.
10. Tripod.
11. Water thermometer.
12. Container with disinfectants.

Preparation for the procedure
10. Explain to the patient the essence and course of the upcoming procedure. Obtain the patient's consent for the procedure.
11. Wash and dry your hands.
12. Put on an apron and gloves.
13. Open the package, remove the tip, attach the tip to Esmarch’s mug.
14. Close the valve on Esmarch’s mug, pour 1 liter of water at room temperature into it (for spastic constipation, the water temperature is 40–42 degrees, for atonic constipation, 12–18 degrees).
15. Mount the mug on a tripod at a height of 1 meter from the level of the couch.
16. Open the valve and drain some water through the nozzle.
17. Using a spatula, lubricate the tip with Vaseline.
18. Place an absorbent diaper on the couch at an angle, hanging into the basin.

20. Remind the patient of the need to retain water in the intestines for 5–10 minutes.

Executing the procedure
21. Spread the buttocks with the 1st and 2nd fingers of your left hand, with your right hand carefully insert the tip into the anus, moving it into the rectum towards the navel (3–4 cm), and then parallel to the spine to a depth of 8–10 cm.
22. Open the valve slightly so that water slowly flows into the intestines.
24. Invite the patient to breathe deeply into the abdomen.
24. After introducing all the water into the intestine, close the valve and carefully remove the tip.
25. Help the patient get off the couch and walk to the toilet.

Completing the procedure
26. Disconnect the tip from Esmarch's mug.
27. Place used equipment in a disinfectant solution.
28. Remove gloves, place them in a disinfectant solution, and then dispose of them. Remove the apron and send it for disposal.
29. Wash and dry your hands.
30. Make sure that the procedure was effective.
31. Make a record of the procedure and the patient's response.

Carrying out siphon lavage of the intestines

Equipment


3. Gloves.
4. Container with disinfectant solution.
5. A container for collecting wash water for testing.
6. Container (bucket) with water 10 -12 liters (T - 20 - 25*C).
7. Capacity (basin) for draining wash water for 10 - 12 liters.
8. Two waterproof aprons.
9. Absorbent diaper.
10. Mug or jug ​​for 0.5 - 1 liter.
11. Vaseline.
12. Spatula.
13. Napkins, toilet paper.

Preparation for the procedure
14. Clarify the patient’s understanding of the purpose and progress of the upcoming procedure. Obtain consent to carry out the manipulation.
15. Wash and dry your hands.
16. Prepare equipment.
17. Put on gloves and an apron.
18. Place an absorbent diaper on the couch, angle down.
19. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought toward the abdomen.

Executing the procedure
20. Remove the system from the packaging. Lubricate the blind end of the probe with Vaseline.
21. Spread the buttocks with fingers 1 and 2 of your left hand, insert the rounded end of the probe into the intestine with your right hand and push it to a depth of 30–40 cm: the first 3–4 cm - towards the navel, then parallel to the spine.
22. Attach a funnel to the free end of the probe. Hold the funnel slightly inclined, at the level of the patient’s buttocks. Pour 1 liter of water into it from the jug along the side wall.
23. Invite the patient to breathe deeply. Raise the funnel to a height of 1 m. As soon as the water reaches the mouth of the funnel, lower it over the wash basin below the level of the patient’s buttocks, without pouring water out of it until the funnel is completely filled.
24. Drain the water into the prepared container (basin for washing water). Note: The first wash water can be collected in a container for testing.
25. Fill the funnel with the next portion and lift it up to a height of 1 m. As soon as the water level reaches the mouth of the funnel, lower it down. Wait until it is filled with rinsing water and pour it into the basin. Repeat the procedure many times until the rinsing water is clear, using all 10 liters of water.
26. Disconnect the funnel from the probe at the end of the procedure, leave the probe in the intestine for 10 minutes.
27. Remove the probe from the intestine with slow forward movements, passing it through a napkin.
28. Immerse the probe and funnel in a container with disinfectant.
29. Wipe toilet paper skin in the anal area (in women, in the direction from the genitals) or wash the patient in case of helplessness.

Completing the procedure
30. Ask the patient how he is feeling. Make sure he feels okay.
31. Ensure safe transportation to the ward.
32. Pour rinsing water into the sewer and, if indicated, carry out preliminary disinfection.
33. Disinfect used instruments and then dispose of disposable ones.
34. Remove gloves. Wash and dry your hands.
35. Make a note in the patient’s medical record about the procedure performed and the reaction to it.

Hypertensive enema

Equipment


3. Spatula.
4. Vaseline.
5. 10% sodium chloride solution or 25% magnesium sulfate
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Tray.
10. Container with water T - 60°C for heating the hypertonic solution.
11. Thermometer (water).
12. Measuring cup.
13. Container with disinfectant

Preparation for the procedure

15. Before administering a hypertensive enema, warn that pain may occur during manipulation along the intestinal tract.
16. Wash and dry your hands.
17. Warm up hypertonic solution up to 38°C in a water bath, check the temperature of the medicine.
18. Draw a hypertonic solution into a pear-shaped balloon or into a Janet syringe.
19. Put on gloves.

Executing the procedure






26. Warn the patient that the onset of the effect of a hypertensive enema occurs after 30 minutes.

Completing the procedure

28. Place used equipment in a disinfectant solution.
29. Remove gloves and place them in the disinfectant solution.
30. Wash and dry your hands.
31. Help the patient get to the toilet.
32. Make sure that the procedure was effective.
33. Make a record of the procedure and the patient’s reaction.

Oil enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas outlet tube.
3. Spatula.
4. Vaseline.
5. Oil (vaseline, vegetable) from 100 - 200 ml (as prescribed by a doctor).
b. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen (if the procedure is performed in the ward).
10. Tray.
11. Container for heating oil with water T - 60°C.
12. Thermometer (water).
13. Measuring cup.

Preparation for the procedure
14. Provide the patient with the necessary information about the procedure and obtain his consent to the procedure.
15. Place a screen.
16. Wash and dry your hands.
17. Heat the oil to 38°C in a water bath, check the oil temperature.
18. Fill a pear-shaped balloon or Janet’s syringe with warm oil.
19. Put on gloves.

Executing the procedure
20. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought toward the abdomen.
21. Lubricate gas outlet pipe Vaseline and insert it into the rectum 15–20 cm.
22. Deflate the air from the pear-shaped balloon or Janet syringe.
23. Attach a pear-shaped balloon or Janet syringe to the gas outlet tube and slowly inject the oil.
24. Without unclenching the pear-shaped balloon, disconnect it (Zhanet’s syringe) from the gas outlet tube.
25. Remove the gas outlet tube and place it together with a pear-shaped balloon or Janet syringe in the tray.
26. If the patient is helpless, wipe the skin in the anal area with toilet paper and explain that the effect will occur in 6–10 hours.

Completing the procedure
27. Remove the absorbent diaper and place it in a container for disposal.
28. Remove gloves and place them in a tray for subsequent disinfection.
29. Cover the patient with a blanket and help him find a comfortable position. Remove the screen.
30. Place used equipment in a disinfectant solution.
31. Wash and dry your hands.
32. Make a record of the procedure and the patient’s reaction.
33. Assess the effectiveness of the procedure after 6–10 hours.

Medicinal enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas outlet tube.
3. Spatula.
4. Vaseline.
5. Medicine 50 -100 ml (chamomile decoction).
6. Gloves.
7. Toilet paper.
8. Absorbent diaper.
9. Screen.
10. Tray.
11. Container for heating the medicine with water T -60°C.
12. Thermometer (water).
13. Measuring cup.

Preparation for the procedure
14. Provide the patient with the necessary information about the procedure and obtain his consent to the procedure.
15. Give the patient a cleansing enema 20–30 minutes before performing a medicinal enema
16. Place a screen.
17. Wash and dry your hands. Wear gloves.

Executing the procedure
18. Warm up medicine up to 38°C in a water bath, check the temperature with a water thermometer.
19. Draw chamomile decoction into a pear-shaped balloon or into a Janet syringe.
20. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought toward the abdomen.
21. Lubricate the gas outlet tube with Vaseline and insert it into the rectum 15–20 cm.
22. Deflate the air from the pear-shaped balloon or Janet syringe.
23. Attach a pear-shaped balloon or Janet syringe to the gas outlet tube and slowly inject the medicine.
24. Without unclenching the pear-shaped balloon, disconnect it or the Janet syringe from the gas outlet tube.
25. Remove the gas outlet tube and place it together with a pear-shaped balloon or Janet syringe in the tray.
26. If the patient is helpless, wipe the skin in the anal area with toilet paper.
27. Explain that after the manipulation it is necessary to spend at least 1 hour in bed.

Completing the procedure
28. Remove the absorbent diaper and place it in a container for disposal.
29. Remove gloves and place them in a tray for subsequent disinfection.
30. Cover the patient with a blanket and help him find a comfortable position. Remove the screen.
31. Place used equipment in a disinfectant solution.
32. Wash and dry your hands.
33. After an hour, ask the patient how he feels.
34. Make a record of the procedure and the patient’s reaction.

Insertion of a nasogastric tube

Equipment

2. Sterile glycerin.

4. Syringe Janet 60 ml.
5. Band-Aid.
6. Clamp.
7. Scissors.
8. Probe plug.
9. Safety pin.
10. Tray.
11. Towel.
12. Napkins
13. Gloves.

Preparation for the procedure
14. Explain to the patient the process and essence of the upcoming procedure and obtain the patient’s consent to carry out the procedure.
15. Wash and dry your hands.
16. Prepare equipment (the probe must be in the freezer for 1.5 hours before the procedure).
17. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last hole of the probe is below the xiphoid process).
18. Help the patient assume a high Fowler's position.
19. Cover the patient's chest with a towel.
20. Wash and dry your hands. Wear gloves.

Executing the procedure
21. Liberally treat the blind end of the probe with glycerin.
22. Ask the patient to tilt his head back slightly.
23. Insert the probe through the lower nasal passage to a distance of 15–18 cm.
24. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add pieces of ice to the water.
25. Help the patient swallow the probe, moving it into the pharynx during each swallowing movement.
26. Ensure that the patient can speak clearly and breathe freely.
27. Gently advance the probe to the desired mark.
28. Make sure that the probe is located correctly in the stomach: attach the syringe to the probe and pull the plunger towards you; The contents of the stomach (water and gastric juice) should flow into the syringe.
29. If necessary, leave the probe for a long time, secure it to the nose with a plaster. Remove the towel.
30. Close the probe with a plug and attach it with a safety pin to the patient’s clothing on the chest.

Completing the procedure
31. Remove gloves.
32. Help the patient take a comfortable position.
33. Place the used material in a disinfectant solution and then dispose of it.
34. Wash and dry your hands.
35. Make a record of the procedure and the patient’s reaction.

Feeding through a nasogastric tube

Equipment
1. Sterile gastric tube with a diameter of 0.5 - 0.8 cm.
2. Glycerin or petroleum jelly.
3. A glass of water 30 - 50 ml and a drinking straw.
4. Janet syringe or syringe with a volume of 20.0.
5. Band-Aid.
6. Clamp.
7. Scissors.
8. Probe plug.
9. Safety pin.
10. Tray.
11. Towel.
12. Napkins
13. Gloves.
14. Phonendoscope.
15. 3-4 glasses of nutrient mixture and a glass of warm boiled water.

Preparation for the procedure
16. Explain to the patient the process and essence of the upcoming procedure and obtain the patient’s consent to carry out the procedure.
17. Wash and dry your hands.
18. Prepare the equipment (the probe should be in the freezer for 1.5 hours before the start of the procedure).
19. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the anterior abdominal wall so that the last hole of the probe is below the xiphoid process).
20. Help the patient assume a high Fowler's position.
21. Cover the patient's chest with a towel.
22. Wash and dry your hands. Wear gloves.

Executing the procedure
23. Liberally treat the blind end of the probe with glycerin.
24. Ask the patient to tilt his head back slightly.
25. Insert the probe through the lower nasal passage to a distance of 15 - 18 cm.
26. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add pieces of ice to the water.
27. Help the patient swallow the probe, moving it into the pharynx during each swallowing movement.
28. Ensure that the patient can speak clearly and breathe freely.
29. Gently advance the probe to the desired mark.
30. Make sure that the probe is located correctly in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) should be drawn into the syringe or air should be introduced into the stomach using a syringe under the control of a phonendoscope (characteristic sounds are heard).
31. Disconnect the syringe from the probe and apply a clamp. Place the free end of the probe in the tray.
32. Remove the clamp from the probe, connect the Janet syringe without a piston and lower it to the level of the stomach. Tilt the Janet syringe slightly and pour in food heated to 37–38 °C. Gradually raise until the food reaches the cannula of the syringe.
33. Lower the Janet syringe to the original level and introduce the next portion of food. The required volume of the mixture is administered fractionally, in small portions of 30–50 ml, at intervals of 1–3 minutes. After introducing each portion, clamp the distal portion of the probe.
34. Rinse the tube with boiled water or saline solution at the end of feeding. Place a clamp on the end of the probe, disconnect the Janet syringe and close with the plug.
35. If it is necessary to leave the probe for a long time, secure it to the nose with a plaster and attach it with a safe pin to the patient’s clothing on the chest.
36. Remove the towel. Help the patient find a comfortable position.

Completing the procedure
37. Place used equipment in a disinfectant solution and then dispose of it.
38. Remove gloves and place in a disinfectant solution for subsequent disposal.
39. Wash and dry your hands.
40. Make a record of the procedure and the patient’s reaction.

Gastric lavage with a thick gastric tube

Equipment
1. A sterile system of 2 thick gastric tubes connected by a transparent tube.
2. Sterile funnel 0.5 - 1 liter.
3. Gloves.
4. Towel and napkins are medium.
5. Container with disinfectant solution.
b. Container for analysis of wash water.
7. Water container 10 liters (T - 20 - 25*C).
8. Capacity (basin) for draining wash water for 10 - 12 liters.
9. Vaseline oil or glycerin.
10. Two waterproof aprons and an absorbent diaper if washing is carried out while lying down.
11. Mug or jug ​​for 0.5 - 1 liter.
12. Mouth retractor (if necessary).
13. Language supporter (if necessary).
14. Phonendoscope.

Preparation for the procedure
15. Explain the purpose and progress of the upcoming procedure. Explain that when inserting a probe, nausea and vomiting are possible, which can be suppressed by breathing deeply. Obtain consent for the procedure. Measure blood pressure and count pulse if the patient’s condition allows this.
16. Prepare equipment.

Executing the procedure
17. Help the patient take the position required for the procedure: sitting, pressed against the back of the seat and slightly tilting his head forward (or lay him on the couch in a side position). Remove the patient's dentures, if any.
18. Put on a waterproof apron for yourself and the patient.
19. Wash your hands and wear gloves.
20. Place the pelvis at the patient’s feet or at the head end of the couch or bed if the procedure is performed in the supine position.
21. Determine the depth to which the probe should be inserted: height minus 100 cm or measure the distance from lower incisors to the earlobe and to the xiphoid process. Place a mark on the probe.
22. Remove the system from the packaging, moisten the blind end with Vaseline.
23. Place the blind end of the probe on the root of the tongue and ask the patient to make swallowing movements.
24. Insert the probe to the desired mark. Assess the patient's condition after swallowing the probe (if the patient coughs, remove the probe and repeat the insertion of the probe after the patient has rested).
25. Make sure that the probe is in the stomach: draw 50 ml of air into the Zhane syringe and attach it to the probe. Introduce air into the stomach under the control of a phonendoscope (characteristic sounds are heard).
26. Attach the funnel to the probe and lower it below the level of the patient’s stomach. Fill the funnel completely with water, holding it at an angle.
27. Slowly lift the funnel up 1 m and control the passage of water.
28. As soon as the water reaches the mouth of the funnel, slowly lower the funnel to the level of the patient’s knees and drain the rinsing water into a basin for rinsing water. Note: The first wash water can be collected in a container for testing.
29. Repeat washing several times until clean wash water appears, using the entire amount of water, collecting the wash water in a basin. Make sure that the amount of the injected portion of liquid corresponds to the amount of rinsing water released.

End of the procedure
30. Remove the funnel, remove the probe, passing it through a napkin.
31. Place used instruments in a container with a disinfectant solution. Pour the rinsing water into the sewer and first disinfect it in case of poisoning.
32. Remove aprons from yourself and the patient and place them in a container for disposal.
33. Remove gloves. Place them in a disinfectant solution.
34. Wash and dry your hands.
35. Give the patient the opportunity to rinse his mouth and escort (deliver) to the ward. Cover warmly and observe the condition.
36. Make a note about the completion of the procedure.

Diluting the antibiotic in a vial and performing an intramuscular injection

Equipment
1. Disposable syringe with a volume of 5.0 to 10.0, an additional sterile needle.
2. Bottle of benzylpenicillin sodium salt 500,000 units each, sterile water for injection.


5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Non-sterile tweezers for opening the bottle.
9. Containers with disinfectant solution for disinfecting used equipment

Preparation for the procedure
10. Check with the patient for information about the drug and his consent to the injection.
11. Help the patient find a comfortable lying position.
12. Wash and dry your hands.
13. Put on gloves.
14. Check: syringe and needles tightness, expiration date; medicine name, expiration date on the bottle and ampoule; packaging with tweezers expiration date; packaging with soft material expiration date.
15. Remove the sterile tray from the packaging.
16. Assemble the disposable syringe, check the patency of the needle.
17. Using non-sterile tweezers, open the aluminum cap on the bottle and file open the ampoule with the solvent.
18. Prepare cotton balls and moisten them with a skin antiseptic.
19. Treat the bottle cap with a cotton ball moistened with alcohol and the ampoule with solvent, open the ampoule.
20. Draw into the syringe the required amount of solvent for diluting the antibiotic (200,000 units in 1 ml of dissolved antibiotic).
21. Puncture the stopper of the bottle with a needle of a syringe with solvent, | add solvent into the bottle.
22. Shake the bottle to ensure complete dissolution of the powder, and draw the required dose into the syringe.
23. Change the needle, displace the air from the syringe.
24. Place the syringe in a sterile tray.

Executing the procedure
25. Determine the site of the intended injection and palpate it.
26. Treat the injection site twice with a napkin or cotton ball with a skin antiseptic.
27. Stretch the skin at the injection site with two fingers or make a fold.
28. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two-thirds of the way, holding the cannula with your little finger.
29. Release the skin fold and use the fingers of this hand to pull the syringe plunger towards you.
30. Press down on the piston and slowly inject the medication.

End of the procedure
31. Remove the needle, pressing the injection site with a napkin or cotton ball with skin antiseptic.
32. Give a light massage without removing the napkin or cotton ball from the injection site (depending on the drug) and help to stand up.
33. Used material and equipment must be disinfected and subsequently disposed of.
34. Take off gloves and throw them into a container with disinfectant.
35. Wash and dry your hands.
36. Ask the patient how he feels after the injection.
37. Make a record of the procedure performed in the patient’s medical record.

Intradermal injection

Equipment
1. Disposable syringe 1.0 ml, additional sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) 3 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.

Preparation for the procedure

10. Help the patient find a comfortable position (sitting).
11. Wash and dry your hands.
12. Put on gloves.



16. Prepare 3 cotton balls, moisten 2 balls with skin antiseptic, leave one dry.

Executing the procedure
21. Determine the site of the intended injection (middle inner part of the forearm).
22. Treat the injection site with a napkin or cotton ball with a skin antiseptic, then with a dry ball.
23. Stretch the skin at the injection site.
24. Take a syringe, insert the needle onto the bevel of the needle, holding the cannula with your index finger.
25. Press the piston and slowly introduce the drug with the hand used to stretch the skin.

End of the procedure
26. Remove the needle without cleaning the injection site.


29. Wash and dry your hands.

Subcutaneous injection

Equipment
1. Disposable syringe 2.0 volume, additional sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
6. Gloves.
7. Sterile tweezers.
8. Containers with disinfectant solution for disinfecting used equipment

Preparation for the procedure
9. Check with the patient for information about the drug and obtain his consent to the injection.

11. Wash and dry your hands.
12. Put on gloves.
13. Check: syringe and needles tightness, expiration date; medicine name, expiration date on the package and ampoule; packaging with tweezers expiration date; packaging with soft material expiration date.
14. Remove the sterile tray from the packaging.
15. Assemble the disposable syringe, check the patency of the needle.

17. Open the ampoule with the medicine.
18. Draw up the medicine.
19. Change the needle, displace the air from the syringe.
20. Place the syringe in a sterile tray.

Executing the procedure


23. Take the skin at the injection site in the fold.
24. Take a syringe and insert the needle under the skin (at an angle of 45 degrees) two-thirds of the needle’s length.
25. Release the skin fold and use the fingers of this hand to press the piston and slowly inject the medication.

End of the procedure
26. Remove the needle, pressing the injection site with a napkin or cotton ball with skin antiseptic.
27. Used material and equipment must be disinfected and subsequently disposed of.
28. Take off gloves and throw them into a container with disinfectant.
29. Wash and dry your hands.
30. Ask the patient how he feels after the injection.
31. Make a record of the procedure performed in the patient’s medical record.

Intramuscular injection

Equipment
1. Disposable syringe with a volume of 2.0 to 5.0, an additional sterile needle.
2. Medicine.
3. The tray is clean and sterile.
4. Sterile balls (cotton or gauze) at least 5 pcs.
5. Skin antiseptic.
b. Gloves.
7. Sterile tweezers.
8. Containers with disinfectant solution for disinfecting used equipment

Preparation for the procedure
9. Check with the patient for information about the drug and obtain his consent to the injection.
10. Help the patient find a comfortable lying position.
11. Wash and dry your hands.
12. Put on gloves.
13. Check: syringe and needles tightness, expiration date; medicine name, expiration date on the package and ampoule; packaging with tweezers expiration date; packaging with soft material expiration date.
14. Remove the sterile tray from the packaging.
15. Assemble the disposable syringe, check the patency of the needle.
16. Prepare cotton balls and moisten them with a skin antiseptic.
17. Open the ampoule with the medicine.
18. Draw up the medicine.
19. Change the needle, displace the air from the syringe.
20. Place the syringe in a sterile tray.

Executing the procedure
21. Determine the site of the intended injection and palpate it.
22. Treat the injection site twice with a napkin or cotton ball with a skin antiseptic.
23. Stretch the skin at the injection site with two fingers.
24. Take a syringe, insert the needle into the muscle at an angle of 90 degrees, two-thirds of the way, holding the cannula with your little finger.
25. Pull the syringe plunger towards you.
26. Press down on the piston and slowly inject the medication.

End of the procedure
27. Remove the needle; pressing the injection site with a napkin or cotton ball with skin antiseptic.
28. Give a light massage without removing the napkin or cotton ball from the injection site (depending on the drug) and help to stand up.
29. Used material and equipment must be disinfected and subsequently disposed of.
30. Take off gloves and throw them into a container with disinfectant.
31. Wash and dry your hands.
32. Ask the patient how he feels after the injection.
33. Make a record of the procedure performed in the patient’s medical record.

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

INDICATIONS: The patient is vomiting.

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

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

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

3. Report the patient to the doctor through an intermediary

4. Wear gloves and personal protective equipment.

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

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

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

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

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

10. Monitor the patient’s condition.

The patient is weakened or unconscious

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

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

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

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

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

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

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

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

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

Gastric lavage with a thick probe

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

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

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

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

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

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

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

4.If there is one, remove the removable teeth

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

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

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

7. Carry out hand hygiene and put on gloves.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

8. Document the execution of the manipulation.

Lecture TOPIC No. 16: Probe procedures

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

Lecture outline

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

2. Ethical and deontological nursing interventions during probing

3. Safety rules for probe procedures

4. Algorithm for fractional gastric intubation.

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

6. Algorithm for duodenal intubation

7. Algorithm for gastric lavage

8. Nursing assistance when vomiting

9. Glossary.
Therapeutic probe procedures

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

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

Goals of probe procedures:

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

Probes are distinguished by

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

Contraindications:

1) esophageal and gastric bleeding

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

3) pronounced cardiovascular pathology

Ethical and deontological support for sounding

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

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

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

Safety regulations

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

Attention!

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

Attention!

Attention!

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

Attention!

Contraindications for all probe manipulations:

Manipulation algorithms

Fractional gastric intubation using the Leporsky method

Purpose of manipulation:

Obtaining gastric juice for research.

Contraindications:

Patient preparation:

In the morning, on an empty stomach.

Equipment:

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

Dishes: 7 clean bottles with labels.

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

Direction

to a clinical laboratory

analysis of gastric juice obtained using an enteral stimulus

Patient: Full name, age

D.S: examination

Signature (doctor):

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

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

Remember!

There are marks on the probe every 10 cm.

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

Fractional gastric intubation with parenteral stimulus
Purpose of manipulation:

Obtaining gastric juice for examination.

Contraindications:

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

Patient preparation:

In the morning, on an empty stomach.

Equipment:

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

Dishes: 9 clean jars with labels.

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

gloves, towel, tray, direction:

Direction

to a clinical laboratory

analysis of gastric juice obtained using a parenteral stimulus

Patient: Full name age

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

D.S: examination

Signature (doctor):

Algorithm of action when introducing a probe:

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

2. Take written consent.

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

4. Wash your hands and put on gloves.

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

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

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

9. Invite the patient to open his mouth.

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

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

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

Duodenal sounding

Purpose of manipulation:

Obtaining bile for examination.

Contraindications:

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

Patient preparation:

In the morning, on an empty stomach.

Equipment:

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

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

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

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

Direction

to a clinical laboratory

Bile

Patient: Full name, age

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

D.S: examination

Signature (doctor):

Algorithm of action when introducing a probe:

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

Remember!

There are marks on the probe every 10 cm.

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

Algorithm for obtaining material for research:

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

Gastric lavage

Indications:

Poisoning: food, drugs, alcohol, etc.

Contraindications:

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

Equipment:

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

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

Sterile funnel, 1 liter capacity.

Sterile petroleum jelly.

Basin for rinsing water.

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

Rubber gloves, aprons.
Action algorithm:

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

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

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

Note:

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

Help with vomiting

The reflex return of stomach contents is called vomiting.

Equipment:

Oilcloth, towel, basin, glass of water.

Algorithm of actions:

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

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

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

4. Remove the basin and oilcloth.

5. Inspect the vomit and disinfect it.

Note:

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

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

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

Pre-sterilization cleaning and sterilization of probes:

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

Sterilization:

In a steam sterilizer:

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

Probeless methods

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

Workplace equipment:

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

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

• 
  2 needles for ampoule and injection set

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

Comparative characteristics of duodenal and fractional sounding

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

Glossary

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

Main:

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

Additional:

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

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

GASTRIC WASHING WITH A THICK PROBE

Target: therapeutic and diagnostic.

Indications: acute poisoning, preparation for research, operations.

Equipment: gastric lavage system - 2 thick sterile gastric probes connected by a glass tube (the blind end of one probe is cut off); glass funnel 0.5-1 l, towel, napkins, sterile container for collecting wash water for research, container with water (10 l) at room temperature, jug, container for draining wash water, gloves, waterproof apron - 2 pieces, liquid Vaseline oil or glycerin (saline solution).

Contraindications: ulcers, tumors, bleeding from the gastrointestinal tract, bronchial asthma, severe cardiovascular failure.

Stages	Rationale
I. Preparation for the procedure 1. Introduce yourself kindly and respectfully to the patient, clarify how to address him. Explain the purpose and progress of the upcoming procedure. Explain that when inserting a probe, nausea and vomiting are possible, which can be suppressed by breathing deeply. Obtain consent for the procedure. Measure blood pressure and count pulse if the patient’s condition allows this	Psychological preparation of the patient for the procedure. Motivation for cooperation. Respect for patient rights to information
2. Prepare equipment	Performance necessary condition effectiveness of the procedure
II. Executing the procedure 1. Help the patient take the position required for the procedure: sitting, pressed against the back of the seat and slightly tilting his head forward (or lay him on the couch in a side position)	Ensuring free passage of the probe
2. Remove the patient’s dentures, if any.	Prevention of complications
3. Separate the patient with a screen if necessary	Providing psychological comfort
4. Put on a waterproof apron for yourself and the patient	Protecting clothes from getting wet and dirty
5. Wash and dry your hands, put on clean gloves	Ensuring infection safety

6. Place the pelvis at the patient’s feet or at the head end of the couch or bed if the procedure is performed in the supine position.	Ensuring the procedure is hygienic
7. Determine the depth to which the probe should be inserted: measure the distance from the incisors to the navel, add the width of the patient’s palm or subtract 100 cm from his height	Fulfilling the necessary conditions for inserting a tube into the stomach
8. Transfer the mark to the probe, starting from the blind end. Moisten the probe with water or glycerin	Ensuring the advancement of the probe through the esophagus
9. Stand to the right of the patient, invite him to open his mouth, slightly lower his head down. Place the blind end of the probe on the root of the tongue	Preparing for probe insertion
10. Ask the patient to make a swallowing movement, while simultaneously advancing the probe into the esophagus (during swallowing, the epiglottis closes the entrance to the trachea, at the same time the entrance to the esophagus opens)	Carrying out the procedure
11. Invite the patient to clasp the probe with his lips and breathe deeply through his nose. Advance the probe slowly and evenly to the marked mark, tilting the patient's head forward and down. If resistance is encountered, stop and remove the probe. Then try again (resistance when inserting the probe, cough, cyanosis, vomiting, change in voice indicate insertion of the probe into the trachea)	Facilitating the passage of the probe through the esophagus and relieving the urge to vomit
12. Make sure that the probe is in the stomach: draw 50 ml of air into the Zhane syringe and attach it to the probe. Insert air into the stomach under the control of a phonendoscope (characteristic sounds are heard)	Prevention of complications
13. Advance the probe another 7-10 cm	Ensuring the effectiveness of the procedure
14. Attach the funnel to the probe and lower it below the level of the patient’s stomach. Fill the funnel completely with water, holding it at an angle	Preventing air from entering the stomach
15. Slowly lift the funnel up 1 m	Ensuring that water enters the stomach
16. Monitor the decrease in liquid. Lower the funnel to knee level once it reaches the mouth of the funnel. Keep the funnel in this position until the funnel is completely filled with wash water.	According to the law of communicating vessels, it enters the stomach, and then again into the funnel
17. Drain the wash water into a basin. If necessary, drain the first waters into containers for research.	At exogenous poisoning The first and last portions of wash water are collected in clean containers. The first - to determine the unknown poison, the second - to assess the quality of washing
18. Repeat the previous two steps if it is necessary to collect the wash water for examination in a sterile container	Collecting rinsing water into a sterile container is carried out in case of food toxic infection

19. Repeat washing several times until clean wash water appears. Make sure that the amount of the injected portion of liquid corresponds to the amount of rinsing water released. Collect rinsing water in a basin	Ensuring the quality of manipulation
III. End of the procedure 1. Remove the funnel, remove the probe, passing it through a napkin	Protecting clothes from contamination
2. Place used instruments in a container with a disinfectant solution. Pour the rinsing water into the sewer. Pre-disinfect them in case of poisoning. Remove aprons from yourself and the patient and place them in a container with a disinfectant solution. Remove gloves. Place them in a disinfectant solution. Wash and dry your hands	Prevention of nosocomial infections
3. Give the patient the opportunity to rinse his mouth and escort (deliver) to the room. Cover warmly, observe the condition	Ensuring Patient Safety
4. Make a note about the completion of the procedure	Ensuring continuity of nursing care
Criteria for assessing the implementation of the procedure Timeliness of completion Availability of a record of completion Absence of complications during and after the procedure Patient satisfaction with the quality of service Timely delivery of rinsing water to the laboratory