🔙 Quay lại trang tải sách pdf ebook Điều dưỡng cơ bản - Tập 2 Ebooks Nhóm Zalo BO Y TE DIED DUONG CO BAN TAP II SACH DAO TAO CAO DANG 01 £u DlfONG Ma so: C.34.Z.02 Chu bien: TS. 0 6 OINH XUAN NHA XUAT BAN Y HOC HA NOl - 2007 CHi DAO BIEN SOAN: Vu Khoa hoc & Dao tao, Bo Y te CHU BIEN: TS. Do Oinh Xuan NHQNG NGUCJI BIEN SOAN: ThS. Nguyen Manh Dung BS CKI. Ta Khanh Hue BS CKI. Vu Thi Thuc Anh CNOD. Tong VTnh Phu THLf KV BIEN SOAN: ThS. Nguyin Manh Dung THAM GIA T6 CHCTC BAN THAO: ThS. Phi Van Tham ThS. Le Thi Binh © Ban quyen thuoc Bo Y te (Vu Khoa hoc va Dao tao) 2 LOI GIOI THIEU Thuc hien mot so dieu cua Luat Giao due, Bo Giao due & Dao tao va BoY te da ban hanh chutdng trinh khung dao tao Cao dang dieu dUdng. Bo Y te t3 chiic bien soan tai lieu day- hoc cac mon cd sd, chuyen mon va cd ban chuyen nganh theo chifdng trinh tren nham tting budc xay dung bo sach chuan trong cong tac dao tao nhan lUc y te. Sach “Dieu dUdng cd ban” dUdc bien soan dUa tren chUdng trinh giao due cua Trufdng dai hoc Dieu diidng Nam Dinh tren cd sd chUdng trinh khung da dUdc phe duyet. Sach dadc bien soan dUa tren cd sd: kien thijtc cd ban, he thong; noi dung chinh xac, khoa hoc; cap nhat cac tien bo khoa hoc, ky thuat hien dai va thiic tien Viet Nam. Sach “Dieu dtfdng cd ban” da dUdc bien soan bdi cac nha giao giau kinh nghiem va tam huyet da dUdc Hoi dong chuyen mon tham dinh sach va tai lieu day-hoc chuyen nganh Cvf nhan dieu dtfdng va Cil nhan dieu dtfdng va Cao d4ng dieu difdng cua Bo Y te tham dinh vao nam 2006. Bo Y te ban hanh lam tai lieu day-hoc dat chuan chuyen mon cua nganh y te trong giai doan 2006-2010. Trong qua trinh sik dung, sach phai dUdc chinh ly, bo sung va cap nhat. Bo Y te xin chan thanh cam dn cac Nha giao, cac chuyen gia cua Trutdng dai hoc Dieu dtfdng Nam Dinh da danh nhieu cong siic hoan thanh cuon sach nay, ThS. Tran Thi Thuan va ThS. Le Thi Binh da doc, phan bien de cuon sach difdc hoan chinh kip thdi phuc vu cho cong tac dao tao nhan lUc y te. Lan dau xuat ban, chung toi mong nhan dUdc y kien dong gop cua dong nghiep, cac ban sinh vien va cac doc gia de lan xuat ban sau dUdc hoan thien hdn. VU KHOA HOC VA OAO TAO BQ Y 3 LOl NOI OAU Cuon sach Dieu dUdng cd ban dUdc bien soan can cut theo chiidng trinh khung da difdc Bo Y te phe duyet danh cho doi tUdng la Cao dang dieu dUdng nham giai quyet nhu cau ve sach giao khoa giang day dieu diidng hien nay. Cuon sach cung cap cho cac ban sinh vien kien thiic ly luan chung ve khoa hoc Dieu dUdng va cac ky thuat Dieu dtfdng cd ban trong thuc hanh cham soc ngUcfi benh. Mot so" chu de dUdc md rong them ve noi dung de ban doc tham khao. Tham gia bien soan gom tap the giang vien co trinh do tien sy, thac sy, bac sy chuyen khoa cap I, Cti nhan dieu dUdng, co kinh nghiem da tham gia giang day dieu difdng nhieu nam, co tham khao cac tai lieu trong nildc va nifdc ngoai. NhCng ngUdi bien soan da danh nhieu cong siic, tri tue, thdi gian de cho ra mat cuon sach dap ling long mong moi cua ban doc. Song do han che ve thdi gian, trong qua trinh bien soan khong the tranh khoi nhflng thieu sot. Chung toi rat mong nhan dUdc sU dong gop nhiet thanh tti ban be dong nghiep va ban doc de lan tai ban sau cuon sach se dtfdc hoan thien hdn. Chung toi xin chan thanh cam dn Hoi dong chuyen mon tham dinh sach giao khoa va tai lieu day hoc chuyen nganh CiJ nhan dieu dUdng va Cao dang dieu dutdng Bo Y te, cac chuyen gia, Hoi dong Khoa hoc - Dao tao va tap the giao vien bo mon Dieu dUdng Tnidng dai hoc Dieu dUdng Nam Dinh da dong gop y kien, tao dieu kien de cuon sach diidc ra mkt ban doc. Chu bien NGlfT. TS. Do Dinh Xuan Hieu trtfdng Trtfcfng dai hoc Dieu dtfdng Nam Dinh 5 MUC LUC ■ ■ Ldi gicii thieu 3 Ldi noi dau 5 Bai 1. Cham soc ngUdi benh hap hoi tu vong 9 Bai 2. Tiep nhan ngUdi benh vao vien - chuyen vien - ra vien 15 Bai 3. Cham soc - ve sinh cho ngUdi venh 23 Bai 4. Nhu cau dinh diidng cho ngUdi benh 36 Bai 5. Mot so' che do an benh ly 47 Bai 6. Ky thuat dtfa chat dinh dtfdng vao cd the 53 Bai 7. Chuan bi gitfdng benh - thay vai trai giUdng 63 Bai 8. Cac tu the nghi ngdi tri lieu thong thUdng 73 Bai 9. Cach lay benh pham xet nghiem 78 Bai 10. Phan loai va quan ly chat thai benh vien 87 Bai 11. Chuan bi dung cu cho thay thuoc kham benh 91 Bai 12. Cho ngUdi benh thd oxy 96 Bai 13. Hut thong dUdng ho hap 103 Bai 14. Hut dich da day 107 Bai 15. Hut dich ta trang 112 Bai 16. ROfa da day 117 Bai 17. Do lifdng dich vao - ra 123 Bai 18. Dil phong loet ep 128 Bai 19. Ve sinh doi tay - mac ao choang - di gang tay 134 Bai 20. Thut thao - thut riia 142 Bai 21. ChUdm nong - chUdm lanh 150 Bai 22. Phu giup thay thuo'c dat catheter vao tlnh mach dudi don 159 Bai 23. Ky thuat duta thuoc vao cd the ngUdi benh 167 Bai 24. Phu giup thay thuoc dat ong noi khi quan 197 Bai 25. Phu giup thay thuoc mcl khi quan 205 B&i 26. Ch&m soc ngUdi benh thci may 214 Bai 27. Van chuyen ngiidi benh 221 Bai 28. Thay bang va riia vet thUdng 229 Dap an cau hoi lildng gia 238 Tai lieu tham khao 242 7 Bai 1 CHAM SOC NGUOl BENH HAP HOI - TLf VONG Myc Tieu 1. Trinh bay diidc cac giai doan cuoi cuoc ddi cua ngitdi benh. 2. Trinh bay diidc nhitng bieu hien cua giai doan hap hoi va dau hieu cua cai chet. ,A ' i t - I • * r’ , ' > * » * 3. Trinh bay diidc cdch chdm soc ngiicti benh d giai doan hap hoi- fi? vong. 1. CAC GIAI DOAN CUOI CUA CUOC D di NGUCl BENH 1.1. Stf tvf choi Giai doan nay ngUdi benh khong chap nhan cai chet, ngUdi benh thUdng ngh! cai chet khong the xay ra vdi ho. Day la phan ting dau tien cua ngiidi benh. 1.2. Stf tvfc gian Co the bieu hien b&ng sU gian dQ mot cach vo cd v6i nhan vien benh vien hoac ngildi nha ngUdi benh vi mot ly do nao do. 1.3. Stf mac ca 6 giai doan nay ngildi benh mac ca vdi viec chQa benh, muon tim cach de co sU thay doi khac ve ket qua cua sii viec. NgUdi benh co the yeu cau goi thay cung, thay mo, muc sii... tham chi co sii trang troi lien quan den toi loi. 1.4. Stf buon rau NgUdi benh rat lo l&ng buon rau vi biet cai chet sip den v6i ho. Ho tiec nhflng ngay da qua di va mong muon diidc ke le, tam stf vdi ngtfdi than hoac dieu dtfdng. 1.5. Stf chap nhan Day la giai doan tuyet vong, ngildi benh da chap nhan cai chet. 6 giai doan nay giao tiep v6i ngtfdi benh thildng kho khan, ngtfdi benh thtfdng tram l&ng hofic lai n6i nhieu (khi hap hoi ngtfdi benh muon gap ngtfdi than de noi ldi tr&ng troi, di chuc, cach bo tri tang ll). 9 2. NHLfNG BIEU HIEN CUA GIAI DOAN HAP HOI VA DAU HIEU CUA cAl CHET - Chan tay lanh, sac mat nhdt nhat, mong tay tim tai (day la bieu hien cua sii lilu thong mau giam). - NgUdi benh co the va mo hoi dam dia (do roi loan van mach). - Trildng lilc cd giam, cd the trd nen u ru, thieu sinh lilc, ham tre xuong, mieng lech, mui veo, noi kho, nuot kho, dan dan mat phan xa hoan toan. - Mat lom xuong, dd dai khong cut dong. -r Ho hap thay doi: ngildi benh thd cham va kho thcl, li dong ddm va chat nhay. Khi thd co the gay ra am thanh goi la “tieng nac hap hoi”. - Mach nhanh nho, ro'i loan kho bat. - Y thiic lu lan. - TrU6c luc ngUdi benh ngting thd mach se md ddn di roi khong sd thay mach nQa. * Chu y: Trong luc nay ngUdi dieu dvldng phai luon co mat d canh ngildi benh, phat hien kip thdi cac dau hieu song va sii thay doi ve tinh trang ngildi benh de bao cao ngay cho dieu diidng trilclng hoSc bac si biet. Sii co mat thildng xuyen cua dieu dildng se la nguon an ui 16n doi vdi ho va than nhan. 3. CHAM SOC NGUOl BENH 6 GIAI DOAN HAP HOI - TtT VONG 3.1. Cham soc ngtfdi benh d giai doan hap hoi 3.1.1. Nguyen tac cham soc - Chuyen ngildi benh den phong rieng, tranh gay on ao va tien cho viec cham soc khong anh hilclng den ngildi benh khac. - Giup dd ngildi benh ve mat tam ly, sinh ly va tinh than. - Thilc hien khan trildng y lenh va bang moi cach lam giam dau kho, cac trieu chCfng cho ngUdi benh. - Tan tinh cham soc ciiu chfla ngildi benh den phut cuoi cung. - Dam bad cho ngildi benh va than nhan khong bi ddn doc trong giai doan cuoi nay. - Khi ngildi benh hap hoi neu khong co than nhan ben canh, ngildi benh co trang troi dieu gi dieu dtfdng phai ghi ch6p day du d ! bao cho than nhan hdac cd quan biet. 10 3.1.2. Dap ting nhu cau cho ngitdi benh - Dap ting nhu cau ca nhan: t&m, lau ngUdi, ve sinh rang mieng cho ngiidi benh. - Nhu cau tu the: luon thay doi tu the l't nhat 2 gid mot lan de ngiidi benh thoai mai, ngan ngtia loet. - Nhu cau giao tiep: benh nhan con tinh tao dieu dUdng luon d ben canh an ui benh nhan, lUu y khong noi nhting dieu lien quan den benh. - Nhu cau ve thi giac: phong benh sach se, thoang khi du anh sang. - Nhu cau ve dinh diidng: benh nhan con an diidc cho an long de tieu, chia nhieu btia trong ngay. Neu khong an diidc cho an qua sonde hoac truyen dich. - Nhu cau ve bai tiet: + Benh nhan tang tiet nhieu ddm rai phai hut ddm rai. + Benh nhan dai tieu tien khong tii chu phai thay qu&n ao, giti ve sinh sach se. - Nhu cau ve lieu phap oxy: thcl oxy qua sonde (neu can). - Nhu cau ve tinh than: ton trong nhu cau tinh cam cua benh nhan, tuan theo ton giao va nhting yeu cau tai thdi diem benh nhan chet. 3.1.3. Doi vdi than nhan - Moi cong viec phai dtfdc thvtc hien mot cach nhe nhang, nhanh gon, co hieu qua tranh ngiidi nha hieu lam. - Khi benh nhan doi hoi dieu diidng chi diidc tra ldi nhting cau hoi trong pham vi cho phep. - Phai te nhi lich sii, nhe nhang cam thong vdi ngiidi nha. - Doi khi phai thong bao va giai thich cho than nhan ve viec minh can lam va yeu cau gia dinh benh nhan ra ngoai. 3.1.4. Ky thuat cham soc benh nhan d giai doan hap hoi • Chuan bi benh nhan - Chuyen ngiidi benh sang phong rieng, neu khong co phong rieng phai co binh phong de tranh anh hiidng den ngiidi benh khac. - Dong vien ngiidi benh va than nhan ho. - Thong bao tinh trang cua ngiidi benh cho than nhan diidc biet, de ho khoi bi sang chan tinh than. • Chuan bi ngtfdi dieu diidng - Dieu diidng c6 du mu, ao, khau trang. - Rtia tay thiidng quy. 11 • Chuan bi dung cu - Chan, lo stfdi (neu ngiidi benh lanh). - Dung cu hut ddm rai (neu co tang tiet ddm rai) - Dung cu thd oxy (neu ngtfdi benh thieu oxy) - Dung cu dem mach, nhip thd, do nhiet do, huyet ap - Dung cu ve sinh ca nhan (ngtfdi benh tang bai tiet, roi loan van tim mach). - Dung cu an uong (ngtfdi benh con an dtfdc). • Ky thuat tien hanh - Giup ngtfdi benh d tu the thuan ldi (trong ttf the nghi ngdi dieu tri). - Dap chan, lo stfdi, u am de tang than nhiet cho ngtfdi benh (giut than nhiet cho ngUdi benh). - Tang tiet ddm rai phai hut ddm rai cho ngtfdi benh (bai hut ddm rai). - Cho ngtfdi benh thd oxy neu thieu oxy (bai lieu phap oxy). - Theo doi mach, nhiet do, huyet ap, nhip thd (bai dau hieu sinh ton). - Cho ngtfdi benh an uong theo chi dinh (dap ting nhu cau dinh dtfdng). • Thu don dung cu - Dtfa cac dung cu dem xtf ly theo quy dinh. - Ghi phieu cham soc. 3.2. Ky thuat cham soc ngtfdi benh of giai doan tuf vong Khi bac si xac dinh ngiidi benh da chet, ngoai viec dap ting cac nhu cau cua than nhan ngtfdi chet, dieu dtfdng phai chuan bi day du dung cu, phtfdng tien de thtfc hien cac c6ng viec xi\ ly tii thi. • Chuan bi dung cu, phiidng tien: - Ho sd benh an, khay chtf nhat, gang tay. - Tru c^m hai kim Kocher, keo, bang dinh. - Bong, gac. - Bo dung cu thay bang rtia vet thtfdng (neu la ngtfdi benh sau mo). - Bong khong tham ntfdc, quan ao sach cua ngtfdi benh. - Hai dai bang nho va ng^n, ba dai b&ng to ban. - Khan bong, chau ntfdc am (ntfdc la thdm...). - Vai phu, tui dung do ban. - Cang ho&c xe day. 12 Ky thuat tien hanh - Yeu cau than nhan ra khoi phong, che binh phong (neu khong co phong rieng). - Dieu dUdng mang gang tay. - Dat ngUdi benh nSm tu the thuan ldi. - Dung bong khong tham nUdc nut cac lo tu nhien (lo tai, lo mui, mieng, hau mon, sinh due). - Rut cac orig thong, ong dan lUu (neu co). - Thao nep bot, bang cu, thay bang (neu co). - Thao bo do trang stic tren ngUdi ngUdi benh. - Dung gac tham nUdc am vuot hai mat cho khep lai. - Khep kin mieng ngildi benh. - Riia mat, ccfi bo ao cu, lau ntia ngUdi tren va mac ao cho ngUdi benh. - Cdi quan, lau niia ngUdi phia dudi va mac quan cho ngUdi benh. - De hai canh tay doc theo canh sUdn, long ban tay up len bung. - Buoc hai ngon tay cai lai v6i nhau. - De hai chan duoi thing, buoc hai ngon chan cai lai vdi nhau. - Buoc hai dai bang cf cac vi tri: hai ba vai, hai mao chau, hai dau goi. - Chuyen ngUdi benh nhe nhang len cang hoSc xe day. - Phu vai kin ngUdi benh. - Ghi ho sd ngay, gid ngUdi benh tik vong. - Gai phieu ngildi benh len ngUc ben ngoai vai phu. - Chuyen thi the ngildi benh xuong nha xac. - Sap xep va xti ly dung cu dung quy dinh. - NgUdi benh khdng co than nhan, tai san cua ngUdi benh phai lap bien ban va giii tai phong tiep don. CAU h6| Tli LUONG GIA Hoan thi$n cac cau sau bang cach chon tit, cum til thich hdp dien vao cho trong: v. 1. SiJ cha'p nhan la giai doan....A......ngUdi benh ch&p nhan cai chet. 13 2. Giai doan hap hoi ngUdi benh co bieu hien....A....do roi loan van mach. 3. Khi ngUdi benh hap hoi neu khong co than nhan d do. NgUdi benh co....A.... dieu gi dieu dUdng phai ghi va bao cao cho ngUdi nha biet. 4. Khi ngUdi benh hap hoi thUdng co roi loan nhip thd bieu hien....A.... cham dan roi ngiing thd. 5. Neu nam bieu hien d giai doan cuoi cua cuoc ddi ngUdi benh: A: Su tU choi. B:.................... C: Su mac ca. D :.................. E: Su chap nhan. Phan biet dung, sai cac cau sau bang cach danh dau (V) vao cot A cho cau dung, cot B cho cau sai: TT Noi dung A B 6 Giai doan hap hoi than nhiet ngudi benh thUdng tang 7 Giai doan hap hoi truong luc cd cua ngudi benh giam 8 Giai doan hap hoi cac phan xa cua ngi/di benh thUdng tang 9 Ngudi benh d giai doan hap hoi khong phai sir dung thuoc cho ho 10 Ngudi benh a giai doan hap hoi khong nen thay ddi tu the 14 Bai 2 TIEP NHAN NGlfdl BENH VAO VIEN - CHUYEN VIEN ■ RA VIEN ■ ■ “ v c n e u 4 't ' , / P th 'i. / % , ’ ’ i * /r v 4. Neu dUQc qui dinh chung vi viec tiep nhq.n ngiidi b$nh. 5. Trinh bdy diipc qui trinh tiep nhg.n ngiidi bqnh d khoa khdm benh, dieu tri khi ngiidi bink vHo viin, chuyin vien h U j . m mm il' 1. QUI DINH CHUNG CUA BENH VIEN VE CONG TAC TIEP NHAN NGLfdl BENH - Cac thanh vien trong benh vien (thay thuoc, dieu diidng, ho ly, hoc sinh, sinh vien, can bo cong chtfc khac trong benh vien) phai co tinh than trach nhiem, niem ncl tan tinh don tiep ngtfdi benh ttf khoa kham benh, khoa dieu tri den cac khoa can lam sang de tao niem tin, stf yen tarn trong dieu tri. - Benh vien phai dam bao cac thu tuc hanh chinh theo qui dinh. - Khong dtfdc gay phien ha cho ngtfdi benh khi den kham, dieu tri tai cac cd scl kham benh, dieu tri. 2. TIEP NHAN NGUOl BENH TAI KHOA KHAM BENH • • • • Ngtfdi benh den kham benh tai khoa kham benh deu dtfdc thay thuoc tham kham, cho lam cac xet nghiem, chan doan va cho ngtfdi benh vao vien dieu tri, lam ho sd benh an ban dau cho ngtfdi benh theo qui che chan doan benh cho ngtfdi benh vao vien dieu tri, lam ho sd benh an va ke ddn dieu tri cho ngtfdi benh ngoai tru. Dieu dtfSng tiep don ngtfdi benh, thtfc hien cac thu tuc cho ngtfdi benh vao vien, thong bao cho khoa nhan ngtfdi benh dtfdc biet trtfdc de chuan bi dieu kien de don tiep va phuc vu ngtfdi benh. Doi vdi ngtfdi benh cap ctfu phai dtfdc kham, dieu tri ho&c cho ngtfdi benh nhap vien ngay, moi thu tuc h&nh chinh giai quyet sau. Qui trinh don tiep ngtfdi benh tai khoa kham benh bao gom nhflng noi dung sau 2.1 Chu£n bi ti£p nhan ngtfdi benh Khoa kham b$nh ludn phai dtfdc chu£n bi theo cac yeu c&u sau: 15 - Phong doi la ndi ngtfOi benh ngoi chd de dtfdc kham benh. Phong ddi can phai dam bao cac tieu chuan: + Gon gang, sach se, yen tinh, co day du ghe cho ngtfdi benh ngoi trong khi chd kham benh. + Phong ddi can phai co ti vi, tranh, anh, td rdi, ap phfch... tuyen truyen ve stfc khoe cho ngtfdi benh doc trong khi chd kham benh. + Co ntfdc uong, ndi ve sinh cho ngtfdi benh. - Phong kham benh: la ndi thay thuoc, dieu dtfdng thtfc hien cong viec kham, dieu tri, cham soc ngtfdi benh. + Phong kham benh phai sach se, thoang mat, am ve mua dong. + Chuan bi day du cac dung cu can thiet phuc vu cho thay thuoic kham benh. + Co day du cac loai giay td can thiet (benh an, phieu dieu tri, phieu xet nghiem...) de phuc vu cho cong tac kham, dieu tri cho ngtfdi benh. 2.2. Tiep nhan ngtfdi benh Dieu dtfdng lam nhiem vu tiep nhan ngtfdi benh tai khoa kham benh c&n phai co thai do dung mtic khi tiep xuc vdi ngtfdi benh. - Tiep xuc vdi ngtfdi benh: ngtfdi dieu dtfdng can phai ting xti linh hoat, giao tiep dung mtic, ton trong ngtfdi benh. + Chao hoi ngtfdi benh, gidi thieu ban than minh vdi ngtfdi benh. + Htfdng din ngtfdi benh cac thu tuc can thiet trtfdc khi kham benh. + Sip xep cho ngoi cho ngtfdi benh d phong ddi, mdi ngtfdi benh vao kham benh theo trat ttf (tfu tien nhting ngtfdi benh thuoc dien cap ctiu, benh nang, ngtfdi gia, tre em). i - Nhan dinh ngtfdi benh. + Quan sat danh gia tinh trang ngtfdi benh: trang thai tinh than, the trang, dang di... + Do cac dau hieu sinh ton: mach nhiet do, huyet ap, nhip thd... + Phong van ngtfdi benh, gia dinh (neu ngtfdi benh la tre em, ngtfdi gi&, yeu, benh n&ng) de thu thap cac thong tin ve benh sti, tien stf, qua trinh dieu tri benh cua ngtfdi benh trtfdc khi den kham b$nh. Chu y phat hien nhting trtfdng hdp benh n&ng, soc truy mach, suy ho hap,... de bao cao thay thuoic, chuan bi phtfdng tifn xti tri vfi chu ddng xti tri ngtfdi benh khi c&n thiet. Vi du: ngtfdi benh kh6 thd cho ngtfdi b$nh nftm d ttf the Fowler ho&c nim ngtia ke goi dtfdi vai. Ngtfdi b^nh tim tai do thieu o xy: hut ddm rai, cho ngtfdi benh thd oxy. v i I - Mdi thSy thuoc kham benh cho ngtfdi b$nh. * M 16 + Ho trd thay thuoc kham benh. f Thuc hien day du, nhanh chong cac chi dinh cua thay thuoc neu co - Chuyen ngtfdi benh vao khoa dieu trj: dieu dtfdng khoa kham benh chuyen ngtfdi benh vao khoa dieu tri khi co chi dinh cua thay thuoc. + Tuy thuoc tinh trang cua ngtfdi benh ma co the stf dung cac phUdng tien: xe day, cang, xe lan... hoac dan ngUdi benh vao khoa dieu tri, khong dtfdc de ngtfdi benh ttf di. + Den khoa dieu tri, ngtfdi benh dtfdc ban giao cho dieu dtfdng trtfdng khoa hoac dieu dtfdng co trach nhiem tiep nhan ngtfdi benh da dtfdc phan cong (co sd ky nhan ban giao cu the). - Doi vdi ngtfdi benh co quyet dinh dieu tri ngoai tru. + Lam ho sd benh an day du nhtf ngtfdi benh noi tru va dtfdc theo doi quan ly tai khoa kham benh hoac cac khoa dtfdc giam doc benh vien giao nhiem vu. + Lap sd y ba theo doi dieu tri ngoai tru cho ngtfdi benh ghi ro chan doan, ke ddn dieu tri, htfdng din stf dung thuoc va hen kham lai. + Htfdng d in ngtfdi benh thtfc hien che do an, uong, nghi ngdi, tap luyen phuc hoi chtfc nang. Chu y: doi vdi ngtfdi benh den kham benh theo yeu cau. + Htfdng dan ngtfdi benh thtfc hien day du cac qui dinh cua khoa kham benh. + Ngtfdi benh phai co giay de nghi thoa thuan kham chtfa benh theo mau qui dinh cua benh vien. 3. TIEP NHAN NGl/Cfl BENH TAI KHOA DIEU TRI • • • • - Chuan bi ho sd ngtfdi benh va cac dung cu, phtfdng tien can thiet. Tai khoa dieu tri luon san co cac giay td, trang thiet bi can thiet de thtfc hien tiep don ngtfdi benh: + Ho sd benh an, phieu dieu tri, phieu theo doi, cham soc ngtfdi benh, bang theo doi dau hieu sinh ton, giay xet nghiem... + Cac dung cu: nhiet ke, ong nghe, huyet ap, de ltfdi, bo, o'ng nho... + Gitfdng n&m, quan ao, chan man... + Cac do dung: phich dtfng ntfdc, ca, coc... - Tiep nhan ngtfdi benh. + Nhan ban giao ngtfdi benh ttf dieu dtfdng trtfdng hoac dieu dtfdng cua khoa kham b€nh dftn ngtfdi benh va’o khoa dieu tri. + Nhan ho sd b^nh an, thuoc, cac dung cu ttf trang khac (neu co). 17 + Dan ngtfdi benh ve buong benh da chuin bi sin: xep gitfdng n&m cho ngtfdi benh, chon gtfdng nam, phong benh cho thi'ch hdp vdi tinh trang benh tat va nhu cau cua ngtfdi benh (neu co the). - Nhan dinh ngtfdi benh va lap ke hoach cham soc cho ngtfdi benh. + Do, dem cac dau hieu sinh ton. + Quan sat, phong van, tham kham thtfc the ngtfdi benh de biet dtfdc cac nhu cau, dtfa ra dtfdc cac chan doan dieu dtfdng ttf do lap ke hoach cham soc ngtfdi benh cho phu hdp. Trong moi trtfdng hdp can phat hien sdm, chinh xac cac dau hieu nang cua benh, cac tinh trang cap ciiu: soc, truy tim mach, suy ho hap, mat mau nang... de bao cao thay thuoic, phoi hdp cung thay thuoic xtf tri kip thdi chd ngtfdi benh. - Htfdng dan cho ngtfdi benh va gia dinh cac noi qui, qui dinh cua benh vien. + Htfdng dan cach stf dung cac phtfdng tien trang thiet bi co trong buong benh: stf dung dien, ntfdc, nha ve sinh, ti vi tu lanh... + Htfdng dan cac qui dinh, quy che cua benh vien, khoa phong de cho ngtfdi benh (ngtfdi nha ngtfdi benh) biet va thtfc hien nghiem chinh: gid kham benh hang ngay, gid vad tham ngtfdi benh. Qui dinh ve ve sinh, an toan, giao tiep, qui che ve kham benh, hoi chan theo yeu cau... trong benh vien va khoa. - Ghi chep vao ho sd ngtfdi benh. + Sau khi thtfc hien xong moi cong viec cua minh ngtfdi dieu dtfdng can phai ghi chep lai nhiing dieu can thiet vao ho sd ngtfdi benh, cung nhtf phieu theo doi cham soc ngtfdi benh theo qui dinh. + Bao cao cong viec cua minh da lam vdi ngtfdi phu trach (dieu dtfdng trtfdng, thay thuoc). 4. NGirdl BENH CHUYEN VIEN 4.1. Dieu kien de ngtfdi benh dtfdc chuyen khoa, chuyen vien - Ngtfdi benh co tinh trang benh nang (benh khong dung vdi chuyen khoa) vtfdt qua kha nang dieu tri cua khoa, cua benh vien. - Ngtfdi benh da dtfdc hoi chan toan khoa, lien khoa (doi vdi benh vien hang I, II), toan vien (doi vdi benh vien hang III) va c6 chi dinh chuyen vien sau khi hoi chan. - Co stf dong y cua thay thuoic trtfdng khoa neu la chuyen khoa. - Co giay chuyen vien do giam doc benh vien ky (doi vdi benh vien hang III). Trtfdng phong ke hoach tong hdp dtfdc giam d& uy nhiem Id gift'y chuyen vien doi vdi benh vie 18 4.2. Qui trinh chuyen ngtfdi benh Chuan bj thu tuc cho ngtfdi benh chuyen khoa, chuyen vie__. + Phai lien he trtfdc vdi khoa mdi, benh vien mdi de chuyen ngudi benh den (trtf trtfdng hdp cap ctfu). + Chuan bi day du ho sd benh an tom tat: chan doan, qua trinh dieu tri, tinh trang benh, ket qua cac xet nghiem da va tinh trang benh hien tai cua ngtfdi benh... + Chuan bi phtfdng tien van chuyen ngtfdi benh: tuy theo tinh trang cu the ma chuan bi cac phtfdng tien van chuyen cho thfch hdp: cang, xe lan, o to... + Giai thich cho ngtfdi benh, ngtfdi nha hieu rd ly do can chuyen vien chuyen khoa, ngay gid chuyen. + Lam day du thu tuc cho ngtfdi benh ra vien neu la chuyen vien. - Ky thuat tien hanh. + Giup ngtfdi benh thu don do dung ttf trang ca nhan. + Di chuyen ngtfdi benh den khoa mdi cung vdi ttf trang ca nhan bang cac phtfdng phap va phtfdng tien van chuyen an toan tien ldi. + Trong trtfdng hdp ngtfdi benh chuyen vien, neu ngtfdi benh nang phai cd nhan vien y te di kem (thay thuoc hoac dieu dtfdng) mang theo cac phtfdng tien cap ctfu de kip thdi xtf tri tren dtfdng di chuyen. - Ban giao ngtfdi benh cho khoa, benh vien mdi: ngtfdi ho tong ngtfdi benh chuyen vien, chuyen khoa can phai ban giao ngtfdi benh, ho sd benh an, ttf trang (neu co) cho ngtfdi tiep don ngtfdi benh d khoa mdi, benh vien mdi. - Bao cao cong viec cho ngtfdi phu trach (dieu dUdng trtfdng, thay thudc trUc, thay thuoc trtfdng khoa) sau khi hoan thanh nhiem vu. + Thdi gian chuyen ngtfdi benh. + Nhutng dien bien bat thtfdng trong qua trinh van chuyen. 5. NGirdl BENH RA VIEN 5.1. Chuan bi ngtfdi benh - Thong bao cho ngtfdi benh biet quyet dinh cho ra vien cua thay thuoc, giai thich cho ngtfdi benh, ngtfdi nha nhiing dieu chtfa rd neu co the. - Chuan bi cac giay td, thu tuc can thiet cho ngtfdi benh dtfdc xuat vien dung ke hoach. 5.2. Chuan bi cac phtfdng tien, van chuyen ngtfdi benh phu hdp vdi dieu kiln hoan canh cua ngtfdi benh (neu co) 5.3. Tien hanh - Giup ngtfdi benh thu don ttf trang, d6 dung ca nhan. 19 + Tra lai quan ao, do dung cho benh vien theo qui dinh. + Thanh toan vien phi. - Kiem tra, tra lai ngudi benh nhtfng giay td can thiet: giay ra vien... - Htfdng din ngtfdi benh thtfc hien che do dieu tri ngoai tru, kham dinh ky, kham lai (neu co). Can ket hdp tuyen truyen giao due stfc khoe cho ngtfdi benh khi trd ve cong dong sinh song: ve che do &n, uong, sinh hoat, tap luyen, phong benh ... - Giup ngtfdi benh ra khoi phong benh, len xe, noi ldi tarn biet, ldi chuc stfc khoe vdi ngtfdi benh va gia dinh. - Thong bao cho nhan vien ve sinh (ho ly) biet de ve sinh, khii khuan buong benh. - Chuan bi giudng benh, phong benh de san sang don ngtfdi benh mdi. - Bao cao vdi ngtfdi phu trach biet cong viec minh da lam. - Nop ho sd benh an cua ngtfdi benh len phong ke hoach tong hdp. Bang 2. Bang kiem quy trinh tiep nhan ngi/di benh vao vien - chuyln vien - ra vien TT Noi dung Cd Khong NGlfOl BENH VAO VI$N * Tai khoa kham benh - Phong chd. 1 Chuln bi phdng sach se, thoang mat, c6 Neu thtfa ion Na se lam tang ap ltfc tham thtfu dich ngoai b&o, lim te bao mat ntfdc, ngtfdi benh cd cam giac khat ntfdc. 40 • Neu thieu ion Na co kem tinh nhtfdc trUdng cua dich ngoai bao, vi the ntfdc co xu htfdng xam nhap vao ben trong cac te bao. + Kali (K dtfdi dang muoi KC1): nhu ciu hang ngay d ngtfdi ldn khoang 3 gam (50 - lOOmEq). ■ Kali la cation chinh cua dich noi bao. ■ Kali gitf vai tro quan trong trong viec dan truyen than kinh cd va hoat dong cua he than kinh thtfc vat. ■ Kali co nhieu trong thit, khoai tay, rau den, ca rot... ■ Thieu kali ngtfdi benh se bi suy yeu cd, co the mat phan xa, liet cd ho hap, ngu ga, tim dap nhanh, roi loan dien tam do. + Calci (Ca) ■ Nhu cau hang ngay: tre em lg, ngtfdi ldn 1-1,5g, phu ntf co thai va cho con bu 2g. • Calci la nguyen to" chu yeu trong cau tao cua xtfdng va rang, co vai tro trong dan truyen than kinh cd, trong dong mau, trong cd che dieu hoa tim. ■ Calci co trong stfa, cac san pham che bien ttf stfa, long trang trtfng, dau, lac, sup Id... ■ Thieu calci se gay tetani, coi xtfdng, loang xtfdng. + Magie (Mg): nhu cau khoang 20 mEq/ngay. Che do an binh thtfdng dap tfng khoang 30 mEq/ngay. ■ Mg gop phan vao viec dieu hoa kha nang chiu kich thich than kinh cd, dong vai tro chu yeu trong qua trinh hoat hoa adenosin triphosphat tham gia chuyen hoa carbonhydrat va protein. ■ Mg co trong dich ngoai bao va noi bao. • Giam Mg se gay rung cd, dong tac mua vdn, co giat, me sang, hon me. + Sat: nhu cau cua tre em 2,5 mg, nam gidi 10,0 mg, phu ntf 2,5 mg, phu nut cd thai va cho con bu 3,5 mg. ■ Sat tham gia tao mau va dtf tru! d gan, lach, tuy xtfdng dtfdi dang feritin. ■ Sat cd nhieu trong thtfc pham goc thao moc va dong vat. Mot che do an binh thtfdng chtia 15 mg sat. • Thieu sat se gay thieu mau nhtfdc sac. + Phot pho (thtfdng ket hdp vdi calci) 41 1.2.3. Cac vitamin Bang 4.1. Mot so vitamin thong thirbng Ten Nguon goc Tac dung Nhu cau Thieu Vitamin A Rau qua co nhieu mau do (ca rot, du du, gac...). Vitamin D Gan ca, bo, long do trumg. Tham gia qua trinh oxy hoa khdr TSng sir hap thu Ca va P d mang ruot 5000UI/ngay Co thai, cho con bu 800UI/ngay 400 Ul/ngay Tre em 300- 800UI/ngay. Thoai hoa niem mac. kho mat Nang thi thung giac mac. Coi XLfOng, xop xi/Ong Vitamin K Rau xanh, bap cai, rau den. Vitamin E Dau thao moc, rau xanh, lua mi, gia do Tong hop prothrombin Tham gia qua trinh dieu hoa sinh san 1mg/ngay Chay mau keo dai, xuat huyet. 10-30 mg/ngay Thieu nang sinh due, vo sinh. Vitamin B, - Mam lua hat cac loai ngu coc rau xanh, lac. - Gan, tim sue vat Trong chuyen hoa glucid Tuy thuoc vao mCrc tieu thu calo - Q dong add pyruvic a cac co. - Gay r6i loan din truyen than kinh Benh: Beri Beri Vitamin B2 Thjt, ca, sura, rau. Tham gia cau tao enzim 13-15 mg/ngay/ngifdi - Ton thuong niem mac mieng, luOi. - N6t ke mit vanh tai, rung toe. Vitamin B6 Mam lua mi, khoai tay. Tham gia chuyen hoa cac acid amin. Tuy thuoc vao mire tieu thu. Roi loan than kinh va benh ngoai da. Vitamin B12 Than, gan, pho mat, sura, thjt. Tham gia cau tao hong cau chong thieu mau. 3-5 mg/ngliy Gay thieu mau Vitamin C Rau qua tUdi, sura, gan. Tham gia vao nhieu chuyen hoa trong co the. 50-75mg/ngay. Phu nCir co thai, cho con bu nhieu hdn. Gay xuat huyet. Giam stfc de khang cua co the. Hinh 2. Cac thfrc an gi&u vitamin 42 2. cAc LOAI TH l/C PHAM SIJ DUNG 6 VIET NAM 2.1. Stf a - Co nhieu loai stfa sii dung cho moi ltfa tuoi, ddn gian thuan tien cung cap nhieu nang liidng (stfa tUdi, stfa dac, stfa bot, stfa dau nanh...). Doi vdi tre sd sinh den 2 tuoi stf dung stfa me la tot nhat. - Co the noi nuoi con bang siia me la phong tuc tap quan co truyen d nUdc ta. Day la nguon thiic an re va thuan tien (khong phai pha che, khong phai dun nau). Thtfc te viec nuoi con b&ng stfa cua chinh minh mang lai rat nhieu ldi ich cho ca me va dtfa tre, dac biet trong dieu kien kinh te con kho khan hien nay. - Siia me mang nhieu tinh tfu viet hdn bdi: + No cung cap day du nang ltfdng va chat dinh dtfdng can thiet cho stf phat trien cd the tre em. Vi du: 1 lit stfa me cho 600 - 700 calo. Mot ngay ngiidi me bai tiet khoang 600 - 800 ml trong 6 thang dau, 400 - 600 ml nhtfng thang sau. Hdn ntfa lipid cua siia me c6 nhieu acid bed kheng no nen de hap thu, diidng siia cua me co nhieu lactose de dang trong viec hap thu canci va muoi khoang, sufa me co nhieu vitamin A giup cho tre chong diidc benh kho mSt. + Siia me co nhieu khang the giup tre chong cac benh truyen nhilm va nhilm khuan. + Siia me vo khuan. + Suta me co tac dung chong di Gng. + Re, thuan ldi. + Tang ctfdng dUdc tinh cam me con. - Hien nay vdi quan diem mdi ve nuoi con bang suta me: cho con bu cang sdm cang tot ngay sau khi tre lot long, bu theo yeu cau lam cho ty le tre em mSc cac benh tieu chay, benh nhiem khuan cung nhu suy dinh dtfdng giam di rat nhieu. Co the noi stfa me la thtfc an tot nhat cua tre dtfdi 6 thang va cd gia tri dinh dtfdng cao cua tre dtfdi 1 tuoi. Nhiem vu cua ngtf di can bo y te la phai tuyen truyen, giao due htfdng din cho phu ntf dang do tuoi sinh de biet cach bao ve va nuoi con blng stfa me. 2.2. Nhom thtfc an chu yeu: gom cd gao, ngo, khoai, s^n, lua mi. 2.3. Nhom thifc an giau dam - Gom ca dam ddng vftt va dam thtfc v&t. - Dam d6ng vftt c6 nhieu S cac loai thit dong vat: thit ldn, thit ga, thit bo, ca, ngan, ngong, vit, tdm cua. 43 2.4. Nhom thufc an cung cap nang ltfdng Co nhieu d dUdng, mfa, dau thuc vat: dau oliu, dau lac, dziu vting, d^u dtia, co d cac loai bo, md, pho mat... 2.5. Nhom cung cap vitamin Cd nhieu d hoa qua, rau tuoi, gan ca thu. Vi du: O VUONG TH l/C AN + Rau ngot, budi, chanh cung cap nhieu vitamin C. + Hoa qua cd mau dd Thtfc an chu yeu Thtfc an giau dam SCira me (gac, bi ngo, du du, ca chua) cung cap nhieu vitamin A. Thirc an giau vitamin muoi khoang ThCfc an giau nang li/ong 3. NHtTNG DIEM CAN CHU Y KHI XAY DlTNG KHAU PHAN AN HANG n g Ay - Muon sti dung thtfc pham dat dtfdc gia tri ve nhu cau n&ng ltfdng va cd dUdc mot buta an ngon mieng phu hdp vdi dieu kien kinh te mdi gia dinh, mdi dia phUdng ta phai biet cach ket hdp cac nhom thtfc pham tren hay ndi dung hOn la phai biet sti dung o vuong thtic &n mot cach hdp ly. - Cu the: tre em dudi 6 thang tuoi: + Chi nen dung mot loai thtfc pham duy nhat la stia me (neu me cd du stia). + Neu me thieu stia hoac khong cd stia thi mdi thay the b&ng cac loai stia khac (chu y pha dung ty le phu hdp vdi ltia tuoi). - Tre tren 6 thang tuo’i: ket hdp stia me vdi cac nhom thuc pham khac, che bien dudi dang khac nhau phu hdp vdi tuoi cua tre: bot siia, bot thit, sup, chao... - NgUdi ldn cung phai biet ket hdp giiia 4 nhom thtic an (thtic an chu yeu, thtic an cung cap dam, cung cap nang liidng, cung cap vitamin) mot cach can doi ty le trung binh gitia P : L : G la 1 : 1 : 4. Tre em dang do phat trien ty le cd the la 1 : 1 : 5 hoac 1:1:6 dong thdi phai dam bao sU can doi gitia dam dong vat/dam thiic vat, giila lipid dong vat/d£u thiic v a t... - Biet cach phan dinh thdi gian, so" ludng cua moi btia &n trong ngay sao cho phu hdp vdi dieu kien lao dong. - Biet cach che bien thtic an ngon mieng, hdp kh£u vi phti hop tvfng ca nhan va dieu kien kinh te. 44 CAU HOI Tl/LUONG GIA Hoan thien cau sau b&ng cach chon tii, cum tu: thich hdp dien vao cho trong. 1. Nhu cau dinh dUdng cua con ngUdi gom: A. Nhu cau ve nang lUdng. B. Nhu cau ve................................... 2. Nhu cau cua ngUdi binh thUdng ve: A. Lipid la......................................... B. Glucid la....................................... 3. Liet ke nam vai tro cua thtic an co ban chat protid: A: La thanh phan cua nhan va nguyen sinh chat cua moi te bao. B :...................................................... C: Xuc tac cac qua trinh chuyen hoa. D: ...................................................... E. Tham gia vao qua trinh ho hap. 4. Hoan thien cac noi dung trong hinh ve o vuong thtic an dtfdi day. O VUONG THLfC AN ThCrc an chd yeu Sura me ThCrc an giau ........B......... ThCfc an giau nang li/png Chon y dung nhat de tra ldi cho cac cau hoi sau. 5. Cau tao cua thtic an co ban chat protid la: A. Hop chat co C, H, O B. Hdp chat co C, O, NH3 C. Hdp chat co C, H, O, N D. Hdp chat co C, H, C 02 6. Nhu cau protid cua ngtfdi binh thtfdng la: A. 0,5 - 1 g/kg/ngay. B. 1 - 1,5 g/kg/ngay. C. 1,5 - 2 g/kg/ng&y. 45 D. 2 - 2,5 g/kg/ngay. 7. Vitamin D lam tang hap thu Ca, P, d: A. Mang ruot. B. Da day. C. Ta trang. E. Hoi trang. Phan biet dung, sai cac cau sau bang cach dien dau (V) vao cot A cho cau dung, cot B cho cau sai. TT Ndi dung A B 8 Nhu cau nang ludng cua con ngi/di khong phu thuoc vao lira tudi va gidi. 9 Nhu cau ve nang lifdng cua tre sd sinh va tre dang phat trien khac nhau. 10 Phu nu co thai va ngudi lao dong nang co nhu cau ve nang ludng cao hdn binh thudng. 11 Vitamin A co nhieu 6 rau qua co mau do. 46 Bai 5 MOT SO CHE DO AN BENH LY MUC Tieu 1. Trinh bdy diidc nguyen tac xay ditng khau phan an cho ngiidi benh. 2. Neu diidc khai niem, muc dich, chi dinh cua mqt so che do an benh ly. 1. NGUYEN TAC XAY DUNG KHA • • u PHAn An CHO NGUOl BENH - Dam bao chat ltfdng va ty le can doi giiia protid, lipid, glucid, vitamin va muoi khoang. - Dam bao du nang ltfdng. - Dam bao yeu cau ve protid (trong do protid dong vat chiem toi thieu 30 - 50%, nhieu nhat la 65%). - Khau phan an trong ngay can chia ra lam nhieu bQa, khau phan &n khong nen dung lau, tra lai che do &n sinh ly cang sdm cang tot. - Phai dong vien ngtfdi benh an uong, khong nen ep ngtfdi benh mot cach qua mtic. - Dam bao che do an hdp ve sinh, kich thich vi giac cua ngtfdi benh. 2. MOT SO CHE DO AN BENH LY • • • 2.1. Che do an han che sOi va xO • • • • Thiic an co chat sdi va xd: - Sdi co trong thtic &n dong vat nhtf to chtic lien ket, gan, cd, sun. - Xd co trong rau cu, vo ngoai cua te bao thtfc vat. • Tac dung: - Tac dung kich thich co b6p cua ong tieu hoa nhat la doi vdi nhu dong ruot. - Vdi nhting ngtfdi ton thtfdng ong tieu hoa tac dung kich thich tren tin c6 hai. 47 • Tranh chon thiic pham sdi, xd: - Dau do, san khoai, rau difa, cai, mang... - Hoa qua co nhieu ba: dtfa, le, tao... • Nen chon thiic pham khong co sdi, xd: - Suta, trtfng bd. - Khoai nghien, rau non. - Niidc ep hoa qua (chanh, cam, chuoi). • Che bien: - Rau qua nghien nho, nau nhtf. - Thit ca ham nhii de cac sdi bien thanh keo long. - Gao da loai cam. - Khong nen ran, khong an song. • Ap dung: - Ngildi benh loet da day, ta trang. - Viem ruot, cac ton thtfdng khac d ruot. • Che do an han che xd diidc chia lam 3 loai: - Han che chat che: chi an suta, chao, bot. - Han che vtfa phai: an suta, chao, bot them trufng khoai nghien. - Han che it: Sn them thit dong vat, chon nac, bo bi, gan, phai n&u nhtf. 2.2. Che do an han che chat beo • Dac diem che do an cd nhieu chat beo: - Cung cap nhieu nang ltfdng. - Che bien kheo se thdm ngdn nhung chong chan. - Lau tieu. - Kich thich tiet dich mat. • Ap dung che do an han che chat beo: - Ngufdi benh co benh gan mat (suy gan, viem gan, tui mat...). - Beo phi. - Benh tim mach. • Tranh cac loai thiic an: - Thit nhieu m3, md dong vat, thutc &n ran. - Socola. - Trutng, gia vi. 48 • Nen dung: - Bot gao, thit nac, ca luoc. - Dung dau thtfc vat: dau oliu, dau vtfng, dau lac. - Hoa qua tUdi. 2.3. Che do an han che protid • Muc dich: Lam giam san pham chuyen hoa cua protein la NH3 de tranh hien ttfdng tang ure huyet. • Ap dung: - Benh viem cau than cap, suy than cap, viem than man. - Cac hoi chtfng dan den ure huyet cao: tan huyet, chan thildng, phlu thuat. • Khong dp dung: - Ngildi benh co hoi chtfng than hil. - Xd gan (khong chong chi dinh tuyet doi). • Chu y: - Tranh dung cac loai thtfc pham co nhieu protid: thit, ca, trtfng, stfa, ca cao, cac thiic an ho dau. - Nen dung thiic an co nhieu glucid (l)anh mi, khoai, ntfdc qua, bd...). - Tuy thuoc mtfc do ure huyet cao ma co che do an han che cho thich hdp. - Neu ngildi benh tang ure huyet cap tinh phai giam protid xuong 20g - lOg/ngay hoac bo han. - Neu ure mau cao man tinh phai kiem tra ltfdng ure thai ra hang ngay trdng ntfdc tieu, co the han che vtfa phai bang cach cho an ttf 40g den 30g protid/ngay. 2.4. Che do an tang protid • Muc dich: - Dam bao cung cap protid cho cd the bu vao ltfdng protid da huy dong khi bi benh. * • Ap dung: - Hoi chting than htf. - Ngtfdi benh bi cac benh man tinh gay suy mon Gao, nhiem khu£n man). - Cac benh thieu mau, viem gan thdi ky hoi phuc. - Cac benh ngoai khoa: gay xtfdng, sau mo... • Khdng dp dung: 49 - Ngiidi benh suy than kem ure huyet tang. - Hon me gan, suy gan nang. • Nen an thiic an: thit ,ca, tom, cua... 2.5. Che do an han che muoi Muc dich che do an han che muoi: lam giam ltfdng Na dtfa vao cd the trong luc cd the co hien ttfdng tf dong Na. - Han che muoi tuyet doi: + Thtfc Sn nau khong co muoi. + Tranh cac loai thtfc pham thien nhien co sin muoi (ca bien, siia, trtfng...). + Nen an chao dtfdng, stfa dau nanh, ntfdc hoa qua. • Che do an han che muoi tuyet doi dp dung cho: - Ngtfdi benh viem cau than cap, viem cau than man. - Suy tim nang. - Phu cap tinh do cac nguyen nhan khac nhau. • Han che muoi ttfcfng doi: - La loai thtfc an khong co muoi khi nau. - Dtfdc dung cac loai thtfc pham thien nhien co sin muoi (tom, cua, ca bien, rau muong, stfa, trtfng). • Che do an han che muoi ttf Ong doi dp dung cho: - Ngtfdi benh co phu keo dai (suy tim nhe, than nhiem md con phu nhe). - Ngtfdi benh dieu tri bang corticoid keo dai. 2.6. Che do an cho ngtfdi benh tieu dtfdng 2.6.1. Dac diem ve chuyen hod trong benh tieu diidng Benh tieu dtfdng co nhieu nguyen nhan, nguyen nhan pho bien la do thieu nang tuyen tuy, noi tiet gay nen roi loan chuyen hoa dtfdng trong cd the. Ngtfdi benh co bieu hien cua tang dUdng mau, ntfdc tieu co dtfdng, dong thdi lam tang thoai bien protid, lipid nen ngtfdi benh gay nhanh, suy kiet. Do khong chuyen hoa dtfdc dtfdng nen trong che do an phai than trong khi sti dung thtic an co glucid. 2.6.2. Nguyen tac xay dung khau phan an - Dam bao vtfa du so nang ltfdng can thiet khong nen qua 30 calo/kg/24 gi - Anh htfdng den hoat dong cua bo may tieu hoa (an kem, chan an). • Che do an trtfdc mo: - Khi con xa ngay mo can cho an che do boi dtfdng co nhieu protid, glucid, ntfdc va calo. - Vai ngay trtfdc mo: che do an khong co ba, giam calo xuong 1/3. - Ngay mo: ngtfdi benh nhin Sn, uong it ntfdc. • Che do an sau khi mo: - Giai doan chtfa thoat hdi (chtfa co trung tien). + Truyen cac loai dung dich muoi, dtfdng, huyet ttfdng. + Neu mo ngoai bo may tieu hoa cho uong ntfdc chao, ntfdc ep hoa qua. + Neu mo bo may tieu hoa chi cho nhap it ntfdc khoi kho mieng. - Giai doan da trung tien: che do &n long, it n&ng ltfdng, it protid, glucid, nhieu vitamin va ting din so' ltfdng. - Giai doan hoi phuc: che do &n boi dtfdng tang dan ning ltfdng tii 1.600 - 2.000 - 3.000 calo. protid tir 1 - l,5g/kg/24h. 51 CAU HOI TU LUONG GIA Hoan thien cac cau sau bang cach chon tii, cum til thich hdp dien vao cho tro'ng: 1. Che do an han che chat beo dtfdc ap dung cho ngtfdi benh: A: Co benh gan mat (suy gan, viem gan, viem tui mat). B :....................................................... C :....................................................... 2. Cac loai thtfc pham khong nen chon khi che bien che do an han che chat beo la: A: Thit nhieu md. B :......................................................... C: Socola. D :............................................................. Chon y dung nhat de tra ldi cho cac cau hoi sau 3. Che do an giam dam ap dung cho ngtfdi benh: A: Viem cau than cap. B: Hoi chtfng than hu. C: Tieu dtfdng. D: Thieu mau. 4. Thtfc pham khong dtfdc sii dung cho ngtfdi benh tieu dtfdng la: A: Thit nac. B: Trtfng. C: Dau phu, dtfa chuot. D: Banh. Phan biet dung, sai cac cau sau bang cach dien da'u (V) vao cot A cho cau dung, cot B cho cau sai. TT Noi dung A B 5 Khi xay dimg khdu phan an cho ngudi benh c5n dam bao chdt lirong va ty 16 can doi giura protid, lipid, glucid, mudi khoang va vitamin. 6 Chd do an han chd chdt sai va xo duoc ap dung cho ngudi b6nh vi&m ru6t hoac cac ton thuong khac ddudng ruot. 7 Khi chd bidn thtic an han chd soi va xd phai chu y nghidn nho, ndu nhti. 8 TrUdc khi md phien 1-2 tudn cho ngudi b6nh an chd 66 tang chdt dinh duOng. 9 Ngudi benh sau khi md chua trung tidn cho chd d6 an han chd sdi vd xd. 10 Chd d6 an han chd mudi tuy§t ddi la chd dd an khi chd bidn khdng cho mudi vao thtic an nhung dUdc sti dung thtic dn c6 sin mudi trong thidn nhiftn. 52 Bai 6 KY THUAT DUA CHAT DINH DUONG VAO CO THE An uong trong dieu tri benh rat quan trong no giup CO the ngtfdi benh du kha nang chong lai benh tat va phuc hoi stfc khoe. Vi vay bang moi cach ngtfdi dieu dtfdng phai dap tfng nhu cau dinh dtfdng cua ngtfdi benh. Co the ap dung cac hinh thtfc sau day de dtfa chat dinh dtfdng vao cd the: - Dtfdng mieng. - Dtfdng tinh mach. - Bang ong thong qua: + Mui mieng vao da day. + Da vao thang da day. + Hau mon (it stf dung vi kern hap thu va it co hieu qua). A. CHO N G l/O l BENH A n BANG DUONG MIENG Mgc TIEU 1. Trinh bdy diidc tam quan trong cua thiic an ddi vdi ngitdi benh. 2. Trinh bdy diidc nhdng thay doi tdm ly cua ngiidi benh trong an uong va thdi d$ cua diiu diidng khi cho ngiidi b$nh an. ’ . r 3. Cho ngiidi benh an diidc bang diidng miqng theo dung quy trinh ky thuat. 1. t Am QUAN TRONG CUA THlfC An DOI V 6 l NGlTCl BENH - Cung cap cac chat va nang ltfdng de cd the ton tai, phat trien va chong lai benh, tat dong thdi hoi phuc stfc khoe. - An uong co vai tro quan trong ngang nhtf thuoc trong dieu tri benh vi vay phai tuan thu theo che do an ma thay thuoc da quy dinh. 2. NHtfNG THAY DOI TAM LY CUA NGUOl BENH VE AN UONG VA VAI TRO CUA DIEU DlTCfNG 2.1. Nhtfng thay doi tam ly cua ngtfdi benh - Khi bi benh, tfim ly cua ngtfdi benh trong &n uong co nhieu thay doi so vdi luc khoe. Ngtfdi benh c6 the fin it, khong thich an hoac ghe sd khi 53 nhin thay thtic an hay chi thich mot mon an nao do (an ngot, man. nhat, an nong, an lanh...). Vi vay ngtfdi dieu dtfdng can phai quan tam nghien ctiu van de nay mdi co the lam tot viec san soc an uong cho ngtfdi benh. 2.2. Vai tro cua ngtfdi cua dieu dtfdng • Tii the tac phong, thdi do. - Tti khi chuan bi tdi khi cho ngtfdi benh an xong dieu dtfdng phai luon gitf dtfdc thai do an can niem nd, dong vien de ngtfdi benh de ho an het khau phan. - Trang phuc gon gang sach dep. - Khong de mong tay dai, khong danh mau mong tay. - Giai thich cho ngtfdi benh hieu dtfdc che do an benh ly. - v Lang n^he y kien cua ngtfdi benh gop y ve ky thuat che bien, chat ltfdng cua khau phan an de thay doi vao btfa sau. • Chuan bi thiic an. - Thtfc an phai dam bao mdi che bien khong oi thiu. - Khong cho nhtfng gia vi ngtfdi benh khong thich, nhtfng chat mau vao thtfc an. - Chuan bi thtic an dung vdi thtfc ddn, vtia du trong mot btfa. • Chuan bi do dung. - Khay thtic an phai sach dep. - Bat, dia, thxa, dua, khan hoac giay an phai dam bao ve sinh. • Trinh bay khay thiic an. Bat, dia thtic an phai trinh bay kheo 16o, dep mat. • Thdi gian cho ngiidi benh an. Cho ngtfdi benh an dung gid (dung btia), de ngtfdi benh an het khau phan. 3. QUY TRiNH KY THUAT CHO N G l/d l BENH AN 3.1. Xem ho sd benh an va chuan bi ngtfdi benh • Xem ho sd - Xem chi dinh thtic an. - Dtfdng dtfa thtic an. - So' ltfdng thtic an. • Chuan bi ngiicfi benh. - Thong bao va giai thich de ngtfdi benh chu£n bi ca nhan trtfdc. - Sap xep lai gitfdng benh cho gon gang. - Chuan bi ttf the ngtfdi benh cho thich hop. ,< 54 + Tu the ngoi ap dung cho ngiidi benh tinh, khong di lai dtfdc. + Tu the n^m ap dung cho ngtfdi benh qua yeu hoac do benh khong chd phep d ttf the ngoi neu do yeu cau dieu tri phai n&m d tu the dau thap khi an can gitf nguyen d ttf the do hoac nhtfng ngtfdi benh co ton thtfdng than kinh (liet ntfa ngtfdi, roi loan hoat dong tieu nao...). 3.2. Chuan bi ngtfdi dieu dtfdng - Dieu dtfdng cd du ao, mu, khau trang. - Rtfa tay thtfdng quy. 3.3. Chuan bi dung cu - M6t khay chtf nhat to,m6t khan bdng td quang trtfdc ngtfc ngtfdi benh. - Hai khan bdng nho: mot khan riia mat va lau mieng sau khi an, mot khan de lau kho tay. - Thtfc an theo chi dinh, thtfc an trang mieng (trai cay hoac banh ngot). - Bat nho, dia, hai thia, dua, dao, dia..., coc ntfdc uong. - Chau ntfdc sach de rtia mat, riia tay trtfdc khi an. - Nilon trai len canh gitfdng de dat chau ntfdc. - Khay qua dau de dtfng ntfdc xuc mieng. - Tui dtfng do ban. 3.4. Ky thuat tien hanh - Day xe thiic an den gitfdng ngtfdi benh. - Giup ngtfdi benh d ttf the thuan ldi. - Trai nilon canh gitfdng, dat chau ntfdc, lau mat, rtta tay cho ngtfdi benh va tham kho. Hinh 6.1. Ho tro ngtfdi benh ttf an tai gitfdng - Quang khan bong to trtfdc ngtfc, cho ngtfdi benh xuc mieng. - Lay thiic an ra dia hoac bat thich hdp, kiem tra nhiet do cua thiic an. - Co the cho gia vi len tren thiic an neu can thiet. - B6n tvttig thia nho cho ngtfdi benh an. - Thiic an long ma ngtfdi benh cl ttf the nam ngiia can chu y cho an it mot tranh s&c. - Dong vien de ngtfdi benh an het khau phan. - Cho ngudi benh an trang mieng, xuc mi§ng va uong ntfdc. 55 - Lau mieng cho ngtfdi benh, dat ngtfdi benh d ttf the thoai mai. - Dan ngtfdi benh nhtfng dieu can thiet trtfdc khi rdi khoi gitfdng. 3.5. Thu don dung cu va ghi ho sd - Do thtfc an thtfa vao thung chtfa. - Rtfa sach khay va cac dung cu khac bang ntfdc va xa phong. - Lau kho va de vao ndi quy dinh. - Ghi ho sd: + Ngay, gid an, khau phan an, so ltfdng, loai thtfc an. + Ngtfdi benh ttf an hay can giup dd, ly do. + Dieu dtfdng ky ten. Bang 6.1. Bang kiem ky thuat cho ngtfdi benh an b&ng dtfdng mieng TT Ndi dung Cd Khong • Chuan bj ngtfdi benh 1 Xem y lenh, bao cho ngifdi benh biet viec Seip lam. 2 Giai thich, dong vien de ngtfdi benh yen tam. • Chuan bj ngtfdi dieu dtfdng 3 Dieu dtfdng co day du mO, ao, khau trang, rura tay thtfdng quy. • Chuan bj dung cu 4 Khay chtf nhat to, mot khan bdng to, hai khan bdng nho. 5 Thufc an theo y lenh. 6 Cd'c ntfdc chin, bat nho, hai thia, dia. 7 Chau ntfdc sach, nilon, tui dtfng do ban, khay qua dau. • Ky thuat tien hanh 8 Dat ngtfdi benh d ttf th^ thuan ldi. 9 Trai nilon canh gitfdng, dat chau ntfdc, lau mat, rura tay cho ngtfdi benh va tham kho. 10 Quang khan bdng to trtfdc ngtfc, cho ngtfdi benh sue mieng. 11 Muc thtfc an ra bat nho, kiem tra nhiet do cua thtfc an. 12 Bon ttfng thia nho cho ngtfdi benh an. 13 Dong vien de ngtfdi benh an het khau phan, cho ngtfdi benh u6ng ntfdc. 14 Lau mieng, bo khan quang cd, giup ngtfdi b£nh n&m lai ttf th^ tho&i mai. 15 Dan ngtfdi bdnh nhufng dieu can thi6t trtfdc khi ra kh6i gitfdng. • Thu d?n dung cu 16 Thu don dung cu, ghi phi£u cham sdc. 56 B. NUOI Dl/OfNG N G l/dl BENH QUA ONG THONG DA DAY M y c TI^U 1. Neu dtfdc cac trtfdng hQp dp dung va khong dp dung khi cho ngtfdi benh an bdng ong thdng (sonde). 2. Tien hanh dtfdc ky thuat cho ngtfdi benh an bdng ong thong theo dung qui trinh. 1. cAc TRUONG HOP Ap d u n g , k h o n g Ap d u n g 1.1. Cac trtfdng hdp ap dung - Tre de non, phan xa mut - nuot kern. - Ngtfdi benh hon me, co giat. - Nhtfng ngtfdi benh khong nhai dtfdc, khong nuot dtfdc. - Di dang dtfdng tieu hoa (stit moi, hd ham ech...). 1.2. Cac trtfdng hdp khong ap dung - Ton thtfdng thtfc quan: bong acid, kiem. Ap xe thanh hong. Lo thong thtfc quan. - Hep khit mon vi, tac ruot. - Hon me chtfa dat dtfdc ong noi khi quan. - Viem phuc mac sau thung tang rong. 2. QUY TRINH KY THUAT 2.1. Xem ho sd benh an - chuan bi ngtfdi benh • Xem ho scf: chi dinh cua thay thuoc, ten ngtfdi benh, dtfdng cho an, so ltfdng vh loai thiic in. • Chuan bi ngildi benh. - Thdng b&o v& giai thich cho ngtfdi benh hoftc ngtfdi nha biet ve thu thuat s&p lam. 57 - Dong vien ngtfdi benh yen tam hdp tac vdi dieu diidng. - Htfdng dan ngtfdi benh nhtfng dieu can thiet. - Dat ngtfdi benh n&m ttf the thoai mai, thuan tien de dtfa dtfdc ong thong vao dung thtfc quan (doi vdi ngtfdi benh bat tinh dat ngtfdi benh d ttf the n^m ngtfa, ke goi dtfdi vai (hinh 6.3). Hinh 6.3. Tii the ngi/di benh khi di/a ong thong v&o thirc quan 2.2. Chuan bi ngtfdi dieu dtfdng - Dieu dtfdng co du mu, ao, khau trang. - Rtfa tay thtfdng quy. 2.3. Chuan bi dung cu - Khay chtf nhat sach, tru cam kim Kocher. - Binh dtfng dung dich thtfc an (so' ludng tuy thuoc vao benh ly va chi dinh cua thay thuoc) nhiet do cua thtfc an la 37°C. - Coc ntfdc chin bdm qua sonde trtfdc va sau khi cho an. I ! | N ’ - Khan bong to quang trtfdc ngtfc ngtfdi benh, khan bong nho lau mieng cho ngtfdi benh.-4— - Ong nghe de kiem tra ong thong da vao tdi da day. - Keo, bang dinh de co' dinh o'ng thong (trtfdng hdp ltfu ong thong). - Que tam bong ve sinh mui ngtfdi benh trtfdc khi cho an. - Coc, bong tam dau nhdn de boi trdn dau ong thong, ong thdng levin, tre nho dung ong thong Nelaton, bdm tiem 50 ml de bdm thiic an, gang tay. - Hop dtfng gac, bong cau, de ltfdi neu can, nilon, khay qua dau, tui dtfng do ban. 2.4. Ky thuat tien hanh - Dtfa dung cu den ben gitfdng ngtfdi benh. - Che binh phong. 58 Giup ngtfdi benh n^m d tu the thuan ldi, quang khan bong trtfdc ngtfc ngtfdi benh, ve sinh mui neu dat ong thong qua mui. - Dat khay qua dau dtfdi cam va ma ngtfdi benh. - Dieu dudng di gang, cam ong thong do va danh dau, khi do ong thong tren ngtfdi benh (tranh cham ong thong vao ngtfdi benh). - Do ong thong: + Cach 1: ttf canh mui tdi dai tai cung ben va tu’ dai tai den diem gitf a tu mui lie den ron. + Cach 2: tii cung rang ctfa tdi ron cua ngtfdi benh. - Bdi dau nhdn vao dau ong thong. - Dtfa ong thong vao da day qua mui (hoac mieng) bang cach: + Mot tay dieu dtfdng cam ong thong kieu cam but, mot tay cuon phan ong con lai. + Nhe nhang dtfa ong thong vao mot ben mui ngtfdi benh. Khi dtfa tdi hong bao ngtfdi benh nuot dong thdi day nhe nhang vao tcii vach danh dau. Hinh 6.4. Do chieu dai ong thong - Kiem tra dau ong thong da vao tdi da day bang hai cach: + Cach 1: dung bdm tiem hut dich trong da day (hay dtfdc ap dung). + Cach 2: dung bdm tiem bdm khoang 20-30 ml khong khi (bdm mot lan dtit khoat) dong thdi dat ong nghe len vung thtfdng vi ngtfdi benh de nghe, nghe thay tieng uc uc la dtfdc. - Co' dinh ong thong bang bang dinh vao ma ngtfcti benh. - C&m bdm tiem hut ntfdc chin bdm vao da day, sau d6 bdm thiic an theo chi dinh (bdm ttf ttf vtfa bdm vtfa Hinh 6.5. Oifa 6ng thong vao da day quan sat s&c mat ngtfdi benh). 59 + Trtfdng hdp dtfa thtfc an vao da day ngtfdi benh qua pheu dung coc do ntfdc chin qua pheu sau do mdi do thtfc an theo chi dinh. + Trtfdng hdp cho ngtfdi benh an bang phtfdng phap nho giot da day thi lap tui dtfng thtfc an vao dau ong thong. - Bdm du so ltfdng thtfc an sau dd bdm ntfdc chin trang ong thong. - Dat gac rut ong neu khong ltfu ong thong. Nut dau ong thong lai co Hinh 6.6. Cach dd thifc an vao pheu dinh vao ao ngtfdi benh (trtfdng hdp ltfu ong thong). - Thao bo khan bong quang d ngtfc, bo nilon, lau mat va mieng cho ngtfdi benh. - Theo doi ngtfdi benh sau khi an (quan sat hien ttfdng trao ngtfdc). - Stfa lai gitfdng va giup ngtfdi benh nam lai ttf the thoai mai. 2.5. Thu don dung cu va ghi ho sd - Riia sach cac dung cu de vao ndi quy dinh, thao gang tay. - Ghi ho sd: + Ngay gid cho an. + Loai thtfc an, so' ltfdng. + Tinh trang ngtfdi benh khi dat sonde, trong va sau khi cho an. + Dieu dtfdng ky ten. 3. NHLTNG DIEU CAN LUtJ Y - Khong dat o'ng thong qua dtfdng mui neu ngtfdi benh bi viem mui, chay mau cam, polip d mui. Hinh 6.7. Nuoi dudng ngi/di benh qua may nhd giot da day - Trong khi dtfa ong thong vao neu thay ngtfdi benh cd phan ling ho sic sua, tim tai thi phai rut ra ngay. - Chi dtfdc bdm thiic an cho ngtfdi benh khi kiem tra d&u ong thong da chinh xac vao tdi da day. - Moi lan thay ong thdng thi doi luon lo mui de dftt 0,5 ml. • Xem ho scf benh an - chuan bi ngtfdi benh Thong bao, giai thich va dong vien ngUdi benh ve viec lav mau xet nghiem de ngUdi benh yen tam. • Chuan bi ngtfdi dieu dtfdng - Dieu dUdng co du ao, mu, khau trang. - Riia tay thUdng quy. • Chuan bi dung cu - Khay chut nhat, tru d m mot kim Kocher. - Bdm tiem (tuy theo yeu cau xet nghiem), gang tay. - Con iod, con 70° de sat khuan vi tri lay mau, hai coc dung bong cau. - Gia dUng, ong nghiem, phieu xet nghiem. - Huyet ap ong nghe, hop chong soc, goi ke tay, day garo. - Hop dUng vat s£c nhon, tui dung do ban. • Tien hanh - Dieu dUdng mang gang, giup ngUdi benh nSm ngUa thoai mai tren giudng. - Boc lo, xac dinh vi tri lay mau, ke goi dudi vi tri lay mau (neu lay mau d tay), dat day garo phia tren cach vi tri lay mau tU 3 - 5 cm va that day garo. - Sat khuan vi tri lay mau: con iod trUdc, con 70° sau. - Cam bdm tiem dam kim vao tinh mach, lay du lUdng mau theo yeu cau xet nghiem, thao day garo. - Rut kim nhanh ket hdp k6o chech da, sat khuan lai vi tri lay mau. - Thao kim tiem, bdm mau vao ong nghiem (khi bdm mau de ong nghiem nghieng mot g6c 45° va bdm ttf ttf vao thanh o'ng nghiem). - Lac nhe ong nghiem (n£u c6 chat chong dong) va gtfi benh pham, giay xet nghiem len phdng x6t nghiem. 79