Duodenal sounding technique. Probe procedures Probe manipulations

The date: 08.03.2020

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

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. Put on gloves.

Performing a 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 the required level (if this is not possible, change the linen, observing the biomechanics of the body).
11. Remove the duvet cover from the duvet, fold it and hang it on the back of a chair.
12. Make sure you have clean bedding ready for you.
13. Stand on the opposite side of the bed that you will be making (from the side of the lowered handrail).
14. Make sure that there are no small personal items of the patient on this side of the bed (if there are, ask where to put them).
15. Turn the patient on his side towards you.
16. Raise the side rail (the patient can keep himself in a position on his side by holding on to the rail).
17. Return to the opposite side of the bed, lower the handrail.
18. Raise the patient's head and remove the pillow (if there are drainage tubes, make sure they are not kinked).
19. Make sure that the patient's small items are not on this side of the bed.
20. Roll up a 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 with the patient's skin and a clean sheet).
21. Fold a clean sheet in half lengthwise and place its center fold in the center of the bed.
22. Unfold the sheet towards you and tuck the sheet at the head of the bed using the "bevel corner" method.
23. Tuck the middle third, then the bottom third of the sheet under the mattress, with your hands palms up.
24. Make the roll of the rolled up clean and dirty sheets as flat as possible.
25. Help the patient "roll" over these sheets towards you; make sure the patient is lying comfortably and, if there are drainage tubes, that they are not kinked.
26. Raise the side rail on the opposite side of the bed where you just worked.
27. Go to the other side of the bed.
28. Change bedding on the other side of the bed.
29. Lower the side rail.
30. Roll up a dirty sheet and place it in a laundry bag.
31. Straighten a clean sheet and tuck under the mattress first its middle third, then the top, then the bottom, using the technique in p.p. 22, 23.
32. Help the patient turn on his back and lie down in the middle of the bed.
33. Tuck the duvet into a clean duvet cover.
34. Straighten 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 a laundry bag.
37. Turn a clean pillowcase inside out.
38. Take the pillow by its corners through the pillowcase.
39. Pull the pillowcase over the pillow.
40. Raise the patient's head and shoulders and place a pillow under the patient's head.
41. Raise the side rail.
42. Make a fold in the blanket for the toes.

Completion of the procedure
43. Remove gloves, place them in a disinfectant solution.
44. Wash and dry your hands.
45. Make sure the patient is comfortable.

Patient Eye Care

Equipment
1. Sterile tray
2. Sterile tweezers
3. Sterile gauze wipes - at least 12 pcs.
4. Gloves
5. Waste tray
6. Antiseptic solution for the treatment of mucous eyes

Preparation for the procedure
7. Clarify the patient's understanding of the purpose and course 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 in order to detect purulent discharge
11. Wear gloves

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

Completion of the procedure
16. Remove all used equipment with subsequent disinfection
17. Help the patient accept comfortable position
18. Place wipes in a container with a disinfectant for subsequent disposal
19. Remove gloves and place them in a disinfectant solution
20. Wash and dry your hands
21. Record in medical card about the patient's response

Examination 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 course of the study.
5. Obtain patient consent for the study.
6. Wash and dry your hands.

Performing a procedure
7. During the procedure, the patient can sit or lie down (hands are relaxed, hands should not be on weight).
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 rhythm of the pulse for 30 seconds.
10. Choose 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 more strongly than before against the radius and determine the tension of the pulse (if the pulsation disappears with moderate pressure, the tension is good; if the pulsation does not weaken, the pulse is tense; if the pulsation has completely stopped, the tension is weak).
13. Record the result.

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

Technique for measuring blood pressure

Equipment
1. Tonometer.
2. Phonendoscope.
3. Handle.
4. Paper.
5. Temperature sheet.
6. Napkin with alcohol.

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 down at the table.
10. Wash and dry your hands.

Performance
11. Help take off clothes from your hand.
12. Put the patient's hand in an extended position with the palm up, at the level of the heart, the muscles are relaxed.
13. Apply a cuff 2.5 cm above the cubital fossa (clothes should not squeeze the shoulder above the cuff).
14. Fasten the cuff so that two fingers pass between the cuff and the surface of the upper arm.
15. Check the position of the pressure gauge arrow relative to the zero mark.
16. Find (by palpation) the pulse on the radial artery, quickly inflate 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 region of the cubital fossa and firmly place the membrane of the stethophonendoscope on this place.
18. Close the valve on the pear and pump air into the cuff. Inflate the air until the pressure in the cuff, according to the readings of the tonometer, does not exceed 30 mm Hg. Art., the level at which the pulsation of the radial artery or Korotkoff's tones ceases to be determined.
19. Open the valve and slowly, at a speed of 2-3 mm Hg. per second, deflate the cuff. At the same time, listen to the tones on the brachial artery with a stethophonendoscope and monitor the indications of the manometer 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 tones on the brachial artery.
22. Repeat the procedure after 2-3 minutes.

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

Determining the 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 test will be performed.
5. Obtain the consent of the patient to conduct the study.
6. Ask the patient to sit or lie down to see upper part his chest and/or abdomen.
7. Wash and dry your hands.

Performing a procedure
8. Take the patient by the hand as for a pulse test, hold the patient’s hand on the wrist, put your hands (your own and the patient’s) on the chest (in women) or on the epigastric region (in men), simulating a pulse test and counting the respiratory movements for 30 seconds, multiplying the result by two.
9. Record the result.
10. Help the patient to take a comfortable position for him.

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

Measurement of temperature in the armpit

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 region, if necessary, wipe dry with a tissue or ask the patient to do so. In the presence of hyperemia, local inflammatory processes, temperature measurement cannot be carried out.
12. Place the thermometer tank in the axillary region so that it is in close contact with the patient's body on all sides (press the shoulder against the chest).
13. Leave the thermometer for at least 10 minutes. The patient should lie in bed or sit.
14. Remove thermometer. Evaluate readings by holding the thermometer horizontally at eye level.
15. Inform the patient of the results of thermometry.

Completion of the procedure
16. Shake the thermometer so that the mercury column falls into the tank.
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, body weight and BMI

Equipment
1. Height meter.
2. Scales.
3. Gloves.
4. Disposable wipes.
5. Paper, pen

Preparation and conduct of 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 work, raise the bar of the stadiometer above the expected height, put a napkin on the platform of the stadiometer (under the patient's feet).
9. Ask the patient to take off their shoes and stand in the middle of the stadiometer platform so that it touches the vertical bar of the stadiometer with the heels, buttocks, interscapular region and the back of the head.
10. Set 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 bar of the stadiometer onto the patient's head and determine the height of the patient on the scale along the lower edge of the bar.
12. Ask the patient to get off the platform of the stadiometer (if necessary, help to get off). Inform the patient about the measurement results, record 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), lay a napkin on the scale platform
15. Invite the patient to take off their shoes and help him stand in the middle of the scale platform, to determine the patient's body weight.
16. Help the patient get off the scale platform, tell him the result of the body weight study, write down the result.

End of procedure
17. Put on gloves, remove napkins from the platform of the height meter and scales and place them in a container with disinfectant solution. Treat the surface of the height meter and scales with a disinfectant solution once or twice with an interval of 15 minutes in accordance with guidelines on the use of a 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 - obesity of the 1st degree; 35 - 39.9 - obesity of the II degree; 40 and over - obese III degree. Write down the result.
21. Inform the patient of BMI, write down the result.

Applying a warm compress

Equipment
1. Compress paper.
2. Cotton wool.
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 seat or lay down the patient.
9. Wash and dry your hands.
10. Cut off with scissors necessary (depending on the area of application, a piece of bandage or gauze and fold it into 8 layers).
11. Cut out a piece of compress paper: around the perimeter 2 cm more than the prepared napkin.
12. Prepare a piece of cotton around the perimeter 2 cm larger than the compress paper.
13. Fold the layers for the compress on the table, starting with the outer layer: at the bottom - cotton wool, then - compress paper.
14. Pour alcohol into the tray.
15. Moisten a napkin in it, squeezing it slightly and put it on top of the compress paper.

Performing a procedure
16. Put all layers of the compress at the same time on the desired area (knee joint) of the body.
17. Fix the compress with a bandage so that it fits snugly against the skin, but does not restrict movement.
18. Mark the time of applying the compress in the patient's chart.
19. Remind the patient that the compress is set for 6-8 hours, give the patient a comfortable position.
20. Wash and dry your hands.
21. After 1.5 - 2 hours after applying the compress with your finger, without removing the bandage, check the degree of moisture in the napkin. Secure the compress with a bandage.
22. Wash and dry your hands.

Completion of 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 compress area and apply a dry bandage.
26. Dispose of used material.
27. Wash and dry your hands.
28. Make an entry in the medical record about the patient's reaction.

Staging mustard plasters

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

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

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

End of procedure
16. Wipe the patient's skin with a damp warm cloth and dry with a towel.
17. Used material, mustard plasters, a napkin should be placed in the waste material tray, then disposed of.
18. Cover and lay the patient in a comfortable position, warn the patient that he must remain in bed for at least 20 to 30 minutes.
19. Wash and dry your hands.
20. Record the procedure performed in the patient's medical record.

Heating pad application

Equipment
1. Heating pad.
2. Diaper or towel.
3. A 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 a heating pad, squeeze it slightly at the neck, releasing air, and close it with a cork.
8. Turn the heating pad upside down to check the water flow and wrap it with a veil of some or
towel.

Performing a procedure
9. Put a heating pad on the desired area of the body for 20 minutes.

End of 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 abundantly moistened with a disinfectant solution bactericidal action 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 chart.

Setting up an ice pack

Equipment
1. Bubble for ice.
2. Diaper or towel.
3. Pieces of ice.
4. A 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 to the procedure.
7 Wash and dry your hands.
8. Put the pieces of ice prepared in the freezer into the bubble and fill them with cold water (T - 14 - 1b ° C).
9. Place the bladder on a horizontal surface to expel air and screw on the lid.
10. Turn the ice pack upside down, check the tightness and wrap it in a diaper or towel.

Performing a procedure
11. Put 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 procedure
14. Examine the patient's skin, in the area of application of the ice pack.
15. At the end of the procedure, treat the water from the bladder 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 chart.

Care of the external genitalia and perineum of a woman

Equipment
1. Pitcher with warm (35-37°C) water.
2. Absorbent diaper.
3. Reniform tray.
4. Vessel.
5. Soft material.
6. Kortsang.
7. Capacity for discarding used material.
8. Screen.
9. Gloves.

Preparation for the procedure
10. Explain to the patient the purpose and course of the study.
11. Obtain the consent of the patient to perform the manipulation.
12. Prepare the necessary equipment. Pour warm water into a pitcher. Put cotton swabs (napkins), forceps in the tray.
13. Fence off the patient with a screen (if necessary).
14. Wash and dry your hands.
15. Put on gloves.

Performing a procedure
16. Lower the head of the bed. Turn the patient to the side. Place an absorbent pad under the patient.
17. Place the vessel in close proximity to the patient's buttocks. Turn her on her back so that the crotch is over the opening of the vessel.
18. Help to take an optimally comfortable position for the procedure (Fowler's position, legs slightly bent at the knees and separated).
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. Fix the swab (napkin) with a forceps.
20. Hold the jug in the left hand, and the forceps in the right. Pour water on 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 right and left c) further right and left labia (large) lips c) anus, intergluteal fold Discard used swabs into the vessel.
21. Dry the pubis, inguinal folds, genitals and anus area of the patient with blotting movements using dry wipes in the same sequence and in the same direction as when washing, changing wipes after each stage.
22. Turn the patient on her side. Remove the vessel, oilcloth and diaper. Return the patient to the starting position, supine. Place the oilcloth and diaper in a container for disposal.
23. Help the patient to take a comfortable position. Cover her. Make sure she feels comfortable. Remove screen.

End of procedure
24. Empty the vessel from the contents and place it in a container with a disinfectant.
25. Remove gloves and place them in a waste tray for disinfection and disposal.
26. Wash and dry your hands.
27. Record the performance of the procedure and the patient's response in the documentation.

Bladder catheterization of a woman with a Foley catheter

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

6. A pitcher of warm water (30–35°C).
7. Vessel.

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

13. Urinary bag.

15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. Korntsang.
19. A container with a 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. Fence off the patient with a screen (if the procedure is performed in the ward).
22. Place an absorbent pad (or oilcloth and diaper) under the patient's pelvis.
23. Help the patient to 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. Put on clean gloves.
25. Carry out hygienic treatment of the external genitalia, urethra, perineum. Remove gloves and place them in a container with a disinfectant solution.
26. Wash and dry your hands.
27. Put large and medium sterile wipes into the tray using tweezers). Moisten medium wipes with an antiseptic solution.
28. Put on gloves.
29. Leave the tray between the legs. Spread the labia minora to the sides 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 waste container.
33. Treat your hands with an antiseptic.
34. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
35. Open a bottle of glycerin and pour into a beaker
36. Open the package with the catheter, put the sterile catheter into the tray.
37. Put on sterile gloves.

Performing a 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 opening of the urethra for 10 cm or until urine appears (direct the urine into a clean tray).
41. Dump urine into the tray.
42. Fill the balloon of the Foley catheter with 10 - 30 ml of sterile saline or sterile water.

Completion of the procedure
43. Connect the catheter to a container for collecting urine (urinal).
44. Tape the urinal to your thigh or to the edge of your bed.
45. Make sure that the tubes connecting the catheter and the container do not have kinks.
46. Remove 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 des. Solution.
49. Remove gloves and place them in a disinfectant solution.
50. Wash and dry your hands.
51. Make a record of the procedure done.

Bladder catheterization of a man with a Foley catheter

Equipment
1. Sterile Foley catheter.
2. Sterile gloves.
3. Clean gloves 2 pairs.
4. Sterile wipes medium - 5-6 pcs.
5. Large sterile wipes - 2 pcs.
b. Pitcher with warm water (30 - 35°C).
7. Vessel.
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. Urinary bag.
14. Absorbent diaper or oilcloth with a diaper.
15. Plaster.
16. Scissors.
17. Sterile tweezers.
18. A container with a 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 pad (or oilcloth and diaper) under the patient's pelvis.
22. Help the patient to take the necessary position: lying on his back with legs apart, bent at the knee joints.
23. Wash and dry your hands. Put on clean gloves.
24. Carry out hygienic treatment of the external genital organs. Remove gloves.
25. Treat your hands with an antiseptic.
26. Put large and medium sterile wipes into the tray using tweezers). Moisten medium wipes with an antiseptic solution.
27. Put on gloves.
28. Treat the head of the penis with a napkin soaked in an 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 des. solution.
31. Treat your hands with an antiseptic.
32. Put a clean tray between your legs.
33. Open the syringe and fill it with sterile saline or water 10 - 30 ml.
34. Open a bottle of glycerin.
35. Open the catheter package, put the sterile catheter into the tray.
36. Put on sterile gloves.

Performing a 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 up, as if pulling it on the catheter, applying a slight uniform force until urine appears (direct the urine into the tray).
40. Dump urine into the tray.
41. Fill the balloon of the Foley catheter with 10 - 30 ml of sterile saline or sterile water.

Completion of the procedure
42. Connect the catheter to a container for collecting urine (urinal).
43. Attach the urinal to the 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 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 des. Solution.
48. Remove gloves and place them in a disinfectant solution.
49. Wash and dry your hands.
50. Make a record of the procedure done.

Cleansing enema

Equipment
1. Mug of Esmarch.
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 patient 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 (with spastic constipation, the water temperature is 40–42 degrees, with atonic constipation, 12–18 degrees).
15. Fix 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. Lubricate the tip with petroleum jelly with a spatula.
18. Place an absorbent pad on the couch with an angle hanging down into the pelvis.

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

Performing a procedure
21. Spread the buttocks 1 and 2 with the fingers of the left hand, with the 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. Slightly open the valve so that water slowly enters 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 up from the couch and go to the toilet.

Completion of the procedure
26. Disconnect the tip from Esmarch's mug.
27. Place used equipment in a disinfectant solution.
28. Remove gloves and place in a disinfectant solution for subsequent disposal. Remove the apron and send for recycling.
29. Wash and dry your hands.
30. Verify that the procedure was effective.
31. Record the performance of the procedure and the patient's response.

Siphonic bowel lavage

Equipment

3. Gloves.
4. Container with disinfectant solution.
5. Tank for taking wash water for research.
6. Capacity (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 course of the upcoming procedure. Obtain consent for manipulation.
15. Wash and dry your hands.
16. Prepare equipment.
17. Put on gloves, an apron.
18. Lay an absorbent pad 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 to the stomach.

Performing a procedure
20. Remove the system from the packaging. Lubricate the blind end of the probe with Vaseline.
21. Spread the buttocks 1 and II with the fingers of the left hand, insert the rounded end of the probe into the intestine with the right hand and advance 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 obliquely, at the level of the patient's buttocks. Pour 1 liter of water into it from a 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 lavage 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 may be collected in a test container.
25. Fill the funnel with the next portion and raise 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 washing water and drain them into the basin. Repeat the procedure many times until clean rinsing water, 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 translational movements, passing it through a napkin.
28. Immerse the probe and funnel into the disinfectant container.
29. Wipe the skin around the anus with toilet paper (for women, away from the genitals) or wash the patient in case of helplessness.

Completion of the procedure
30. Ask the patient how they feel. Make sure he feels okay.
31. Ensure safe transportation to the ward.
32. Pour the wash water into the sewer, if indicated, carry out preliminary disinfection.
33. Disinfect used instruments with subsequent disposal of disposable instruments.
34. Remove gloves. Wash and dry hands.
35. Make a note in the patient's medical record about the procedure performed and the reaction to it.

Hypertonic 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. A container with water T - 60 ° C for heating a hypertonic solution.
11. Thermometer (water).
12. Measuring cup.
13. Disinfectant container

Preparation for the procedure

15. Before setting up a hypertonic enema, warn that pain may occur during manipulation along the course of the intestine.
16. Wash and dry your hands.
17. Heat the hypertonic solution to 38°C in a water bath, check the temperature of the drug.
18. Draw a hypertonic solution into a pear-shaped balloon or Janet's syringe.
19. Put on gloves.

Performing a procedure

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

Completion of the procedure

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

Oil enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas 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. Tank for heating oil with water T - 60°C.
12. Thermometer (water).
13. Measuring cup.

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

Performing a procedure
20. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought to the stomach.
21. Lubricate the gas outlet tube with petroleum jelly and insert it into the rectum 15–20 cm.
22. Release 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 expanding the pear-shaped balloon, disconnect it (Jane's syringe) from the gas outlet tube.
25. Remove the gas outlet tube and place it together with the pear-shaped balloon or Janet syringe in the tray.
26. In the event that the patient is helpless, wipe the skin around the anus with toilet paper and explain that the effect will come in 6-10 hours.

Completion of the procedure
27. Remove the absorbent pad, place in a container for disposal.
28. Remove gloves and place them in a tray for subsequent disinfection.
29. Cover the patient with a blanket, help him to take a comfortable position. Remove 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 response.
33. Evaluate the effectiveness of the procedure after 6-10 hours.

Medicinal enema

Equipment
1. Pear-shaped balloon or Janet syringe.
2. Sterile gas 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 drug with water T -60°C.
12. Thermometer (water).
13. Measuring cup.

Preparation for the procedure
14. Inform the patient of the necessary information about the procedure and obtain his consent to the procedure.
15. Give the patient a cleansing enema 20-30 minutes before setting the medicinal enema
16. Put up a screen.
17. Wash and dry your hands. Put on gloves.

Performing a procedure
18. Heat the drug to 38°C in a water bath, check the temperature with a water thermometer.
19. Draw a decoction of chamomile into a pear-shaped balloon or Janet's syringe.
20. Help the patient lie on his left side. The patient's legs should be bent at the knees and slightly brought to the stomach.
21. Lubricate the gas outlet tube with petroleum jelly and insert it into the rectum 15–20 cm.
22. Release 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 drug.
24. Without expanding the pear-shaped balloon, disconnect it or Janet's syringe from the gas outlet tube.
25. Remove the gas outlet tube and place it together with the pear-shaped balloon or Janet syringe in the tray.
26. In the event that the patient is helpless, wipe the skin around the anus with toilet paper.
27. Explain that after the manipulation it is necessary to spend at least 1 hour in bed.

Completion of the procedure
28. Remove the absorbent pad, place in a container for disposal.
29. Remove gloves and place them in a tray for subsequent disinfection.
30. Cover the patient with a blanket, help him take a comfortable position. Remove 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 response.

Preparation for the procedure
14. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
15. Wash and dry your hands.
16. Prepare the equipment (the probe must be in the freezer 1.5 hours before the start of 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 opening of the probe is below the xiphoid process).
18. Help the patient to accept the high position of Fowler.
19. Cover the patient's chest with a towel.
20. Wash and dry your hands. Put on gloves.

Performing a procedure
21. Copiously 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 at 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 ice cubes to the water.
25. Help the patient to swallow the probe, moving it into the throat during each swallowing movement.
26. Make sure the patient can speak clearly and breathe freely.
27. Gently advance the probe to the desired mark.
28. Make sure the probe is in the correct location in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) must enter the syringe.
29. If necessary, leave the probe on long time fix it with a band-aid to the nose. Remove towel.
30. Close the probe with a plug and attach with a safety pin to the patient's chest clothing.

Completion of the procedure
31. Remove gloves.
32. Help the patient to take a comfortable position.
33. Place the used material in a disinfectant solution for subsequent disposal.
34. Wash and dry your hands.
35. Make a record of the procedure and the patient's response.

Preparation for the procedure
16. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.
17. Wash and dry your hands.
18. Prepare the equipment (the probe must be in the freezer 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 opening of the probe is below the xiphoid process).
20. Help the patient to assume the high position of Fowler.
21. Cover the patient's chest with a towel.
22. Wash and dry your hands. Put on gloves.

Performing a procedure
23. Copiously 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 at 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 ice cubes to the water.
27. Help the patient to swallow the probe, moving it into the throat during each swallowing movement.
28. Make sure the patient can speak clearly and breathe freely.
29. Gently advance the probe to the desired mark.
30. Make sure the probe is in the correct location 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 enter the syringe or inject air with a syringe into the stomach 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 into the tray.
32. Remove the clamp from the probe, connect Janet's syringe without a piston and lower it to the level of the stomach. Tilt Janet's syringe slightly and pour in food heated to 37–38 °C. Gradually raise until the food reaches the cannula of the syringe.
33. Lower Janet's syringe to the initial level and introduce the next portion of food. The introduction of the required volume of the mixture should be carried out fractionally, in small portions of 30-50 ml, at intervals of 1-3 minutes. After the introduction of each portion, pinch the distal portion of the probe.
34. Rinse the probe with boiled water or saline at the end of feeding. Place a clamp on the end of the probe, disconnect Janet's syringe and close with a plug.
35. If it is necessary to leave the probe for a long time, fix it with a plaster to the nose and attach it with a safety pin to the patient's clothes on the chest.
36. Remove the towel. Help the patient to assume a comfortable position.

Completion of the procedure
37. Place used equipment in a disinfectant solution for subsequent disposal.
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 response.

Gastric lavage with a thick gastric tube

Equipment
1. Sterile system of 2 thick gastric tubes connected by a transparent tube.
2. Sterile funnel 0.5 - 1 liter.
3. Gloves.
4. Towel, napkins are medium.
5. Container with disinfectant solution.
b. Tank for washing water analysis.
7. Container with water 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 done lying down.
11. Mug or jug for 0.5 - 1 liter.
12. Mouth expander (if necessary).
13. Language holder (if necessary).
14. Phonendoscope.

Preparation for the procedure
15. Explain the purpose and course of the upcoming procedure. Explain that when the probe is inserted, nausea and vomiting are possible, which can be suppressed by deep breathing. Obtain consent for the procedure. Measure blood pressure, count the pulse, if the patient's condition allows it.
16. Prepare equipment.

Performing a procedure
17. Help the patient to take the position necessary for the procedure: sitting, clinging to the back of the seat and slightly tilting his head forward (or lay on the couch in the side position). Remove the patient's dentures, if any.
18. Put on a waterproof apron for yourself and the patient.
19. Wash your hands, put on 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 the lower incisors to the earlobe and to the xiphoid process. Put a mark on the probe.
22. Remove the system from the packaging, moisten the blind end with Vaseline.
23. Put the blind end of the probe on the root of the tongue and ask the patient to swallow.
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 rests).
25. Make sure that the probe is in the stomach: draw 50 ml of air into Janet's 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 raise the funnel up to 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, drain the rinsing water into the basin for rinsing water. Note: The first wash water may be collected in a test container.
29. Repeat rinsing several times until clean rinsing water appears, using the entire amount of water, collecting rinsing water in a basin. Make sure that the amount of the injected portion of the liquid corresponds to the amount of the allocated wash water.

End of procedure
30. Remove the funnel, remove the probe, passing it through a napkin.
31. Place the used instrumentation in a container with a disinfectant solution. Drain the wash water into the sewer, pre-disinfect them in case of poisoning.
32. Remove the 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 accompany (deliver) to the ward. Cover warmly, observe the condition.
36. Make a note about the procedure.

Dilution of the antibiotic in a vial and intramuscular injection

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

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

Preparation for the procedure
10. Clarify the patient's awareness of the drug and his consent to the injection.
11. Help the patient to take a comfortable lying position.
12. Wash and dry your hands.
13. Put on gloves.
14. Check: - syringe and needles - tightness, expiration date; - medicinal product - name, expiration date on the vial and ampoule; - packaging with tweezers - expiration date; - packaging with soft material - expiration date.
15. Remove the sterile tray from the package.
16. Collect a disposable syringe, check the patency of the needle.
17. Open the aluminum cap on the vial with non-sterile tweezers and file the ampoule with the solvent.
18. Prepare cotton balls, moisten them with a skin antiseptic.
19. Treat the bottle cap with a cotton ball moistened with alcohol and an ampoule with a solvent, open the ampoule.
20. Draw the required amount of solvent into the syringe to dilute the antibiotic (in 1 ml of the dissolved antibiotic - 200,000 units).
21. Pierce the bottle cap with the needle of the solvent syringe, | add solvent to the vial.
22. Shaking the vial, achieve complete dissolution of the powder, dial the desired dose into the syringe.
23. Change the needle, expel the air from the syringe.
24. Put the syringe in a sterile tray.

Performing a procedure
25. Determine the site of the proposed injection, 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 length, holding the cannula with your little finger.
29. Release the skin fold and use the fingers of this hand to pull the plunger of the syringe towards you.
30. Press the plunger, slowly inject the drug.

End of procedure
31. Remove the needle by pressing the injection site with a tissue or cotton ball with a skin antiseptic.
32. Make light massage, without removing the napkin or cotton ball from the injection site (depending on the drug) and help to stand up.
33. Disinfection of used material and equipment with subsequent disposal.
34. Remove gloves, throw 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 to take 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.

Performing a procedure
21. Determine the site of the proposed 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 a needle into the needle section, holding the cannula with your index finger.
25. Press on the plunger, slowly inject the drug with the hand that was used to stretch the skin.

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

29. Wash and dry your hands.

subcutaneous injection

Equipment
1. Disposable 2.0 syringe, extra 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 disinfection of used equipment

Preparation for the procedure
9. Clarify the patient's awareness of 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; - medicinal product - 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 package.
15. Collect a disposable syringe, check the patency of the needle.

17. Open the ampoule with the drug.
18. Dial the drug.
19. Change the needle, expel the air from the syringe.
20. Put the syringe in a sterile tray.

Performing a procedure

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

End of procedure
26. Remove the needle by pressing the injection site with a tissue or cotton ball with a skin antiseptic.
27. Disinfection of used material and equipment with subsequent disposal.
28. Remove gloves, discard into a container with disinfectant.
29. Wash and dry your hands.
30. Ask the patient how he feels after the injection.
31. Record 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 disinfection of used equipment

Preparation for the procedure
9. Clarify the patient's awareness of the drug and obtain his consent to the injection.
10. Help the patient to take a comfortable lying position.
11. Wash and dry your hands.
12. Put on gloves.
13. Check: - syringe and needles - tightness, expiration date; - medicinal product - 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 package.
15. Collect a disposable syringe, check the patency of the needle.
16. Prepare cotton balls, moisten them with a skin antiseptic.
17. Open the ampoule with the drug.
18. Dial the drug.
19. Change the needle, expel the air from the syringe.
20. Put the syringe in a sterile tray.

Performing a procedure
21. Determine the site of the proposed injection, 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 length, holding the cannula with your little finger.
25. Pull the plunger of the syringe towards you.
26. Press on the plunger, slowly inject the drug.

End of procedure
27. Remove the needle; pressing the injection site with a napkin or cotton ball with a skin antiseptic.
28. Make a light massage without removing the napkin or cotton ball from the injection site (depending on the drug) and help to get up.
29. Used material, equipment subjected to disinfection with subsequent disposal.
30. Remove gloves, discard 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.

CHAPTER 25

In the practice of children's medical institutions great importance attached to such medical manipulations as enemas, gas removal, gastric lavage, catheterization Bladder, duodenal sounding, etc. Their implementation requires careful preparation, knowledge of the characteristics of each specific manipulation in children of different ages.

Setting an enema. With the help of an enema, various liquids can be introduced into the large intestine for therapeutic or diagnostic purposes. There are cleansing, medicinal, nutritious enemas.

Cleansing enemas prescribed for the release of the intestines from feces and gases. They are used for constipation, food poisoning, to prepare the patient for endoscopic examination methods (rectoscopy, colonofibroscopy), X-ray examination of the stomach, intestines, kidneys, to perform ultrasound organs of the abdominal cavity, before operations, the introduction of drugs. Contraindications are inflammatory changes in the lower segment of the colon, hemorrhoids, prolapse of the rectal mucosa, suspected appendicitis, intestinal bleeding.

For a cleansing enema, water at room temperature is used, which is administered using a balloon with a soft tip. Do children use pear-shaped balloons for administering an enema for the first 2-3 months of life? 2 (capacity - about 50 ml), 6 months -? 3 or 4 (75-100 ml), one-year-olds -? 5 (150 ml), children 2-5 years old -? 5-6 (180-200 ml), 6-12 years - ? 6 (200-250 ml). For cleansing enemas, older children use Esmarch's mug.

Before use, the pear-shaped balloon is sterilized by boiling. Fill it with liquid (water or medicinal solutions), remove air by slightly squeezing the balloon until liquid appears from the tip facing upwards. The tip is lubricated with Vaseline. An infant is usually laid on the back with legs raised up, older children - on the left side, with the lower limbs pulled up to the stomach. tip bal-

the womb is introduced carefully. In the position of the patient on the back, the tip is directed forward and somewhat anteriorly, then, without effort, overcoming the external and internal sphincters of the anus, slightly backward. The tip is inserted to a depth of 3-5 cm in children younger age, 6-8 cm older and gradually compress the balloon. After emptying the balloon, without opening it, carefully remove the tip. To hold the injected fluid in the intestines, the child's buttocks are squeezed by hand for several minutes, after which defecation (emptying) occurs. The amount of liquid for a cleansing enema depends on the age of the child and the indications for its implementation.

Permissible one-time volume of fluid administered when administering an enema in children.

For introduction more liquids, especially older children, use the Esmarch mug. The procedure is performed in the position of the child on the left side with legs bent and pulled up to the stomach. An oilcloth is placed under the buttocks, the free edge of which is lowered into the pelvis in case the child cannot hold the liquid. Esmarch's mug is filled with water at room temperature up to 1 liter and hung on a tripod to a height of 50-75 cm. Having opened the tap, air and a small amount of water are released from the rubber tube. The rubber tip is lubricated with petroleum jelly and, spreading the child's buttocks, is inserted into the anus. The first 2-3 cm of the tip is advanced anteriorly towards the navel, then backwards parallel to the coccyx to a depth of 5-8 cm.

The rate of fluid introduction is regulated by a valve on a rubber tube. If it is difficult for fluid to enter, for example, if the feces are hard, the tube is removed by 1-2 cm and Esmarch's mug is raised by 20-30 cm. The direction of the tip is also changed, the child is asked to bend his legs more, bring them to the stomach, which leads to relaxation of the anterior abdominal wall. If in the process of setting a cleansing enema there is a feeling of fullness due to accumulated gases, then the mug should be lowered below the level

beds; after the passage of gases, the mug is gradually raised. After completion of the procedure, the tip is carefully removed. The patient is in the supine position for 8-10 minutes until intestinal motility increases and the urge to defecate appears.

To enhance intestinal motility, various substances are added to the liquid: sodium chloride ( salt, 1-2 tablespoons per 1 liter of water), glycerin or vegetable oil (1-2 tablespoons), infusion or decoction of chamomile (1 cup). With atonic constipation, a laxative effect occurs at a fluid temperature of 18-20 ° C, with spastic constipation - 37-38 ° C.

At the end of the procedure, pear-shaped balloons and rubber tips are washed with hot water and boiled. Esmarch's mug is washed, wiped dry and covered with gauze.

Cleansing enemas include oil, hypertonic, siphon.

oil enemas used for mild bowel cleansing, as well as for persistent constipation. Vegetable oils are used (sunflower, linseed, olive, hemp and vaseline), which are preheated to a temperature of 37-38 ° C. A rubber tip is put on a pear-shaped balloon, it is carefully inserted to a depth of 10-12 cm into the rectum. You can use a syringe with a rubber catheter put on it. For the procedure, from 20 to 80 ml of oil is used, depending on the age of the child. After the introduction of the oil, it is necessary to lay the child on the stomach for 10-15 minutes so that the oil does not leak out. Since the cleansing effect occurs after 8-10 hours, the procedure is recommended to be done in the evening.

Hypertensive enemas used to stimulate intestinal motility. Indications for hypertonic enema are atonic constipation, contraindication - inflammatory and ulcerative processes in the lower part of the colon. For enema, hypertonic solutions are used: 5-10% sodium chloride solution (1 tablespoon per glass of water), 20-30% magnesium sulfate solution. Using a rubber bulb with a tip, 50-70 ml of the solution is injected into the rectum at a temperature of 25-30 ° C, depending on the age of the child. The laxative effect usually occurs after 20-30 minutes, during which time the patient should lie down.

Siphon enemas given mainly to older children. Indications are the need to remove all fecal

masses or poisonous products that have entered the intestines as a result of poisoning with chemical or vegetable poisons. Such enemas are recommended when conventional cleansing enemas are ineffective, as well as when intestinal obstruction is suspected. Siphon enemas are contraindicated in case of appendicitis, peritonitis, gastrointestinal bleeding, diseases of the rectum, in the first days after surgery on the abdominal organs.

Through a rubber tube with a diameter of 0.8-1.0 mm and a length of up to 1.5 m (one end of the tube ends with a funnel, the other with a tip), 5 to 10 liters are injected into the rectum in several steps clean water, heated to 37-38 ° C, or a disinfectant liquid (a weak solution of potassium permanganate, a solution of sodium bicarbonate). The end of the tube lubricated with petroleum jelly is inserted through the anus into the intestine to a depth of 20-30 cm. The funnel is filled with water from a jug and raised to a height of 50-60 cm above the bed, and then lowered to the level of the child's pelvis without removing the rubber tube from the rectum. According to the law of communicating vessels, water with the contained feces returns to the funnel, and the contents are poured into the basin (Fig. 66). The procedure is repeated several times in a row until clear water appears. Then the rubber tube is carefully removed, the entire system is washed and boiled.

All must be carefully observed technical rules, and when setting "high" enemas - remember such a formidable complication as fecal intoxication. The latter occurs in patients with intestinal obstruction and with untimely evacuation of the injected fluid. The setting of a siphon enema is carried out under the obligatory supervision of a doctor.

Medicinal enemas indicated when it is impossible to administer drugs through the mouth. They are divided into enemas local and general action. In the first case, medicinal enemas are used for inflammatory processes in the large intestine, and in the second - for the absorption of drugs through the mucous membrane of the rectum and their entry into the blood.

Medicinal enemas are placed 10-15 minutes after cleansing enemas, less often after spontaneous bowel cleansing. Since all medicinal enemas are microclysters, a conventional 20-gram syringe or a rubber “pear” balloon with a capacity of 50 to 100 ml is used. The administered drug should have a temperature of 40-41 ° C, since at a lower

Rice. 66.Setting a siphon enema. Explanation in the text

temperature, there is an urge to defecate, and the drug is not absorbed. The volume of medicinal enemas depends on the age of the children: patients of the first 5 years of life are administered 20-25 ml, from 5 to 10 years - up to 50 ml, older children - up to 75 ml.

The composition of medicinal enemas may include various medicines, including sedatives, sleeping pills, etc. The following enemas are most commonly used: starch enemas (1 teaspoon per 100 ml of water); from chamomile (15 g of chamomile is boiled for 2 minutes in 250 ml of water, cooled to 40-41 ° C, filtered); from sea buckthorn oil, rose hips. With convulsions and strong arousal, chloral hydrate enemas are indicated - a 2% solution of chloral hydrate is used.

Nutrient enemas are rarely used, since only water, an isotonic solution of sodium chloride (0.85%), glucose (5%), proteins and amino acids are absorbed in the large intestine - in a very limited amount. Perform nutritional enemas after cleansing using a dropper (in young children) or Esmarch's mug (in older children). The rate of fluid administration is regulated by a screw clamp: children in the first months of life are injected with 3-5 drops per minute, from 3 months to 1 year - 5-10, older ones - 10-30. This method, called a drip enema, improves the absorption of fluid through the mucous membrane of the rectum, does not increase intestinal peristalsis, does not overfill it, and does not cause pain. Thus, 200 ml of liquid or more can be introduced into the child's body.

Gas removal. Most often, gas removal is carried out for children early age, newborns and infants. However, the removal of gases is also indicated for older children with intestinal diseases accompanied by flatulence or delayed elimination of gases. Before the procedure, put a cleansing enema. The gas outlet tube with a diameter of 3-5 mm and a length of 30-50 cm is pre-lubricated with vaseline oil and inserted into the rectum with a rotational motion as high as possible so that the outer end of the tube protrudes from anus by 10-15 cm. The tube is left for 20-30 minutes, less often for a longer time. The procedure can be repeated after 3-4 hours. The gas outlet tube is thoroughly washed warm water with soap, wipe and sterilize by boiling.

Gastric lavage. It is used for therapeutic or diagnostic purposes, as well as to remove poor-quality food from the stomach, pesticides, medicines, toxins of bacterial and plant origin that have entered the child's body. The procedure requires a gastric tube with two holes on the side walls and a funnel (previously sterilized by boiling), as well as a basin. For gastric lavage in older children

age, you can use a thick probe 70-100 cm long and 3-5 mm in diameter. For an approximate determination of the length of the probe inserted into the stomach, the distance from the bridge of the nose to the navel is measured in a child. For a more accurate determination of the length of the probe, equal to the distance from the teeth to the entrance to the stomach, apply the formula: 20 + and, where n- the age of the child.

The position of children during gastric lavage depends on age, and in some cases - on the severity of the patient's condition. Infants are most often laid on their side with their faces slightly turned down. The nurse or her assistant picks up a child of preschool age, wraps him in a sheet (diaper), the child's legs are tightly clamped between their legs, press his head to his shoulder. Another nurse asks the child to open his mouth or opens it with a spatula and quickly inserts the probe behind the root of the tongue. He asks the child to make several swallowing movements, during which the nurse, without violent movements, advances the probe along the esophagus to a previously made mark. Confirmation that the probe is in the stomach is the cessation of vomiting. Older children are seated on a chair for gastric lavage, the chest is covered with an oilcloth apron or sheet (diaper).

After inserting the probe into the stomach, a glass funnel with a capacity of about 500 ml is attached to its outer end and filled with the liquid prepared for washing: water, 2% sodium bicarbonate solution or a light pink solution of potassium permanganate at room temperature. Using the siphon principle, the funnel is lifted up and liquid is injected into the stomach (Fig. 67, a). When the liquid reaches the throat of the funnel, the latter is lowered below the level of the stomach and wait until the gastric contents pour out of the probe through the funnel into the pelvis (Fig. 67, b). The funnel is again filled with clean water and the procedure is repeated until clean lavage water flows from the stomach (Fig. 67, c). In young children, gastric lavage can be performed using a 20-gram syringe.

After the end of the procedure, the funnel is removed and the probe is removed with a quick movement. The funnel and probe are rinsed with a strong jet hot water and then boil for 15-20 minutes. If necessary, the collected wash water is poured into clean boiled dishes and sent for laboratory testing. Often, gastric lavage, especially in case of poisoning, is combined with intestinal lavage, i.e. make a siphon enema.

Rice. 67.Gastric lavage. Explanation in the text

Gastric sounding(Fig. 68). Are thin probes used for probing? 10-15 with a diameter of 3-5 mm and a length of 1.0-1.5 m. They end blindly, and have two holes on the side. The technique of introducing a thin probe is similar to the introduction of a thick probe during gastric lavage. A 20-gram syringe is put on the free end of the probe to suck gastric contents. The procedure is carried out in the morning on an empty stomach. To stimulate the secretion of the stomach, various test breakfasts are used: meat broth, 7% cabbage broth,

Rice. 68.Take gastric juice:

a - inventory: a rack with test tubes, a syringe, a thin probe; b - the position of the child during manipulation

coffee breakfast, etc. The most commonly used histamine test is the subcutaneous injection of a 0.1% histamine solution at the rate of 0.008 mg per 1 kg of body weight. Other physiological stimuli are also used: pentagastrin, histology.

duodenal sounding(Fig. 69). For probing, a thin probe with a metal olive at the end and several holes is used. The study is carried out in the morning on an empty stomach in the treatment room. In the patient's standing position, the distance from the incisors to the navel is measured with a probe. Make a mark on the probe. The child is seated on a hard trestle bed, a metal olive is taken under the third finger of the right hand and inserted at the root of the tongue, while the patient makes several swallowing movements and breathes deeply through the nose. When the urge to vomit appears, the child should squeeze the probe with his lips and breathe deeply through the nose. After passing through the pharynx, the olive and the probe move independently due to the peristalsis of the esophagus.

Rice. 69.Duodenal sounding:

a - inventory: rack with test tubes, 25% magnesium sulfate solution, duodenal probe, syringe; b - the position of the child during manipulation

After the probe enters the stomach, the patient is placed on the right side, on the roller. A hot heating pad wrapped in a towel should be placed on top of the roller. The patient's legs are bent at the knees.

The location of the probe is judged by the content received. When the probe is in the stomach, clear or slightly cloudy juice is secreted. To obtain bile, the patient slowly and gradually swallows the probe to the mark. After 30-60 minutes, bile appears, as evidenced by a change in the color of the secreted contents. There are several portions obtained by duodenal sounding.

Portion 1 (A) is the contents of the duodenum, light yellow, transparent, has an alkaline reaction. Portion II (B) appears after the introduction of an irritant (20-50 ml of a 25% solution of magnesium sulfate or xylitol) to relax the sphincter of the common bile duct; gallbladder fluid is clear

dark brown. Portion III (C) appears after complete emptying of the gallbladder, is a light bile coming from the bile ducts; it is light lemon color, transparent, without impurities.

Duodenal sounding lasts an average of 2-2.5 hours. After receiving all three portions, the probe is carefully removed.

Bladder catheterization. The introduction of a catheter into the bladder is carried out in order to remove urine from it in the absence of independent urination, washing and administering drugs, obtaining urine directly from the urinary tract.

Catheterization is carried out with a soft catheter, which is a tube 25-30 cm long and up to 10 mm in diameter. Depending on the size of the catheters are divided by numbers (from? 1 to 30). The upper end of the catheter is rounded, on the lateral surface there is an oval hole. The outer end of the catheter is cut obliquely or funnel-shaped to insert the tip of a syringe for the administration of medicinal solutions and bladder lavage.

Before use, the catheters are boiled for 10-15 minutes. After use, they are thoroughly washed with soap and water, wiped with a soft cloth. Store catheters in enamel or glassware with a cap, usually filled with a 2% solution of carbolic acid.

Before the procedure, the nurse washes her hands with soap, wipes the nail phalanges with alcohol and iodine, puts on disposable gloves.

Girls are pre-washed. For bladder catheterization, the nurse stands slightly to the right of the child. The baby is placed on the changing table. With the left hand, the nurse pushes the labia apart, with the right hand, from top to bottom, wipes with cotton wool moistened with a disinfectant solution (furatsilin), the external genitalia and the opening of the urethra.

The catheter is taken with tweezers, the upper end is doused with sterile vaseline oil, the catheter is inserted into the external opening of the urethra and slowly advanced (Fig. 70, a). The appearance of urine from the catheter indicates that it is in the bladder. The outer end of the catheter is placed below the level of the bladder, therefore, according to the law of communicating vessels, urine flows out freely; when urine ceases to stand out on its own, the catheter is slowly withdrawn.

Rice. 70.Bladder catheterization in a girl (a) and a boy (b)

The introduction of a catheter in boys is technically more difficult, since urethra they are longer and form two physiological constrictions. The patient during catheterization lies on his back with legs slightly bent at the knees, a urinal is placed between the feet. The nurse takes the penis in her left hand, the head of which is carefully wiped with cotton wool moistened with a solution of furacilin and another disinfectant. Right hand takes a catheter poured with sterile vaseline oil or glycerin and slowly, with little effort, introduces it into the urethra (Fig. 70, b).

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

STATE AUTONOMOUS EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION IN THE NOVOSIBIRSK REGION

"KUPINSKY MEDICAL COLLEGE"

METHODOLOGICAL DEVELOPMENT

FOR INDEPENDENT WORK

according to the professional module:

"Performance of work by profession junior nurse for patient care"

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

MDK 07.01. Technology for the provision of medical services.

Topic: "Technology for performing probe manipulations as one of the types

medical services"

Specialty: 060101 General Medicine

(advanced 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 “performance of work by profession junior nurse for patient care on the topic: “Technology for performing probe manipulations as one of the types of medical services.

The methodological manual was developed for independent work of students in order to form skills and knowledge on the topic: “Technology for performing probe manipulations as one of the types of medical services.

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

In accordance with the GEF, after studying this topic, the student must

be able to:

Gather information about the patient's health status.

Identify the patient's health problems.

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

Carry out current and general cleaning of premises using various disinfectants.

know:

Technologies for performing medical services.

Factors affecting the safety of the patient and staff.

Fundamentals 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 needs to be pitied, the patient needs to be cared for,

Near the patient you need to work.

The student must know:

Types of probes;

Purpose of probe procedures;

Types of irritants of gastric secretion;

The student must be able to:

Help the patient with vomiting;

Rinse the patient's stomach;

Take gastric lavage for research;

Perform gastric and duodenal sounding.

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

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

During vomiting, chemicals harmful to the body or poor-quality food are removed from the stomach, while the person experiences relief. The vomit contains residues undigested food have an acidic smell.

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

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

Nursing intervention for vomiting.

cook: waterproof cloth / towel, gloves, vomit container, glass of water, container with disinfectant.

Patient position: sitting.

Sequencing:

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

2. Place a tissue/towel on the patient's chest.

3. Place the pelvis on the floor at the patient's feet.

4. Hold the forehead and shoulders of the patient.

5. Apply water for rinsing 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, discard in disinfectant, wash and dry hands.

9. Ensure the patient is in a comfortable position.

Rice. 1 Caring for a patient with vomiting:

a - the position of the patient sitting;
b - the position of the patient is lying.

1. Turn your head to one side to prevent aspiration of vomit from the airways.

2. remove the pillow, remove the dentures.

3. Put the diaper on your chest.

4. Substitute a kidney-shaped tray to your mouth.

5. aspirate the contents of the oral cavity with a pear.

6. perform oral hygiene for the patient with an antiseptic (soda solution, furacilin).

Nursing supervision of a patient with vomiting requires a medical assessment of the clinical situation. When diagnosing food poisoning, a nurse performs a stomach sounding procedure.

Goals of probe procedures:

Therapeutic - detoxifying - cessation of absorption toxic substances and their removal from the stomach;

Diagnostic - laboratory - sampling of the contents of the stomach / intestines for research.

Therapeutic probe procedures

Dependent nursing intervention in the administration of poor-quality food, drugs, chemicals is gastric lavage. procedure in medical institution carried out with a probe.

To probe means to find out, to receive information about the presence or absence of something - or with the help of an object of care - a probe.

Distinguish between probes

Appointment

kind of material

diameter

Gastric

duodenal

polymeric (disposable)

rubber (reusable)

thin (gastric, duodenal)

medium

thick (gastric)

duodenal probe at the working end has an olive to overcome the pylorus of the stomach when passing from the stomach into the duodenum during the probing procedure.

Sounding ( French research) - instrumental research hollow and tubular organs, channels, wounds using probes.

Contraindications:

1) esophageal and stomach bleeding

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

3) severe cardiovascular pathology

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

Indications are determined by the doctor. The procedure is carried out by probe and without probe methods.

Target:

medical- termination of exposure to toxic substances and their evacuation from the body;

diagnostic– detection of chemical substances, microorganisms and their toxins in wash waters.

The most effective is the probe washing method according to the principle of communicating vessels (siphon method). Fluid is introduced 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 confirmed by laboratory studies of gastric lavage.

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

The depth of insertion of the probe to the patient is determined by:

distance measurement: earlobe - incisors - xiphoid process

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

When the probe is inserted, the patient makes swallowing movements. If you feel nausea/vomiting, you should pinch the probe with your teeth and take deep breaths to suppress the gag reflex.

Features of gastric lavage to an unconscious patient: a nurse inserts a nasogastric tube to 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, a tubeless method of gastric lavage is used.

Gastric lavage with a thick probe

Cook: a tray with a system for gastric lavage, a container with water at room temperature 8 - 10 l, a container for washing water, waterproof wipes, gloves, a towel, a container with a disinfectant.

Patient position: sitting. Provide personal hygiene with waterproof wipes, put a container at the feet for washing water.

Sequencing:

1. wash and dry your hands.

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

3. put on gloves.

4. take a probe, determine the introduction.

5. Pour boiling water over the working end of the probe to ensure glide.

6. ask the patient to open his mouth, put 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. Washing is repeated several times until "clean waters".

11. Disconnect funnel, discard in disinfectant.

12. wrap the probe with a napkin and remove, place in a container.

13. ensure hygiene oral cavity, faces.

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

15. provide a comfortable position for the patient.

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

2. issue a referral to the laboratory.

Tubeless method of gastric lavage

Gastric lavage is allowed outside the hospital natural way. Prepare 2 - 3 liters of water. They induce a gag reflex by mechanically irritating (with a spatula, finger) the root of the tongue. The procedure is repeated several times until "clean wash water". This contributes to detoxification - the cessation of exposure to toxic substances and their removal from the body.

Diagnostic probe procedures

Study of the secretory function of the stomach

Probing of the stomach is carried out for diagnostic purposes to assess its secretory and motor function. Indications are determined by the doctor. Contraindications: acute conditions Gastrointestinal tract, abdominal cavity, heart, respiratory tract, brain.

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

Stimulants of gastric secretion:

enteral - cabbage broth;

parenteral - 0.025% solution of pentagastrin;

0.1% histamine solution.

2-3 days before the examination:

Eliminate gas-producing and secretion-stimulating foods from the diet.

Pick up a magazine or book for distraction withdrawal emotional stress during long procedure(more than 2 hours).

Light dinner on the eve of the study.

On the day of the study:

Control physiological functions.

Prepare a towel.

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

Exclude food and liquids, drugs, smoking.

Take into account the presence of prostheses (tooth, limbs), possible allergic reactions.

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

The patient is examined early in the morning (at 7-8 o'clock) on an empty stomach in the functional diagnostics room.

Fractional gastric sounding

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

Patient position: sitting.

Sequencing:

Leporsky method Veretenov method

Novikova - meat eater

Wash, dry hands.

Open the packaging with the probe.

Put on gloves.

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

Pour boiled water over to ensure slip and enter into the stomach.

Remove fasting gastric contents into a container with a syringe 20.0 (portion 1).

Introduce 200.0 ml of cabbage broth - an enteric irritant (T = 38C) with a syringe to Janet.

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

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

Inject a parenteral stimulus subcutaneously, taking into account body weight.

After 15 minutes, remove the remainder of the contents of the test breakfast (portion 3).

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

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

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

Send all 9 servings to the laboratory.

Drop into container.

Wash, dry hands.

Provide referral and send the biomaterial to the clinical laboratory.

Apply a clamp to the distal end of the probe in order to accumulate gastric contents at the desired time interval.

Insurance Company

№ insurance policy

Branch Chamber

Direction

to the clinical laboratory

Petrov Nikolay Ivanovich

Gastric juice

the date

Signature

m / with

duodenal sounding

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

Indications are determined by the doctor.

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

Portion B - the contents of the gallbladder;

Portion C - the contents of the hepatic ducts.

As irritants of the gallbladder and obtaining bladder contents, one of the stimulants is used:

25%, 33% magnesium sulfate solution,

40% glucose solution,

When diabetes- a solution of sorbitol or xylitol.

Performing duodenal sounding.

The preparation of the patient is similar to the preparation for fractional gastric sounding.

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

Patient position: sitting.

Sequencing:

Wash, dry hands.

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

Open the packaging with the probe.

Put on gloves.

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

1) earlobe - incisors - xiphoid process - mark

№ 1 (level of the stomach);

2) earlobe - incisors + distance to the navel - mark No. 2 (level 12 - duodenal ulcer).

Pour the probe with boiled water and insert into the stomach up to the 1st mark.

Place a clamp on the free end.

Lay the patient on a couch without a pillow on the right side, put a roller or pillow under the pelvic area, and a heating pad under the right hypochondrium.

Continue swallowing the probe up to the 2nd mark for 20-60 minutes.

Place the 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 a test tube - the appearance of a golden yellow content of an alkaline reaction - duodenal portion A.

Inject the gallbladder contraction stimulator with a syringe through the peripheral end of the probe, 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 secret indicates the contents of the hepatic ducts - portion C.

Wrap the probe in a tissue and slowly remove it.

Drop into container.

Remove gloves, discard in disinfectant.

Wash and dry hands.

Ensure patient comfort.

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

Document 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 test tubes.

One portion is sent to the laboratory - the most reliable.

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

Rinse mouth with water after removing the probe to rid the patient of bitterness.

Deliver duodenal portions to the clinical laboratory in a warm form in order to identify protozoa (for example, Giardia).

There are various methods and techniques for taking gastric contents. Modern medical technologies overshadow the proposed author's methods of Leporsky and Veretenov - Novikov - Myasoedov.

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

Independent work of students.

test questions

Definition of the concept of sounding.

The goals of probe procedures.

Characteristics of vomiting of peripheral origin.

Characteristics of vomiting of central origin.

Clinical signs of acute blood loss.

Contraindications for conducting probe manipulations.

Help the patient with food poisoning.

Types of irritants of gastric secretion.

Preparing the patient for diagnostic probe procedures.

Portions of duodenal sounding.

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 their removal from the body.

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

Tracheal intubation- the introduction of a tube into the trachea in order to restore its patency.

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

Belching- involuntary discharge from the stomach into the oral cavity of gases or a small amount of gastric contents.

Wash water- a liquid resulting from the washing of any hollow organ or body cavity; serve as material for diagnostic research.

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

Epigastrium (epiplasty)- the area of the anterior wall of the abdomen, bounded from above by the diaphragm, from below - by the level of the tenth ribs.

Complete the correct answer

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

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

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

Diagnostic probing to the patient is always carried out in a state of ______________ .

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

The depth of insertion of the probe in the study of 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 probing characterize __________________ secretion.

In preparation for fractional gastric sounding, gas-forming and ___________________ gastric secretion products.

Vomiting - involuntary ejection _________________ 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 sent to _____________________ laboratory.

The composition of the vomit states __________________________ .

Tube gastric lavage is based on the method ____________________ .

After the act of vomiting, the sister helps the seriously ill patient to process ________________ .

The harbinger of vomiting ___________ .

Vomit of the color of "coffee grounds" is a sign __________________________ .

In the process of duodenal sounding, three portions are received:

A - content ________________________ .

B - content ________________________ .

C - content ________________________ .

Option I

Indications for gastric lavage

A) alcohol poisoning

B) dehydration

B) food poisoning

D) drug poisoning

Possible impurities of vomit

A) blood

B) specific

B) food

D) bile

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

A) peace

B) hunger

B) warm

D) cold

Contraindications for gastric lavage

A) mushroom poisoning

B) stomach bleeding

B) burn of the esophagus

D) acute abdomen

The amount of water for tubeless gastric lavage, l

A) 0.5

B) 2

B) 2.5

D) 3

The amount of water for tube gastric lavage, l

A) 12

B) 10

AT 8

D) 3

Water temperature for gastric lavage, °С

A) 20 - 22

B) 22 - 24

C) 26 - 28

D) 36 - 38

Purpose of gastric lavage

A) medical

B) preventive

B) rehabilitation

D) diagnostic

Clinical signs of dyspepsia

A) burp

B) convulsions

B) heartburn

D) nausea

Clinical manifestations acute blood loss

A) burp

B) weakness

B) dizziness

D) nausea

Option II

Components of a gastric lavage system for 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

C) 25% magnesium sulfate solution

D) 5% glucose solution

Composition of gastric juice

A) leukocytes

B) slime

B) hydrochloric acid

D) pepsin

Portions of duodenal sounding

A) contents of the duodenum

B) gastric juice

B) cystic bile

D) the contents of the liver ducts

clinical picture penetration of the probe into the respiratory tract characterize

A) cough

B) turning blue

B) difficult breathing

D) heart pain

Skin antiseptics for the treatment of 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 from

A) take food

b) drink water

B) smoke

D) brush your teeth

With duodenal sounding, research is carried out

A) gastric juice

B) pancreatic juice

B) duodenal juice

D) the contents of the hepatic ducts

Gallbladder stimulator temperature, °С

A) 36

B) 37

B) 38

D) 39

Probe manipulation

Horizontally:

1. What should be done with the probe if an obstruction to inserting the probe is detected

3. Probing which is carried out in order to study the gallbladder

4. What relationship is established with the patient before starting the procedure

9. Which side is the patient placed on when probing

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

15. How the patient should come for probing

16. Studies of gastric secretion under physiological conditions

17. Leakage of stomach contents into the oral cavity, followed by leakage into the respiratory system

Vertically:

2. When caring for vomit, what gloves should be

5. What temperature should the water be for gastric lavage

6. What is worn on the patient during gastric lavage

7. Which paths should the probe not fall into?

8. Which hand takes the probe

10. What kind of gloves should honey have. sisters

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

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

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

18. How long should the patient swallow the probe

One of modern methods study of acid-forming and acid-neutralizing functions of the stomach is intracavitary pH-metry - determination of pH content various departments stomach and duodenum by measuring the electromotive force generated by hydrogen ions. For this study, a special pH-metric probe is used.

Share work on social networks

If this work does not suit you, there is a list of similar works at the bottom of the page. You can also use the search button

Orenburg Institute of Communications - a branch of the federal state budgetary educational institution of higher vocational education

Samara State University means of communication"

Orenburg Medical College

PM.04, PM.07 Performance of work by profession

junior nurse

MDK 04.03, MDK 07.03

Solving patient problems through nursing care.

Specialty 060501 Nursing

By specialty 060101 General Medicine

Topic 3.10. "Probe Manipulation"

Lecture

Developed

Teacher

Dryuchina N.V.

Agreed

at the CMC meeting

Protocol No._____

from "___" _______ 2014

CMC Chairman

Tupikova N.N.

Orenburg 2014

Lecture

Subject 3.10. "Probe Manipulation"

The student must be aware of:about the types of gastric and duodenal probes.

The student must know:

types of gastric and duodenal probes;

goals, contraindications and possible complications during gastric and duodenal sounding;

enteral and parenteral irritants of gastric secretion;

irritants used in duodenal sounding;

Lecture plan

1. Types of gastric and duodenal probes.

2. Enteral and parenteral irritants of gastric secretion.

3. Irritants used in duodenal sounding.

4. Goals, contraindications and possible complications during gastric and duodenal sounding.

Lecture

Subject 3.10. "Probe Manipulation"

1. Types of gastric and duodenal probes

The study of the secretory activity of the stomach is the most important method assessment of its functional state. For this purpose, as a rule, various probe methods of research are currently used.

With the probe method of research, a thin gastric tube (reusable or disposable) is used. Entering the stomach, the probe is connected to a syringe or vacuum unit for continuous extraction of gastric juice. First, the contents of the stomach on an empty stomach are studied, and then the so-called stimulated secretion obtained after the introduction various substances that enhance secretion processes.

To stimulate gastric secretion recent times use parenteral and enteral irritants. Which of the stimuli to use in a particular case, the laboratory assistant decides. All extracted portions of gastric juice are sent to the laboratory, where its quantity, color, consistency, smell, presence of impurities (bile, mucus, etc.)

One of the modern methods for studying the acid-forming and acid-neutralizing functions of the stomach is intracavitary h -metry - definition of p h the contents of various parts of the stomach and duodenum by measuring the electromotive force generated by hydrogen ions. For this study, a special h -metric probe. p measurement h in the lumen of the stomach, esophagus or duodenum, carried out during the day, taking into account the interdigestive and nocturnal secretion of acid - the most dangerous in peptic ulcer- puts this method among the most informative, accurate, physiologically justified.

The pH of gastric contents is sometimes determined with the help of special "pills" (radio capsules) equipped with a miniature radio sensor. After swallowing such a radio capsule, the sensor transmits information about r h , temperature and hydrostatic pressure in the lumen of the stomach and duodenum, which is recorded by the receiving device. In the morning on an empty stomach, the patient swallows a radio capsule attached to a thin silk thread or a probe (to keep the capsule in the desired part of the digestive tract). Then a belt is put on the patient, in which a flexible antenna is pre-mounted to receive signals from the radio capsule, and the tape drive mechanism is turned on.

The radiotelemetric method of research is the most physiological in the study of the secretory and motor functions of the stomach.

For duodenal sounding, a probe with a metal olive at the end is used.

2. Preparation of trial breakfasts (enteral irritants)

1. Cabbage broth.7% - 21 grams of dry cabbage per 500 ml of water. Boil for 30 - 40 minutes until 300 ml remains, then strain through two layers of gauze. Keep refrigerated.

If there is no dry cabbage, you can take fresh cabbage - 500 g of fresh cabbage per liter of water. Boil for 30 minutes, then strain through two layers of gauze. Keep refrigerated.

2. Bread breakfast.50 g of white bread is kneaded and placed in 400 ml. warm water. After swelling, slowly heat the mixture to a boil and leave until the morning. In the morning, strain through two layers of gauze.

3. Meat broth. 1 kg. boil lean lean meat in two liters of water until tender. 200 ml. warm broth to enter into the stomach through a probe.

4. Caffeinated breakfast.0.2 g caffeine or 2 ml. 20% caffeine is dissolved in 300 ml. boiled water.

Note: Trial breakfasts sentry sister departments on the eve of the study.

Parenteral irritants used in

fractional study of the stomach

Histamine dihydrochloride - 0.008 mg / kg - s / c;
Histamine phosphate - 0.01 mg / kg - s / c;
Pentagastrin - 0.006 mg / kg - s / c.

Parenteral irritants are physiological;

4. Irritants used in duodenal sounding.

1. 25% magnesium sulfate 40 ml.

2. 40% glucose solution 40 ml.

3. 10 % alcohol solution sorbitol or cholecystokinin.

a) CAPTURE OF GASTRIC JUICE BY FRACTIONAL METHOD.

(gastric sounding)

PURPOSE: To assess the secretory and motor functions of the stomach and to recognize the nature of the disease by their violation.

INDICATIONS ARE DETERMINED BY THE DOCTOR.

Contraindications: gastric bleeding, tumors, bronchial asthma, severe heart disease.

EQUIPMENT: sterile gastric tube (single-use or reusable), 0.5-0.8 cm in diameter, one of the secretion stimulants, syringe for injection (if the irritant is parenteral), alcohol 70%, gloves, graduated vials, syringe for extracting the gastric juice, kidney-shaped tray, towels, sterile tray (Figure 1a)

b) EXAMINATION OF THE CONTENTS OF THE 12 DUO

(duodenal sounding)

GOAL: clarification of the composition of bile for the diagnosis of diseases of the gallbladder, biliary tract, for bacteriological research, to judge functional state pancreas.

INDICATIONS ARE DETERMINED BY THE DOCTOR

gastric bleeding, tumors, bronchial asthma, severe heart disease.

EQUIPMENT: sterile probe with olive, towel, stimulant syringe, kidney tray, stimulant (25% magnesium sulfate 40 ml or 40% glucose solution 40 ml or 10% alcohol solution of sorbitol or cholecystokinin), roller, gloves, rack with test tubes, heating pad, sterile tray, napkins, referral. (Figure 2-a)

Complications: gastric bleeding, fainting, collapse.

1. If in the process of any probe manipulation in the obtained material there is blood - stop probing!

2. If, during the introduction of the probe, the patient begins to cough, suffocate, his face becomes cyanotic, the probe should be removed immediately, since it has entered the larynx or trachea, and not the esophagus.

3. In case of an increased gag reflex in a patient, treat the root of the tongue with an aerosol 10% lidocaine solution.

4. With the introduction of histamine, an allergic reaction may occur in the form of dizziness, a feeling of heat, a decrease in blood pressure, nausea, difficulty breathing, etc.Nurse tactics:urgently call a doctor and prepare one of the antihistamines: diphenhydramine, pipolfen. Pentagastrin side effects almost does not cause.

5. Complications with subcutaneous injection - infiltration, abscess, leaving a fragment of a needle in soft tissues, oil embolism, allergic reactions, erroneous injection of another medication under the skin instead of the prescribed one.

Questions for self-control

1. Goals, contraindications for probe procedures.

2. Equipment for probe procedures.

3. Tactics of the nurse in the case: reactions to the introduction of histamine.

4. Types of gastric and duodenal probes.

5. Enteral and parenteral irritants of gastric secretion.

6. Irritants used in duodenal sounding.

7. Possible Complications during gastric and duodenal sounding.

LITERATURE

Main:

1. Mukhina S.A., Tarnovskaya I.I. A practical guide to the subject "Fundamentals of Nursing": a textbook. - 2nd ed., corrected. And extra. – M.: GEOTAR-Media 2013.512s: ill.- 271-289s.

2. Lecture of the teacher.

3. Order of May 31, 1996 N 222 "On the improvement of the endoscopy service in healthcare institutions Russian Federation. Regulations on nurse department, department, endoscopy room.

Additional:

1. Teaching aid on "Fundamentals of Nursing" for students vol. 1.2, edited by Shpirna A.I., Moscow, VUNMTs 2003 - 582-598s.;

Duodenal sounding technique. Probe procedures Probe manipulations

Patient Eye Care

Examination of the arterial pulse on the radial artery

Technique for measuring blood pressure

Determining the frequency, depth and rhythm of breathing

Measurement of temperature in the armpit

Algorithm for measuring height, body weight and BMI

Applying a warm compress

Staging mustard plasters

Heating pad application

Setting up an ice pack

Care of the external genitalia and perineum of a woman

Bladder catheterization of a woman with a Foley catheter

Bladder catheterization of a man with a Foley catheter

Cleansing enema

Siphonic bowel lavage

Hypertonic enema

Oil enema

Medicinal enema

Insertion of a nasogastric tube

Feeding through a nasogastric tube

Gastric lavage with a thick gastric tube

Dilution of the antibiotic in a vial and intramuscular injection

intradermal injection

subcutaneous injection

Intramuscular injection

CHAPTER 25