🔙 Quay lại trang tải sách pdf ebook Hướng dẫn thực hành 55 kỹ thuật điều dưỡng cơ bản - Tập 2 Ebooks Nhóm Zalo BO Y TE HI/tfNG DAN THI/C HANH 55 KY THUAT DIED DlTOTNG CO BAN ■ TAP 2 (DUNG CHO DAO TAO CTJ* NHAN DIEU DUONG) MA SO: D34.Z02 (Tai ban Ian thu nha't) TRUONG C t\ '’ OANGy '' T I T iI / m i , NHA XUAT BAN GIAO DUC VIET NAM V -, Chi dao bien soan VU KHOA HOC VA DAO TAO - B0 Y TE Chu bien TS. d 6 DiNH XUAN ThS. TRAN THI THU AN Nhufng ngifort bien soan ThS. TRAN THI THUAN ThS. NGUYEN THI SUONG ThS. DOAN THI ANH LE ThS. TRAN THUY KHANH LINH ThS. NGUYEN MANH DUNG CN. TONG VINH PHU ThS. VU THI MINH PHUQNG ThS. HOANG CONG CHANH BS. NGUYEN DANG THANG BS. CKII. TRAN DtfC THAl TS. LE VAN AN TS. NGUYEN THI KIM HOA Thtf ky bien soan ThS. NGUYEN MANH DUNG Tham gia to chutfc ban thao ThS. PHI VAN THAM TS. NGUYEN MANH PHA LOI GIOI THIEU ThUc hien mot so" dieu cua Luat Giao due, Bo Giao due & Dao tao va Bo Y te da ban hanh chUOng trinh khung dao tao Cu nhan Dieu dudng. Bo Y te to chuc bien soan tai lieu day — hoc cac mon cO sd va chuyen mon theo chUdng trinh tren nham tiing budc xay dung bo sach chuan trong cong tac dao tao nhan luc y te. Sach Hiidng dan thuc hanh 55 ky thuat dieu diidng dtfdc bien soan dua tren chiiOng trinh giao due cua cac Truing Dai hoc Dieu difdng tren cd sd chUdng trinh khung da dUdc phe duyet. Sach dUdc cac nha giao giau kinh nghiem va tarn huyet vdi cong tac dao tao bien soan theo phuong cham: Kien thuc cd ban, he thong; noi dung chinh xac, khoa hoc; cap nhat cac tien bo khoa hoc, ky thuat hien dai va thuc tien Viet Nam. Sach Hiidng dan thuc hanh 55 ky thuat dieu diidng da dUdc Hoi dong chuyen mon tham dinh sach va tai lieu day - hoc chuyen nganh Cn nhan Dieu dudng cua Bo Y te tham dinh nam 2009. Bo Y te quyet dinh ban hanh lam tai lieu day - hoc chinh thiic cua nganh Y te. Trong thdi gian ttf 3 den 5 nam, sach phai dUdc chinh ly, bo sung va cap nhat. Bo Y te xin chan thanh cam dn cac tac gia va Hoi dong chuyen mon tham dinh da giup hoan thanh cuon sach. Cam dn TS. Le Thi Binh; CN. Nguyen Thi Kim Loan da doc, phan bien va gop y kien cho viec hoan thanh cuon sach, kip thdi phuc vu cho cong tac dao tao nhan Inc y te. Vi lan dau xuat ban, chung toi mong nhan dude y kien dong gop cua dong nghiep, cac ban sinh vien va cac doc gia de sach diidc hoan thien hdn trong lan tai ban sau. VU KHOA HOC VA DAO TAO - BO Y TE 3 LGI NOI OAU Ky nang thuc hanh Dieu diidng gom 55 ky thuat cd ban diidc Dieu ditong thiic hien tai cac cd sd kham va chufa benh. Cac ky thuat nay dUdc chon loc tu cac nha quan ly, giang vien d cac trUdng Dai hoc, Cao dang dao tao Dieu dudng co uy tin trong nude nham dap ling nhu cau chuan hoa. thong nhat va cap nhat cac ky thuat Dieu dUdng. Dong thdi dUdc sU giup dd, co van cua cac chuyen gia nude ngoai (Ha Lan, Anh) ve cach thiet ke cuon sach dung cho sinh vien Dieu dudng; cac budc cau true xay dung de phu hdp vdi noi dung kien thiic can thiet cho ky nang thUc hanh Dieu dudng va dap Ung phUdng phap tu hoc cho sinh vien Dieu dudng. Cuon sach dUdc bien soan bdi cac giang vien chuyen nganh Dieu dUdng cua cac trUdng Dai hoc Y Ha Noi, Dai hoc Dieu dudng Nam Dinh. Dai hoc Y Hue va Dai hoc Y—DUdc Thanh pho Ho Chi Minh. Noi dung cuon sach dUdc phan ra lam 10 chvfdng va chia thanh 2 tap. Tap 1 tu1 chUdng I den chUdng V ChUdng I: Cac ky thuat lam giUdng va cham soc ngUOi benh tai giUdng ChUdng II: Cac ky thuat ve sinh ca nhan Chutdng III: Cac ky thuat theo doi va tham kham Chifdng IV: Cac ky thuat vo khuan ChUOng V: Cac ky thuat cho an va cham soc bai tiet Tap 2 tii chUdng VI den chtfdng X. ChUdng VI: Cac ky thuat dua thuoc vao cd the ChUdng VII: Cac ky thuat truyen dich Chiidng VIII: Cac ky thuat thay bang vet thiidng ChUdng IX: Mot so' ky thuat khac ChUdng X: Cap ciiu ban dau Cuon sach diio'c trinh bay tuan theo phiidng phap giang day tich cuc, vtfa la tai lieu danh cho sinh vien ciJ nhan Dieu dudng t\i hoc, cung co the lam tai lieu cho cac sinh vien thuoc cac chuyen nganh khac cua Y hoc can tham khao mon Ky thuat Dieu dudng cd ban. Trong qua trinh bien soan, mac du cac tac gia da rat co gang nhu'ng chac chan se khong tranh khoi cac thieu sot, chung toi mong nhan du'Oc su dong gop cua quy dong nghiep va quy ban doc. Dong chu bien TS. Do Dinh Xuan ThS. Tran Thi Thuan M UC LUC Ldi gidi thieu....................................................................................................................... 3 Ldi noi dau............................................................................................................................5 ChUofng VI. CAC KY THUAT DUA THUOC VAO CO THE............................................. 9 Gidi thieu toan chUdng......................................................................................................9 Phat thuoc va ghi ch ep ....................................................................................................12 Cach pha thuoc..................................................................................................................25 DUa thuoc qua dUdng mieng — am dao - trUc trang................................................ 37 Dung thuoc qua dUdng tiem ..........................................................................................58 ChUdng VII. CAC KY THUAT TRUYEN DICH..............................................................80 Chuan bi dat catheter tinh mach trung tarn..............................................................83 Ky thuat dat kim luon ngoai v i...................................................................................99 Ky thuat truyen dich qua tinh mach......................................................................... I l l Truyen dich dudi da....................................................................................................... 125 Ky thuat truyen mau.....................................................................................................137 Nuoi dUdng hoan toan bang dUdng tinh m ach........................................................154 Ky thuat svi dung bdm tiem dien...............................................................................171 Ky thuat siJ dung may truyen d ich ..........................................................................184 ChUdng VIII. CAC KY THUAT THAY BANG VET THUONG.................... ...........200 Thay bang ru'a vet thUdng sach..................................................................................204 Thay bang rUa vet thUdng nhiem khuan..................................................................212 Thay bang rUa vet thUdng dan lUu............................................................................ 221 Ky thuat thay bang hau mon nhan ta o....................................................................230 Thay bang vet thUo'ng - cat c h i..................................................................................240 ChUtfng IX. MOT SO KY THUAT KHAC Ky thuat hut ddm d a i................................................................................................... 250 Thd oxy qua mui va ong md khi q u an ...................................................................... 265 Cach lay benh pham lam xet nghiem ....................................................................... 273 Trd giup bae si choc do..................................................................................................289 Chu'dm nong - chu'dm lanh..........................................................................................300 Chtfcfng X. CAP CtfU BAN DAU.....................................................................................319 Sd ciiu gay xUdng............................................................................................................321 Cac bien phap cam mau tarn thdi .................................................................................340 Ky thuat bang..................................................................................................................351 Cap ciiu ngting tuan h oan ........................................................................................... 360 Van chuyen nan nhan .................................................................................................. 373 Tai lieu tham k h a o.......................................................................................................... 379 Chvftfng VI CAC KY THUAT OUA THUOC VAO CO THE ■ DAI Cl/ONG 1. GlOil THIEU TOAN CHLfdNG 1.1. Danh sach cac ky nang trong chtfcfng - Phat thuoc va ghi chep. — Cach pha thuoc. - Diia thuoc qua diidng mieng - am dao — triic trang. — Dung thuoc qua dudng tiem. + Tiem trong da. + Tiem dii6i da. + Tiem bap. + Tiem tinh mach. 1.2. Muc tieu chung toan chu’cfng 1. Nhan dinh diidc tinh trang chung cua ngiidi benh tritdc khi dung thuoc. 2. Trinh bay diiOc ky nang kiem tra thuoc tritdc khi dung cho ngiidi benh. 3. Trinh bay diidc ky nang dp dung 5 dung khi dung thuoc cho ngiidi benh de ngiia nham lan thuoc.' 4. Thiic hien diitJc ky nang dung thuoc an toan va, hieu qua. 5. Hiidng dan cho ngiidi benh nhan biet cac dau hieu bat thiidng sau khi dung thuoc. 6. Y thiic diidc tarn quan trong cua viec dung thuoc chinh xac va an toan cho ngiidi benh. 2. YEU CAU 2.1. Gicfi thieu tong quan Dua thuoc vao cO the ngUdi benh la cong viec pho bien cua dieu dudng va can thiet cho ngu'di benh. No doi hoi ngiidi dieu diidng phai co kien thiic hieu biet cd ban ve thuoc, cach sii dung de diia thuoc an toan vao cd the ngu'di benh. Hdn the nQa, dieu diidng con phai hieu ve ngiidi benh. Ngoai aiuc dich de tranh nham l^n ngu'di benh, con phai thiic hien dUdc ky thuat dat den miic an toan va giup ngiidi 9 benh hap thu thuoc hieu qua nhat'. Neu nham ten thuoc, tinh lieu thuoc sai. thiic hien khong dat yeu cau ve ky thuat hay thdi gian, tat ca deu co the gay anh hiidng den ket qua dieu tri va ngiidi benh. Ttiy miic do sai sot, co the la tai cho hay nguy hiem hdn la anh hiidng den toan than va co the gay tu vong. Co nhieu diidng diia thuoc vao cd the: - Diidng mieng - Diidng qua mieng, am dao, triic trang - Diidng sU dung ngoai da - Diidng tiem Tuy theo chi dinh cua dieu tri, ap dung diidng cho thuoc thlch hdp, moi diidng C6 nhQng yeu cau khac nhau. Ngiidi dieu diidng can phai thanh thao ve ky thuat, de thiic hien hay hiidng din cho ngiidi benh tii sii dung thuoc an toan. Nhufng yeu cau can thiet khi ngiidi dieu diidng chd ngiidi benh dung thuoc la nhufng kien thiic ve thuoc, thiic hien viec kiem tra cac dieu dung triidc khi cho ngiidi benh dung thuoc nhii: dung ngiidi benh, dung thuoc bac si chi dinh, dung lieu dung, dung diidng cho thuoc va dung thdi gian. Trong khi thiic hien viec cho thuoc, tac phong ngiidi dieu diidng cung can can trong trong viec ap dung cac phiidng phap cho thuoc. Sau khi cho thuoc, dieu diidng cung can theo doi tac dung cua thuoc va hiidng din ngiidi benh phat hien cac dau chiing chii quan de phat hien sdm va xii tri kip thdi cac tai bien co the xay ra do dung thuoc. 2.2. Kiem tra trvfdc hoc Phan biet dung sai cac cau sau bang cach tich (V) vao cot D cho cau dung, cot S cho cau sai STT Noi dung D S 1 Tii the ngoi giup tranh nguy cd hit sac khi chd uong thuoc 2Dieu diidng chi can thiic hien dung thee y lenh cua thay thuoc cho du chiia hieu ro ve thuoc 3NgUdi benh mat phan xa nuot khong cho thuoc bang diidng mieng 4Ngiidi benh co the nhai tat ca cac loai thuoc dang vien cho hap thu de va nhanh 5Thuoc dat hau mon thiidng diidc dung khi ngiidi benh khong uong dUdc 6 Ngiidi benh liet mat, mieng meo khong uong thuoc diidc 7Can ep buoc de diia thuoc vao cd the ngu'di benh khi ho tii choi khong chiu dung thuoc 1 10 8 Cho ngUdi bej^h nam tii the phu khoa khi dat thuoc vao am dao 9Can ve sinh bo phan sinh due cua ngUdi benh trUdc khi dat thuoc vao am dao 10Sau khi dat thuoc vao hau mon, ngUdi benh can n&m nghi it nhat la 10 phut 11 Thuoic dat vao trUc trang sau khoang 2 -h 3 cm doi v6i ngUdi 16n 12 NgUdi benh hon me co the cho thuoc qua ong thong da day 13 Thuoc ldi tieu nen tap trung lieu vao buoi sang NgUdi benh co dat thuoc am dao, DD can phai nhan dinh tinh 14 chat dich am dao, ghi chep chinh xac vao ho sd va bao v6i bac si dieu tri 15Noi man ngiia, chay nUdc mui la bieu hien trong nhQng dau hieu di ling thuoc 11 PHAT THUOC VA GHI CHEP 1. GlCfl THIEU KY NANG ThUc hien phat thuoc cho ngUdi benh va ghi chep vao ho sd la mot phan quan trong trong ky thuat cho ngUdi benh dung thuoc. Vi vay, dieu dUdng nen nhan thiic ro- trach nhiem va lUu y nhiing diem quan trong de tranh sU nham lan gay hau qua den ket qua dieu tri va anh hUdng den ngUdi benh. Dieu dudng can biet ro nhiing thong tin ve dUdc dong hoc cua thuoc phat cho ngUdi benh nhu ten thuoc, loai thuoc, hinh dang, tac dung chinh, tac dung phu, yeu to* hap thu va bai tiet v.v... Sao chep tif ho sd doi hoi sii chinh xac cao nen dieu dUdng can sang sudt sao chep y lenh chinh xac va thuc hien nghiem chinh y lenh. Neu khong ro y lenh phai hoi lai, khong tu y doi y lenh hay thuc hien y lenh mieng. Khi phat thuoc, dieu dUdng phai chac chan rang ngUdi benh nam ro lieu dung thuoc, dudng dung va thdi gian dung thuoc cho tiing loai. Dieu dudng nen tan tinh giai dap cho ngUdi benh khi ho co van de thac mac vi moi sii nghi ngd lien quan den viec dung thuoc deu co the anh hUdng den siic khoe ngUOi benh. 2. MUC TIEU KY NANG 1. Trinh bay nhiing kien thiic cd ban ve thuoc ngiidi dieu diidng can biet. 2. Liet ke cac yeu to quyet dinh tac dung cua thuoc. 3. Phan tich nhiing tac phong cua ngiidi dieu diidng khi phat thuoc cho ngiidi benh. 4. Tinh lieu thuoc chinh xac. 5. Chudn bi day du. 6. Thiic hien dung va an toan quy trinh ky thuat lay thuoc phat cho ngiidi benh. 7. Thiic hien ghi ho sd ro rang. 8. Thao luan va tii ren luyen ve thdi do va cach tiep xuc ngiidi benh khi thiic hien. 3. LY THUYET LIEN QUAN DEN KY NANG 3.1. Nhu’ng kien thtic cd ban ve thuoc ngu’di dieu dudng can biet - Ten thuoc: Mot loai thuoc co the co nhieu ten thuoc: ten hoa hoc, ten biet dUdc, ten thUdng mai - Cong dung thuoc: + Chong nhiem khuan: cac loai khang sinh. sulfamid + Phong benh: vacxin, huyet thanh + Chan doan benh: BCG test + Giam trieu chung: giam dau. giam sot, giam ho v.v... - Tac dung thuoc: + Tac dung tai ch6i nhiing thuoc khong phan phoi toan than, chi co tac dung tai mot ndi nhat djnh de co tac dung mong muon. + Tac dung toan than: nhiing thuoc vUdt qua hang rao sinh hoc vao mau phan phoi kh lp cd the tao nen cac tac dung triic tiep hoac gian tiep vdi cac loai tac dung sau: • Tac dung chinh: tac dung mong muon dat ket qua dieu tri. Vi du: tac dung chinh cua aspirin la khang viem, giam dau. • Tac dung phu: tac dung khong mong muon cua thuoc. Vi du: tac dung phu cua aspirin la viem loet da day. • Tac dung hoi phuc: tac dung cua thuoc gay ra hieu ling nhat thdi sau do trd lai trang thai ban dau. Vi du: thuoc te gay nen tac dung lie che than kinh cam giac mot thdi gian sau do cam giac lai hoi phuc. • Tac dung khong hoi phuc: tac dung cua thuoc gay ra tren cd the khong thay doi. Vi du: dung tetracyclin d tre em gay nen hien tUdng vang rang do tetracyclin tao phiic vdi canxi. .! • Tac dung chon loc: thuoc tac dung toan than phan phoi den nhieu cd quan nhUng co tac dung dac hieu sdm nhat tren mot cd quan. Vi du: codein tac dung chon loc lie che tren trung tam ho nen sii dung chiia hon la tac dung giam dau. • Tac dung doi khang: khi hai thuoc phoi hdp vdi nhau co hien tUdng giam hoac mat hoat tinh cua nhau. Co nhieu loai doi khang nhu doi khang canh tranh, doi khang khong canh tranh, doi khang chiic phan, doi khang hoa hoc v.v... • Tac dung hiep dong: khi hai thuoc phoi hdp vdi nhau c6 hien tUdng gia tang hoat tinh co ldi hoac co hai. - Cac yeu to' quyet dinh tac dung cua thuoc: + Dang thuoc: thuoc vien, thuoc bot, dung dich v.v... Dang thuoc Dac tinh Vien Vien nen: ciing, uong vdi nhieu ni/dc, thuoc diroc hap thu d ruot Vien boc dudng: thuoc dupe ao I6p ngoai la dudng de bao quan, giup uong de, va giam kich thich d da day : Vien bao tan trong ruot: thuoc diroc bao ben ngoai I6p nhu film, giup bao quan thuoc khong bi phan huy d da day, khi xuong ruot non mdi co tac dung Vien ngam The ran cd vj ngot do co dudng, dUdc ngam chd den khi tan het, thuoc hap thu va ngam qua niem mac Co hai loai: - Ngam dudi ludi hap thu qua niem mac dudi luoi - Ngam trong mieng, thuoc hap thu qua niem mac vung ma va mot phan a niem mac da day Vien sui bot Dang vien nen, g5p nude se tan nhanh va sui bot, thuoc dUdc hap thu qua niem mac 13 Vien nang Thuoc di/pc bao ben ngoai la Idp gelatin giup nuot de, hau het Idp gelatin nay se tan d da day, thuoc hap thu qua niem mac da day hay ruot. Co loai vien nang ben trong la thuoc bot, dang hat, dang dau hay gel Dung dich Thuoc hoa tan trong dung moi thudng la nude, hap thu nhanh Si-ro Dung djch co do dam dac do co dudng de bao quan thuoc, co the co them huong tao mui tham giup de uong, thudng dung cho tre em Nhu tirong Thuoc duoc phan tan trong moi trudng dau, hap thu d niem mac da day hay ruot Huyen djch Tinh the thuoc duoc treo trong dung moi la nude, hap thu qua niem mac + Tuoi ngUdi benh: lUu y sii dung thuoc cho tre em va ngu'di cao tuoi vi dac diem sinh ly c0 the tren liia tuoi nay anh hudng nhieu den kha nang hap thu. chuyen hoa va dao thai thuoc. + Phai ti'nh: hoat tinh cua dUOc pham co khi bien doi theo phai, dac biet 6 phai ntif trong thdi ky mang thai va cho con bii. + Can nang: sU hap thu va du trii thuoc thay doi tuy theo lUdng mo md. can lUu y khi sii dung cac loai thuoc tan trong lipid. Doi vdi tre em, can nang co tinh quyet dinh trong viec ti'nh lieu ludng thuoc. + Hien tUdng quen thuoc: trang thai cua cO the chiu dUdc nhufng lieu thuoc dang le gay doc hoac khong dap ling vdi lieu co hoat ti'nh sinh hoc. + Di truyen: mot so dac ti'nh di truyen gay roi loan dUOc dong hoc, tac dung duqc ly lam thay doi qua trinh hap thu, chuyen hoa, va tac dung chi'nh cua thuoc. + Che do dinh dUdng: thiic an va nUdc uong anh hudng tdi dUOc dong hoc. tac dung va doc ti'nh cua thuoc nhu lam nhanh hoac cham thdi gian hap thu thuoc tai da day, thanh phan thuoc tao phiic vdi thiic an hoac doi khang vdi thiic an. + Thdi diem dung thuoc: tac dung dude ly, hieu qua dieu tri lien quan nhieu den thdi diem dung thuoc do su thay doi cua luu lUdng tuan hoan d gan, than, phoi thay doi theo nhip sinh hoc. + Trang thai benh ly: cO the met moi hoac mot ngudi m ic phai nhieu benh khac nhau cung anh hUdng den tac dung cua thuoc. + Moi trUdng nhu' anh sang, nhiet do. - Ham lUdng: so ludng thuoc cd trong thanh phan - Lieu ludng thuoc: la so lUOng thuoc dung cho ngudi benh co tac dung dieu tri ma khong gay tac hai. Tuy theo can nang. tuoi. tinh trang benh, dudng dung thuoc ngu'di Dieu tri se quyet dinh lieu dung phu hdp. - Quy che ve thuoc doc: nhan thuoc doc A va giam doc A mau den. doc B va giam doc B mau do. - Cach bao quan: thuoc can dude de ndi kho rao. thoang mat, va dude phan loai cu the tien ldi cho viec lay thuoc. Xhung thuoc dung khong het phai day nip km. bao quan tot va tranh nhiem khuan. 1-1 3.2. Tac phong can thiet cua ngifofi dieu diidng - Chinh xac, khoa hoc va co trach nhiem. - Sang suot khi nhan y lenh. - Trung thanh vdi chi dinh cua bac si, tuyet doi khong thay doi y lenh, neu nghi ngd phai hoi lai. - Khong thuc hien y lenh qua mieng hoac dien thoai. - Khong pha tron cac loai thuoc vdi nhau khi khong co y lenh. - Sap xep thuoc theo thii tu de de tim va tranh nham lan. - Tu thuoc phai de gan ndi lam viec. - Thuoc phai co nhan ro rang, sach se. - Cac loai thuoc doc bang A, B phai dUdc cat giQ dung theo quy che. - Thuoc nUdc de rieng vdi thuoc vien, thuoc uong de rieng vdi thuoc dung ngoai da. - Kiem tra thuoc hang ngay de bo sung du cd so va xU ly nhiing thuoc qua han sU dung hoac kem chat lUdng. - Kiem ke, ban giao thuoc moi ngay, moi ca trUc va ghi chep so r5 rang. - Nghiem chinh tuan thu 3 kiem tra, 5 doi chieu. - Dam bao an toan cho ngUdi benh. 3.3. Cach tinh lieu thuoc - Ngay khi co y lenh, dieu dUdng phai kiem tra ho sd thuoc va sao y lenh thuoc, trUdc khi chuan bi thuoc can phai tinh dUdc lieu liidng thuoc chinh xac can cho mot ngUdi benh. Doi vdi thuoc vien: Lieu theo y lenh So litdng vien thuoc =Ham lUdng cua moi vien thuoc Doi vdi thuoc dang dung dich Lieu theo y lenh x ddn vi the tfch So lUdng ml =Ham lifdng thuoc quy dinh trong ddn vi the tich - Khi dung thuoc cho tre dieu dUdng can nhiing thong tin sau: + Chi dinh lieu thuoc dUdc tinh tren kg can nang cua tre hay tren nr da + Lieu thuoc dUdi lml, nen dung bdm tiem 1ml (da thao kim) de rut thuoc chinh xac. + Khong nen pha thuoc vao sQa, dich nuoi dudng, vi lieu de bi mat do tre khong an het. + Thuoc dang vien nen pha them dUdng cho tre de uong, chu y de gay sau rang cho tre. + De thuoc xa tam tav cua tre de phong tre lay dur.g. 15 4. QUY TRINH KY THUAT Cac btfdc tien hanh tien hanh Ly doNhCmg diem Phi/dng phap can liAi y Hinh anh minh hoa TrUdc 16 1. Nhan dinh ngi/di benh: tien sir di ifng, tri giac, kien thi/c kinh nghiem ve benh • 2. Kiem tra y lenh va sao phieu thuoc 3. Chuan bi - Rifa tay thudng quy Hoi ket qua dung thuoc tri/dc day cua ngirdi benh (NB) co cac dau hieu noi man, ngCfa, buon non, dn lanh, phu, kho thd Oanh gia tinh trang tri giac cua ngirdi benh Hoi ngudi benh - Thong tin ve benh,ket qua cua viec dung thuoc. - Tinh trang le thuoc vao thuoc - Cam nhan cua NB ve thuoc. Doc y lenh tir ho sd, kiem tra thuoc lan 1, lay phieu thuoc va ghi nhan day du: - Ten ngu'di benh - Ten thuoc, ham ludng - Lieu lifdng thuoc - Dudng dung thuoc - Thdi gian dung thuoc Theo quy trinh rifa tay noi khoa Nhan biet dau hieu dj ung thuoc, bao BS de can nh£c viec dung thuoc Mifc do y thC/c, tinh tao nhan biet thuoc de dung cho dung - Xac dinh si/ hieu biet va nhu cau ve thong tin can biet cua NB - Kha n3ng dung nap thuoc - NB chap nhan va thoai mai khi dung thuoc - Ky thuat thuc hien theo y lenh - Tranh nhQng sai sot lam mat an toan cho ngu'di benh Giam sir lay nhiem vi sinh vat Ngi/di benh hdp tac tra ldi trung thi/c. Lifu y den ngirdi gia va tre em Doi vdi NB co kha nang tif dung thuoc khi co cam tinh vdi thuoc de gay ngo doc thuoc do sir dung qua lieu - Ngirdi benh co the trung ten, nen ghi nhan ho ten, tuoi, so giifdng. - Dung thuoc: gom ten, ham ludng va dang thuoc - Dung lieu: can cCr vao ham lirdng thuoc de tinh chinh xac lieu theo y lenh - So sanh dudng dung cua y lenh vdi chi djnh cho phep trong hi/dng dan cua nha san xuat - Thdi gian dung thuoc phai phu hdp vdi thdi gian thai thuoc, va dieu kien cua NB Chu y mong tay, ke ngon tay - Chuan bj thuoc - Chuan bi khac - Lay thuoc vien - Lay thuoc dang nUdc, dung dich Chon thuoc dung theo yeu cau, kiem tra thuoc lan 2: - Doc ten thuoc - Ham lUdng thuoc - Han sir dung, chat lUdng thuoc Dung cu do ludng: - Coc co chia vach - Thia co vach do lUdng - Ong dem giot - Khay dem thuoc - Hop tan thuoc vien - Ludi cUa - Thia khuay - Hop thuoc ca nhan - Giay lau - Mcf nap chai do thuoc vao khay dem thuoc hoSc vao nap hop thuoc. - Cho vao hop dung thuoc cua NB - Thuoc vien trong vi: mo vi thuoc cho vao hop dung thuoc cua NB - Lac nhe va deu chai thuoc trUdc khi rot - Rot thuoc vao coc co chia vach, hay vat mau do ludng, co the dung bdm tiem bo kim de rut thuoc - Rot thuoc khong de mieng chai cham vao mieng coc - Lay giay lau ben ngoai co chai thuoc - Day kin nap chai va de vao cho cu. An toan ve (huoc, tranh nham lan Dung cno thuoc nUdc Lay thuoc vien Tan thuoc cho ngudi gia va tre em khong the nuot vien thuoc Cua thuoc ong Hoa tan thuoc Chia thuoc theo thdi gian cho ngUdi benh - Han che tay cham thuoc lam nhiem ban thuoc hay mo hoi tay lam udt thuoc. - Moi NB co hop dung thuoc rieng dUdc phan thanh nhieu cur uong trong ngay -Thuoc dUdc tron deu -Tin h lieu chinh xac - Tranh nhiem ban lo thuoc va lam udt nhan thuoc - Bao quan thuoc tot - Thuoc con nguyen bao bi, nhan ro rang. - Luu y nhung thuoc cung ten, khac ham lUdng. - Thuoc sir dung nhieu lan phai bao quan nhiet do mat hay theo quy dinh cua nha san xuat Chon dung cu do lUdng thuoc theo dang thuoc sir dung de lay thuoc chinh xac theo lieu lUdng chi dinh - Hop dung thuoc ca nhan co ghi ten NB, co phan gid uong thuoc. - Thuoc vien nang bot hay hat cai, khong nen thao rdi Idp vo - Doc hudng dan cua nha san xuat thuoc trudc khi tinh lieu va rot thuoc - Coc dung thuoc dUa ngang tarn mat de nhin chinh xac. - De nhan chai thuoc len tren de khong lam ban nhan. - Khong do thuoc thUa trd lai vao chai thuoc i \ _ •j V ! : yj m / IcJL 17 - Thuoc dang bot - Thuoc vien dang sui bot 4 Kiem tra lai thuoc 5. Kiem tra gid dung thuoc 6. Dem thuoc den giUdng benh 7. Doi chieu dung NB 8. Giai thich vdi ngu'di benh 9. Phat thuoc cho ngu'di benh - Xe mieng bao thuoc - Cho thuoc vao coc co san mot it nUdc am - Dung thia khuay deu - Cho thuoc vao ly co nUdc uong dUdc - Chd thuoc sui bot tan hoan toan - Doc nhan thuoc lan 3 trUdc khi cat thuoc hay bo vo thuoc - So sanh lai giUa y lenh thuoc, phieu thuoc va lo • thuoc - Xem gid dung thuoc cua NB tren phieu thuoc Mang khay thuoc hoac xe thuoc Xem ten trong phieu thuoc vdi ten ngu'di benh d dau giUdng dong thdi hoi NB: - Ho ten day du - Tuoi - Trinh bay vdi NB: muc dich. tac dung, tinh chat cua thuoc. - DUa hop hoac bao thuoc da chia theo gid va ghi ro ten NB, ten thuoc cho NB - Hudng dan NB cach dung thuoc: dudng dung, thdi gian - Giup thuoc hoa tan de - ThUc hien dung 3 kiem tra, tranh sai sot vi day la ky thuat doi hoi sU chinh xac cao Phan bo thuoc hdp vdi tinh chat diidc ly cua thuoc Tien nghi, sach se tao niem tin cho NB Xac dinh dung ngudi benh de phat thuoc dung - Cung cap kien thUc cho ngudi benh - Giup NB tin j tUdng vao dieu tri - Tang kha nang tu dung thuoc - NB tu nhan biet dau hieu bat thudng can bao ngay nhan vien y te - NB biet loai , thuoc dang si/ Ludng nude giup hoa tan thuoc phu hdp vdi ludng bot theo hudng dan cua nha san xuat, khong nen qua dac hay qua long. - Khong dUdc uong vien thuoc khi thuoc chua tan - Dieu dudng thuc hien vdi tinh than trach nhiem cao, can than, khong chu quan Thuoc dUdc dung dung theo gid yeu cau cua bac si dieu tri Dung ten, tuoi, so giUdng - Hoi de NB tu tra ldi neu dUdc NgUdi benh hay than nhan chap nhan viec dung thuoc - Yeu cau NB lap lai cach dung thuoc - Giai dap moi th ic m§c cua NB de ho nam ro thong tin, tranh hieu nham va su dung thuoc sai. - NB ky ten trUdc > i w —S B l . - Giai thich nhung dau hieu cua dj Ung, tac dung phu cua thuoc - Cho NB ky ten vao phieu cong khai thuoc dung mat dieu dUdng 10 Don dep dung cu 11. Ghi chep ho sd Sau - De phieu thuoc vao o gid tiep theo. - De khay thuoc, xe thuoc ve cho cu - Dieu dudng rifa tay - Ngay gid phat thuoc cho NB - Ten thuoc da phat - Dudng dung - Phan Unq cua NB - Trudng hdp khong phat thuoc dUdc nhu NB vln g mat, khong hdp tac dung thuoc, ly do NB khong dung thuoc... - Ten DD thuc hien - DD tua sau thuc hien tiep. - De lay su dung - Ghi vao ho sd de bac si dieu tri va dieu dudng cac tua nSm ro - Dung cu xep ngSin nip, theo thU tu - Tuan theo quy dinh ghi ho sd - Ghi trung thuc nhung phan Ung cua NB hoSc ly do khong hdp tac Dieu tri cua NB - Ghi thuoc do chinh tay minh thuc hien - Ban giao DD tua sau nhung trudng hdp chUa phat thuoc dUdc hoSc phan Ung NB can theo doi 5. T l/ d A n H GlA v A HU AN LUYEN 5.1. Danh gia trufcfc huan luyen Phan biet dung sai cac cau sau bang cach tich (V) vao cot D cho cau dung, cot S cho cau sai STT Noi dung D S ' ' ' Dieu dudng phai nam ro 3 kiem tra, 5 doi chieu khi phat 1 thuoc cho NB 2Thuoc can duoc de ndi kho rao, thoang mat, va dUdc phan loai cu the 3 Chi can hoi ten ngUdi benh tru'dc khi phat thuoc 4Lieu ludng thuoc cho tre em thUdng dude ti'nh dua vao kg can nang | 5Dieu dudng khong nen giai dap thac mac ve thuoc cho NB nhieu vi mat thdi gian 6 Dieu dudng duoc phep thuc hien y lenh thuoc qua dien thoai 7 Kiem tra thuoc lan 2 duoc thUc hien tru'dc khi cat lo thuoc 8 •Lieu lu'o'ng thuoc la so lu'o'ng thuoc dung cho nguoi benh co tac dung dieu tri ma khong gay tac hai. 19 9Dau hieu di ling thuoc gom noi man, ngiia, buon non, 6n lanh, phu, kho thd. 10Dieu dudng tranh cham tay vao thuoc khi lay thuoc vien phat cho NB 11Dieu dUdng co the dua ca chai thuoc si-ro ho cho NB tu chia uong trong ngay 12 Dieu dudng nen phat thuoc cho NB dung gid theo y lenh 13 Tac dung phu la tac dung khong mong muon cua thuoc. 14 Luon luon dung thia ca phe de do liidng thuoc cho tre 15Dieu dudng phai ghi tat ca cac loai thuoc phat cho NB vao ho sd 5.2. Huan luyen co giao vien tai phong thiic hanh - TrUdc buoi huan luyen, giao vien co trach nhiem thong bao nhiing yeu cau chinh can dat dUOc trong buoi huan lnyen. - Sinh vien phai chac chan hieu ro cac van de lien quan den ky thuat. - Khi bat dau buoi huan luyen, nen lam ro cac cau hoi, giai dap nhiing thlc mac cua sinh vien, va thao luan nhiing muc tieu sinh vien can dat dUdc trong buoi huan luyen. - Tom tat nhiing van de can chu y. - TrUdc khi thiic hanh, sinh vien thao luan theo nhom, nh&c lai trinh tu cac budc trong ky thuat, neu nhiing budc quan trong trong ky nang, thao luan cac van de kho khan va dUa ra giai phap. - Giao vien giai thich va lam mau. + Giao vien giai thich toan bo quy trinh ky thuat, trinh dien cac budc theo quy trinh, sinh vien quan sat co the vila lam theo. + Sinh vien tii nhan xet va dat cau hoi. + Giao vien giai thich lai cac van de theo veu cau sinh vien. - Kiem tra sii tiep thu cua sinh vien. + Giao vien se mdi mot sinh vien thiic hien lai ky thuat. + Giao vien nhan xet nhung Uu diem, nhung sai sot can chu y vdi ca nhom. - Thiic hanh theo nhom. + \ eu cau tat ca sinh vien deu phai thiic hanh theo quy trinh ky thuat. Giao vien dieu chinh thao tac giup sinh vien quen dan vdi cac ky nang. Giao vien chu y nhung sai sot khi sinh vien thiic hanh, hUdng dan lai giup sinh vien thiic hien chd de dang va dat yeu cau. 20 + Cac ban sinh vien khac cung quan sat ban thUc hien thao tac trong ky thuat, cung dong gop y kien va rut kinh nghiem khi giao vien sUa sai. 5.3. Tii liidng gia (bang kiem quy trinh) - Dudi day la bang kiem thuc hanh. Sinh vien co the dung bang nay de thUc hanh - Ngudi quan sat se dien vao bang thuc hanh trong khi sinh vien thiic hien ky thuat. Sinh vien can biet rang budc nao lam tot, budc nao con chua chi'nh xac va bu6c nao da bo qua. STT Noi dung Tot Dat Sai Khong Ghi lam chu 1 Nhan dinh: - Thong tin ve benh - Ket qua cua viec dung thuoc, xet nghiem lien quan - Tinh trang nghien, le thuoc vao thuoc - S' thich, cam nhan va tam ly dung thuoc 2 Kiem tra y lenh thuoc Thirc hien 6 dung: - Dung ten ngu’di benh - Dung ten thuoc - Dung lieu luqng thuoc - Dung dudng dung thuoc - Dung thdi gian dung thuoc - Dung chi djnh thuoc 3 Rtra tay - RiTa tay noi khoa - Lam kho tay 4 Chuan bj Soan khay dung cu - Soan dung thuoc: + Doc ten thuoc + Han sir dung, chat lUOng thuoc + Ham luqng thuoc -T h ia - Coc co chia vach - Bom tiem - Hop dung thuoc ca nhan - Giay lau - Lifdi cua - Phieu thuoc Lay thuoc 5 Lay thuoc vien 5.1 - Tinh du sd vien thuoc cho vao hop dung thuoc cua NB - Tranh cham tay vao thuocj 21 5.2 I 5.3 5.4 1 Lay thuoc dang nUdc. dung dich Thuoc dung dich trong chai - L£c deu chai thuoc tru'dc khi rot. - LUdng thuoc du lieu cho vao coc - Khong do thuoc thiia trd lai vao chai thuoc - Dung giay lau ben ngoai co chai thuoc Thuoc dung djch dang ong - Dung li/di cua, cua hai dau ong thuoc - Dung bong cau kho be hai dau ong thuoc. cho thuoc I vao ly - Khong can hoa them nude vao thuoc Thuoc nhu tUdng dang goi - Cat hay xe dau vo bao thuoc - Cho thuoc du lieu vao ly - Khong hoa them nUdc Thuoc dang bot Cho thuoc vao coc co san mot it nUdc am. khuay deu Thuoc vien dang sui bot - Cho thuoc vao ly nude uong diroc - Chd thuoc tan hoan toan 6 Kiem tra lai thuoc Doc nhan thuoc lan 3 tru'dc khi cat thuoc hay bo vo thuoc 7 Kiem tra gid dung thuoc dung theo chi dinh ----I 8 Dem thuoc den giUdng benh 9 Doi chieu dung ngu'di benh Kiem tra ten trong phieu thuoc vdi ten NB d dau giirdng dong thdi vdi hoi ho ten ngu’di benh 10 1--------- Phat thuoc cho ngu'di benh Hifdng d in ro cach sir dung thuoc Giai thich tac dung chinh, tac dung phu. nhung dau hieu bat thudng nhu noi man ngi/a, buon non. lanh run v.v... Giai dap thac mac Hoi NB lap lai cach dung thuoc Cho NB ky ten vao phieu cong khai thuoc 11 Don dung cu De phieu thuoc vao o gid tiep theo De dung cu ngan nap ve cho cu Dieu dudng rira tay 12 Ghi ho sd Ngay gid phat thuoc cho ngu'di benh - Ten thuoc da phat - Duong dung - Phan ting cua NB - TrUdng hdp khong phat thuoc duoc nhu NB vang mat, 1 khong hdp tac dung thuoc, ly do NB khong dung thuoc v.v... - Ten DD thuc hien 1 6. THlTC HANH 6.1. Thufc hanh tai labo (khong co giao vien) Tru6c khi bu6c vao phan thUc hanh sinh vien can dam bao: - Hinh thanh nhom thufc hanh v6i hai ngUdi. - Phan chia vai tro cua ngUdi quan sat va sinh vien. - ThUc hanh: + TrUdc khi thUc hanh moi mot thanh vien tham gia tU chuan bi ve vai tro cua minh trong vai phut. Sinh vien can chuan bi nhiing dung cu can phai co, giam sat vien nhin vao bang kiem phat thuoc va ghi chep. Sau do sinh vien bat dau thUc hanh, ngUdi giam sat danh gia dUa tren bang O&P. + ThUc hanh v6i nhom hoac mot minh d bat cii ndi nao khi co dieu kien. + Sinh vien da thuc hanh tai labo, sinh vien co san bang kiem trong tay, vi vay sinh vien co the tu thuc hanh mot minh, hoac vdi nhom hai ngUdi theo bang kiem. - Sap xep viec thuc hanh mot cach co he thong. ThUc hanh co he thong la: + ThUc hien hoat dong dua tren tieu chuan thuc hanh. + Danh gia viec thuc hanh cua sinh vien. + Hoi quan sat ve qua trinh thUc hanh. + Neu can thiet: xac dinh nhiing diem chi tiet trong qua trinh tham gia cho nhung lan thUc hanh tiep theo. 6.2. Thufc hanh tai benh vien theo ke hoach Sau khi sinh vien da thUc hien dUdc quy trinh ky thuat, sinh vien se co thdi gian thuc tap tai benh vien. Tai benh vien co the sinh vien thay cac dieu dUdng vien phat thuoc khong hoan toan giong nhu sinh vien da hoc tai trudng. Sinh vien dung lo ling ma hay quan sat va phan tich xem ho da thuc hien nhu the nao, ly do tai sao lai co khac so v6i sinh vien hoc. Co the cac budc cua quy trinh dude co dong lai theo cac budc it hon hoac khac mot chut, nhung ve cd ban la nhu sinh vien da hoc d trudng. 6.3. Tif danh gia qua trinh ren luyen Sinh vien co the tu danh gia qua trinh ren luyen bang cac cach sau: - Quay camera: sinh vien co the dat may quay 6 mot cho phu hop. hoac nhd mot ngUdi khac quay cho moi khi sinh vien muon xem lai qua trinh thuc hien ky thuat cua minh. Sinh vien giam sat lan nhau: sinh vien cung co the lap mot nhom hoc tap de nhd sinh vien khac quan sat minh trong qua trinh thuc hien ky thuat dua vao bang kiem. - Sinh vien Idp trUdc giam sat: khi di thuc tap tai benh vien, sinh vien se gap cac anh chi sinh vien hoc trUdc va nhd ho quan sat giup. - Nhan vien giam sat: khi di thuc tap tai benh vien, se co nhan vien benh vien giam sat viec phat thuoc va ghi chep ho sd cua sinh vien. Vay sinh vien phai co kha nang ap dung cac kien thiic da hoc va thuc hien dung quy trinh ky thuat. CACH PHA THUOC 1. G Id l THIEU KY NANG Ky thuat pha thuoc la mot trong nhiing ky thuat cd ban trong phan chuan bi thuoc cho ngUdi benh. Tren thi trUdng hien nay, thuoc tiem dUdc dong goi trong hai dang: ong va lo. Thuoc ong chi sU dung mot lieu dudi dang long. Thuoc ong co nhieu the ti'ch khac nhau tii 1ml h- 10ml hay co the 16n hdn. Ong thuoc dUdc lam bang thuy tinh va co mot cho that d co ong thuoc de be ong. Mot vong tron mau xung quanh co ong thuoc la ndi co the be ong thuoc de dang. Thuoc dUdc rut ra khoi ong thuoc bang bdm tiem va kim vdi khau klnh nho nhd dong tac keo nong trong tao ap luc hut trong bdm tiem. Lo thuoc la mot vat chuta thuoc dang long hay dang bot dUdc sU dung cho mot lieu hay nhieu lieu va co mot nap cao su d tren. Tren phan cao su co mot nap bang kim loai hoac bang nhUa bao ve cho den khi thuoc do dUdc sii dung. Tren nhan thuoc co ghi ro loai va lvidng dung moi dung de pha thuoc. Nude muoi sinh ly va nU6c cat vo trung la nhiing dung moi thudng dung de pha thuoc. Mot so lo thuoc chiia dung moi pha thuoc trong khoang tren va thuoc bot trong khoang du6i, hai khoang nay cach biet bang mot nut chan cao su. Khi chuan bi pha thuoc, dieu dUdng chi can an nhe vao phan tren cua lo thuoc de danh bat nut chan cao su xuong thi phan dung moi va phan thuoc bot se hoa tan vao nhau. Khac vdi rut thuoc ong, rut thuoc lo la he thong kin, vi vay can bdm khi vao lo de viec rut thuoc ra dUdc de dang. Dieu dudng can phai biet ro quy trinh pha thuoc va than trong trong thao tac de co dUdc mot bdm tiem thuoc khong bi nhiem khuan va khong lam giam lieu lUdng cua thuoc. 2. MUC TIEU KY NANG 1. Mo ta cac phan cua bdm tiem. 2. Liet ke hai loai bdm tiem thitdng diidc sii dung. 3. Mo ta ba phan cua kim tiem. 4. Nhitng nguyen tac dieu diidng can tuan theo trong quy trinh pha thuoc. 5. Chuan bi day du. 6. Thiic hien dung va an toan quy trinh ky thuat pha thuoc. 7. Thao luan va tii ren luyen ve thdi do va ky nang khi thiic hien quy trinh ky thuat. 25 3. LY THUYET LIEN QUAN DEN KY NANG 3.1. Khai niem cd ban - Bdm tiem: Bdm tiem bao gom mot nong ngoai hinh tru, phan dau dUdc thiet ke khdp vdi doc kim tiem, va nong trong la pittong. Moi bdm tiem dUdc dong goi vo khuan co kim tiem hoac khong co kim tiem trong bao bi nhUa hoac giay. Bdm tiem chi sii dung mot lan. tuyet doi khong tai sU dung trong ky thuat tiem thuoc cho ngUdi benh. Hinh 1. Cac phan cua bdm tiem Bdm tiem dUdc chia lam hai loai: Non-Luer-Lok va Luer-Lok. Bdm tiem Non-Luer-Lok sii dung kim tiem trUdt gan vao dau bdm tiem. Bdm tiem Luer Lok sii dung kim tiem dac biet co the van xoin de gin vao dau bdm tiem de tranh kim tiem bi tuot ra khoi dau bdm tiem. i— CM CO •'J- m g ^ K Hinh 2. Bdm tiem N d n -L u e r-L o k Hinh 3. Bdm tiem L u er-L o k 26 Co nhieu cd bdm tiem khac nhau tu1 1ml den 60ml. Bdm tiem 1ml den 30ml thudng dUdc dung cho cac loai thuoc dudng tmh mach. Bdm tiem 1ml den 3ml diidc dung trong tiem bap va tiem dudi da. Tren than bdm tiem co vach nho chia theo ml hoac ddn vj. Bdm tiem chia theo ddn vi dUdc dung trong tiem insulin. Dieu dudng can xac dinh bdm tiem phu hdp tuy theo loai thuoc va dUdng tiem. Hinh 4. Cac cd bdm tiem thifdng dung i M m t se 2 ^ S 1C S t o s o o o o o ^ ^J®i«^fiSB25^E558l!^^ Hinh 5. Bdm tiem insulin - Kim tiem Kim tiem diidc dong goi vo khuan rieng biet hoac dong goi cung vdi bdm tiem. Mot kim tiem gom co ba phan: doc kim, than kim va mat vat kim. Doc kim dung de gan vdi dau bdm tiem, than kim noi lien vdi doc kim, mat vat kim rat sac nhon, sac de tao vet dam nho khi xuyen kim qua da ngiidi benh va cho xuyen kim nay nhanh chong khit lai khi rut kim ra nham khong cho thuoc hay mau chay ra ngoai. Ca ba phan cua bdm tiem phai diidc giuf vo khuan, de tranh kim tiem bi nhiem khuan, dieu duo'ng luon gan kim co day nap vao bdm tiem an toan. Co nhieu cd kim khac nhau, cd kim diidc chia theo khau kinh (dudng kinh trong cua kim) va chieu dai cua than kim. Chieu dai cua kim tii 1cm den 7,5cm, dieu dudng chon chieu dai kim tuy theo vi tri tiem va trong liidng ngUdi benh. Doi vdi ngiidi benh gay hay tre em chon kim co chieu dai ngan hdn, dung kim dai tii 2,5cm den 4cm de tiem bap, dung kim dai tii 1cm den 1.5cm de tiem dudi da hay 27 tiem trong da. Kim pha thuoc thudng dung co khau kinh tii 19G den 20G. Viec chon kim theo khau kinh can lUu y kim co khau kinh cang nho thi dudng kinh trong cua kim cang 16n. Chon kim co khau ki'nh nao tuy thuoc vao do dam dac hay ti'nh dinh cua thuoc. Hinh 6. Ba phan kim tiem : doc kim (hub), than kim (shaft), m at vat kim (bevel) AAJUA t t A1 ! I I I I j U 1 Hinh 7. Cac cd kim tiem 3.2. Nguyen tac dieu diidng can biet khi pha thuoc - Can biet ro lieu ludng va tfnh chat thuoc trUdc khi chuan bi thuoc. Neu tiem mot lieu lUdng ldn thuoc vao cd the ngUdi benh co the gay ra tac dung phu, dau. va ton thUdng mo. - Nam ro dudng tiem, xac dinh cau true giai phiu cua vi tri tiem tren ngudi benh de quyet dinh vimg tiem phu hdp vdi lieu lUdng thuoc. Viec xac dinh chinh xac nay se giam thieu nhiing tai bien do tiem thuoc gay ra. nhu ton thudng mo, than kinh, mach mau. - Dam bao liia chon cd kim thich hdp cho tiing dudng tiem va vi tri tiem. - Doc ky hudng din sii dung trUdc khi pha thuoc de rut dung lUdng nUdc pha tiem de pha thuoc tuy theo tiing loai thuoc. - Moi phieu thuoc chi ghi mot loai thuoc. Tuan thu nguyen tac vo khuan trong qua trinh pha thuoc va rut thuoc. - Tay dieu dUdng chi dUdc cham vao nong ngoai cua bdm tiem va doc kim. Khong dUdc de vat kim, than kim, than pittong cham vao vat khong vo trung. Khi rut thuoc, giii bdm tiem d ngang tam mat, mot goc 90° de dam bao lay duoc dung ludng thuoc va de duoi dUdc het khi. 28 3.3. Quy trinh ky thuat Cac bi/dc tien hanh tien hanhLy do Nhurng diem can luu yHinh anh Phi/dng phap minh hoa 1. Sao phieu thuoc 2. Kiem tra thuoc Sao y lenh thuoc tCT ho sd vao phieu thuoc vdi noi dung nha sau: - Ten ngUdi benh - Ten thuoc, ham lUdng - Lieu li/dng thuoc - Dudng dung thuoc - Thdi gian dung thuoc Kiem tra nhan thuoc: ten thuoc, ham liTdng, dudng dung, han sir dung. Nhin toan dien ong thuoc va lo thuoc: kiem tra chat liTdng thuoc, si/ nguyen ven cua thuoc Tranh nham lan thuoc Dam bao an toan cho ngirdi benh khi sir dung thuoc, tranh lay sai thuoc, sir dung thuoc khong thich hop, nguy hai cho ngirdi benh Sao phieu thuoc theo dung y lenh cua bac si doi hoi phai co sU chinh xac cao de tranh nham lan thuoc. Do do tranh lam viec khac hay noi chuyen trong khi sao phieu thuoc. Co mot sd loai thuoc con han sir dung nhiTng do bao quan khong tot, co the lam thay doi chat lUdng cua thuoc. Dieu dudng phai kiem tra can than tru'dc khi lay thuoc. Doc ky hudng dan sd dung de biet lUdng nude pha tiem can thiet va chon bdm tiem thich hdp. TrUdc 3. RCra tay RCra tay theo quy trinh riTa tay noi khoa Giam sir lay nhiem vi sinh vat Chu y nhirng vung mong tay, k§ ngon tay Trong 4. Chuan bi dung cu 5. Rut dung djch pha thuoc Soan khay dung cu gom: - Bdm tiem - Kim pha thuoc - Binh ken sat khuan da - Hop bong cau con - Hop bong cau kho - Ong nude cat pha thuoc - Hop chong shock - Gang tay sach - Tui rac y te - Hop di/ng vat sac nhon - Chai dung djch rifa tay nhanh Kiem tra ong nUdc pha tiem (nirdc cat) va Ip thuoc lan 2 Bung nhe dau ong nude pha tiem cho den khi nude td tren co ong xuong het than ong. Day du dung cu giup tien ldi cho qua trinh pha thuoc Chac chan rang da lay dung thuoc. De nUdc td co ong xuong het than ong. Soan dung cu day du, sap xep ng3n nap. Phai kiem tra thuoc ba lan: lan 1 khi lay thuoc td tu , lan 2 trUdc khi rut thuoc, lan 3 trUdc khi vdt Ip thuoc. Sau dong tac nay, khong de nga ong thuoc. 29 --------------- Sat trung co ong thuoc bSng bong cau con Md n3p lo thuoc, de lo phan cao su, sat 1 khuan n ip cao su bang bong cau con. Giam si/ lay r . . ’ .. nhiem vi sinh vat Khong phai tat ca cac nha san xuat deu dam bao rang n ip lo thuoc deu vo khuan Do vay nap Ip thuoc can phai duoc s a t' trung lai bang con trUdc khi rut thuoc Dong tac phai dirt khoat tranh sat trung qua lai ---------------------------- Dong tac dirt khoat. De con kho trUdc khi dam kim vao, con khong theo kim hoa lan vao trong thuoc Be ong nude pha tiem b ln g bong cau kho hoac gac Tranh bi du! tay Khong dung bong cau con de be ong nirdc pha tiem vi con se hoa lan vao nUdc pha tiem Be ong nirdc pha tiem can than tranh de dirt tay. 6. Bdm nUdc pha tiem vao Ip de hoa tan thuoc 7. Rut thuoc da hoa tan vao trong bdm tiem Rut nude pha tiem vao bdm tiem (so liTdng tuy theo ti/ng loai thuoc) Dam kim vao giCra n ip cao su theo hudng tu 45“ sau do di/ng theo hi/dng 90" Bdm nude pha tiem vao lo thuoc, rut khi tra lai bdm tiem. Rut kim ra, lac deu thuoc theo chieu ngang Dung bdm tiem dang co khi, dam lai vao lo thuoc, bdm khi vao lo, de mat vat kim ngap trong thuoc, rut het thuoc trong lo ra De pha thuoc dung lieu lUdng tuy theo tilrng loai thuoc Chinh giCra nap cao su la ndi mong nhat nen de dam kim. Dam tir goc 45° den 90u de tranh cat loi cua nap cao su Can bang ap li/c ben trong bdm tiem va lo thuoc, tranh thuoc bi b ln ra ngoai lam mat thuoc. Dam bao de thuoc hoa tan deu trong nUdc pha tiem Ap luc dudng ben trong lo thuoc se giup rut thuoc ra de dang,khong bi mat thuoc. Dong tac kheo leo, tranh de tay cham vao than kim va phan trong cua pittong, tranh de dau kim cham vao mieng cua ong nude pha tiem Dong tac can than tranh kim cham vao thanh ngoai lo thuoc Lo phai thap hdn bdm tiem. Lac deu Ip thuoc theo chieu ngang, xoay tron tranh lac thuoc theo chieu doc vi se lam thuoc bam vao mieng lo thuoc, lam mat lieu thuoc cua ngu'di benh. Bdm tiem nen de thap hdn lo thuoc, tay khong cham vao than kim va nong trong cua bdm tiem ---------------- * Kiem tra dung, khong chu quan. l----------------- 30 Kiem tra tnuoc lan 3 De chac c h in lai lan nira la da chuan bi dung thuoc cho benh nhan 8 XCr ly rac Sau 9. Chuan b| tiem thuoc cho ngu'di benh Virt lo thuoc vao trong rac y te va ong nifdc pha tiem vao trong hop di/n® vat s ic nhon. Thay kim tiem, cfl kim thich hop tuy theo ti/ng duting tiem. Giup cho viec xCf ly rac de dang, dung quy dinh. Dau kim bi cun sau khi pha thuoc, han che si/ nhiim khuan va ton thifdng mo cho ngu'di benh Dong tac dul khoat, tranh nhiem khuan khi thay kim. 4. TU DANH GlA v A HUAN LUYEN 4.1. Danh gia trUdc huan luyen Phan biet dung sai cac cau sau bang cach tich (V) vao cot D cho cau dung, cot S cho cau sai STT Noi dung D S 1 Phai thay kim sau khi rut thuoc lo. 2Kiem tra thuoc la kiem tra: ten thuoc, lieu dung, dudng dung, chi dinh cua thuoc. 3 Cd kim pha thuoc la 19G. 4Mot phieu thuoc bao gom: ten ngu’di benh, so phong, so giUdng, ten thuoc, lieu ludng, thdi gian va dUdng dung thuoc. 5 Co the ghi nhieu ten thuoc tren cung mot phieu thuoc. 6GiQ bdm tiem d ngang tam mat, mot goc 90° de dam bao lay dUdc dung liidng thuoc va de duoi dUdc het khi. 7 Khong lam nhiem thuoc vdi cac thii khac. 8Khong dUdc cham vao than kim va nong trong cua bdm tiem khi rut thuoc. 9 Viec lu’a chon cd kim phu thuoc vao do nhdt cua thuoc. ____ 10 The tich cua mot ong tiem insulin la 1ml. L 11 Vo lo thuoc dude bo trong tui rac sinh hoat. 12Su dung kim da rut thuoc lo tiem cho ngudi benh de giam chi phi. 13 Kim tiem bap co chieu dai 2,5 - 4cm. I 14 Nen chon kim dai de tiem cho ngUdi gaytI|T - 15 Bdm tiem Luer-Lok sii dung kim tiem co doc k in van xoan.1 31 4.2. Huan luyen co giao vien tai phong thiic hanh - TrUdc buoi huan luyen, giao vien co trach nhiem thong bao nhiing yeu cau chinh czin dat duoc trong buoi huan luyen. - Sinh vien phai chac chin hieu ro cac van de lien quan den ky thuat. - Khi bat dau buoi huan luyen, nen lam ro cac cau hoi, giai dap nhiing thac mkc cua sinh vien, va thao luan nhiing muc tieu sinh vien can dat dUdc trong buoi huan luyen. - Tom tat nhiing van de can chu y. - TrUdc khi thuc hanh, sinh vien thao luan theo nhom, nhac lai trinh tu cac budc trong ky thuat, neu nhiing budc quan trong trong ky nang, thao luan cac van de kho khan va-dUa ra giai phap. - Giao vien giai thich va lam mau: + Giao vien giai thich toan bo quy trinh ky thuat, trinh dien cac budc theo quy trinh, sinh vien quan sat co the viia lam theo. + Sinh vien tii nhan xet va dat cau hoi. + Giao vien giai thich lai cac van de theo yeu cau cua sinh vien. - Kiem tra sU tiep thu cua sinh vien: + Giao vien se mdi mot sinh vien thuc hien lai ky thuat. + Giao vien hoi y kien cac sinh vien con lai. + Giao vien nhan xet nhiing Uu diem, nhiing sai sot can chu y vdi ca nhom. - Thuc hanh theo nhom: + Yeu cau tat ca sinh vien deu phai thiic hanh theo quy trinh ky thuat. Giao vien dieu chinh thao tac giup sinh vien quen dan vdi cac ky nang. Giao vien chu y nhiing sai sot khi sinh vien thiic hanh, hudng din lai giup sinh-vien thiic hien cho de dang va dat yeu cau. + Cac ban sinh vien khac cung quan sat ban thiic hien thao tac trong ky thuat, cung dong gop y kien va rut kinh nghiem khi giao vien sUa sai. 4.3. Tii lu’o'ng gia (bang kiem quy trinh) - Dudi day la bang kiem thuc hanh. Sinh vien cd the dung bang nay de thiic hanh. Ngiidi quan sat se dien vao bang thuc hanh trong khi sinh vien thuc hien ky thuat. Sinh vien can biet rang budc nao lam tot, budc nao con chua chinh xac va budc nao da bo qua. STTNoi dung Tot Dat Sai Khong lam Pha thuoc ong 1 Sao phieu thuoc Neu duoc hoi co the ke duoc 3 kiem tra, 5 doi chieu. 2 Tinh lieu thuoc Neu duoc hoi co the noi duoc cach tinh lieu thuoc. 3 Lay thuoc, kiem tra thuoc lan 1 Neu duoc hoi co the trinh bay dupe noi dung kiem tra thuoc. 4 RCra tay, mang khau trang: - RCra tay - De tay kho 5 Soan dung cu: - Dung cu bao gom: - KhSn sach - Ong tiem - Kim tiem - Bong cau con - Bong cau kho - Ong thuoc - Binh ken sat khuan da - Hop chong shock - Gang tay sach - Chai dung djch rCra tay nhanh - Hop dung vat sac nhon - Tui rac y te 6 Sat trung ong thuoc bang bong cau con. Kiem tra thuoc lan 2 7 Be ong thuoc bang bong cau kho: - Can than khi be ong thuoc, tranh lam dut tay. - Xu" ly manh v5 ong thuoc dung quy dinh 8 Chon ong tiem va kim tiem thich hop Neu duoc hoi co the chon duoc bom tiem, kim tiem phu hop vdi lupng thuoc va dudng tiem. 9 Rut thuoc vao trong bom tiem: Chu y nhung vung vo khuan tren bom tiem. Khong cham vao than kim va nong trong cua bom tiem. Khong de dau kim, than kim cham vao mieng ong thuoc. Khong dupe dudi khi d ben trong ong thuoc. Khi dudi khi, tranh khong day luon djch. Tranh rut luon ca manh thuy tinh vao trong ong tiem. Ghi chu 33 10 Kiem tra thuoc lan 3. Bo ong thuoc Neu dupe hoi co the trinh bay di/pc cach phan loai rac. Xif ly rac dung quy djnh. 11 Day nap kim. Dat bdm tiem vao trong khay. Tranh dam kim vao tay. Dat bom tiem len tren phieu thuoc. Pha thuoc lo 1 Sao phieu thuoc: Neu dupe hoi co the ke dupe 3 kiem tra, 5 doi chieu. 2 Tinh lieu thuoc NeU di/pc hoi co the noi diroc each tinh lieu thuoc. 3 Lay thuoc, kiem tra thuoc lan 1 Neu dupe hoi co the trinh bay dupe noi dung kiem tra thuoc. 4 Rifa tay, mang khau trang: - Rfra tay - De tay kho; 5 Soan dung cu: Dung cu bao gom: - Khan sach - Ong tiem - Kim tiem - Bong cau con - Bong cau kho - Thuoc Ip - Dung dich pha tiem - Binh ken sat khuan da - Hop chong shock - Gang tay sach - Chai dung dich rifa tay nhanh - Hop difng vat sac nhon - Tui rac y te 6 Mo nap Ip thuoc, sat trung nap Ip thuoc bang bong cau con Kiem tra thuoc lan 2 De cho con kho. 7 Chon ong tiem va kim tiem thich hop: Neu duoc hoi co the chon dupe bom tiem, kim tiem phu hop voi luOng thuoc va dirong tiem. 8 Rut thuoc vao trong bom tiem: Chu y nhiing vung vo khuan tren bom tiem. Khong cham vao than kim va nong trong cua bom tiem. Khong de dau kim, than kim cham vao mieng ong thuoc. iI Khong dupe dudi khi 6 ben trong ong thuoc. Khi duoi khi, tranh khong day luon djch. Tranh rut luon ca manh thuy tinh vao trong ong tiem. 9 Dam kim vao nap Ip thuoc, bom dung dich pha tiem vao Ip. De Ip thuoc thap hon bdm tiem. Khong cham vao than kim va nong trong cua bom tiem. 10 Lui nong rut khi trong Ip, rut kim ra, lac deu Ip thuoc. Khong cham vao than kim va nong trong cua bom tiem. Lac nhe Ip thuoc, khong lac Ip thuoc theo chieu doc. 11 Bom khi vao trong Ip thuoc. Rut thuoc vao bom tiem. Khi bom khi vao trong Ip de Ip thuoc thap hon bom tiem. De dau kim ngap trong thuoc. Khi rut thuoc vao trong bom tiem. De bom tiem thap hon Ip thuoc. Khong cham vao than kim va nong trong cua than kim. 12 Kiem tra thuoc lan 3. Bo Ip thuoc. Neu dupe hoi co the trinh bay dupe cach phan loai rac. Xur ly rac dung quy djnh. 13 Thay kim tuy theo tiing duong tiem. Neu dupe hoi co the neu dupe cac cP kim thich hop vPi tiing duong tiem. 14 Day nap kim. DSt bom tiem vao trong khay. Tranh dam kim vao tay. DSt bom tiem len tren phieu thuoc. 5. THl/C HANH 5.1. Thtfc hanh tai labo (khong co giao vien) TrUdc khi budc vao phan thUc hanh sinh vien can dam bao: - Hinh thanh nhom thUc hanh vdi hai ngUdi. - Phan chia vai tro cua ngudi quan sat va sinh vien. 5.2. Thtfc hanh - TrUdc khi thUc hanh moi mot thanh vien tham gia tu chuan bi ve vai tro cua minh trong vai phut. Sinh vien can chuan bi nhiing dung cu can phai co. giam sat vien nhin vao bang kiem pha thuoc ong va pha thuoc lo. Sau do sinh vien bat dau thUc hanh, ngudi giam sat danh gia dUa tren bang O&P. - ThUc hanh vdi nhom hoac mot minh 0 bat cd ndi nao khi co dieu kien. - Sinh vien da thuc hanh tai labo, sinh vien co san bang kiem trong tay, vi vay sinh vien co the tu thuc hanh mot minh, hoac vdi nhom hai ngudi theo bang kiem. - Sap xep viec thuc hanh mot cach co he thong. Thiic hanh co he thong la: + Thiic hien hoat dong diia tren tieu chuan thUc hanh + Danh gia viec thuc hanh cua sinh vien + Hoi quan sat ve qua trinh thUc hanh + Neu can thiet: xac dinh nhung diem chi tiet trong qua trinh tham gia cho nhiing lan thiic hanh tiep theo. 5.3. Thtfc hanh tai benh vien theo ke hoach Sau khi sinh vien da thuc hien dUdc quy trinh ky thuat, sinh vien se co thdi gian thuc tap tai benh vien. Tai benh vien co the sinh vien thay cac dieu dudng vien pha thuoc khong hoan toan giong nhu sinh vien da hoc tai trUOng. Sinh vien difng lo ldng ma hay quan sat va phan tich xem ho da thuc hien nhu the nao. ly do tai sao lai co khac so vdi sinh vien hoc. Co the cac budc cua quy trinh dupe co dong lai theo cac budc l't hon hoac khac mot chut, nhUng ve cO ban la nhu sinh vien da hoc 0 trUdng. 5.4. TU danh gia qua trinh ren luyen Sinh vien co the tii danh gia qua trinh ren luyen bang cac cach sau: - Quay camera: sinh vien co the dat may quay d mot cho phu hop, hoac nhd mot ngUdi quay cho moi khi sinh vien muon xem lai qua trinh thuc hien ky thuat cua minh. - Sinh vien giam sat lan nhau: sinh vien cung co the lap mot nhom hoc tap de nhd sinh vien khac quan sat qua trinh thUc hien ky thuat dua vao bang kiem. - Sinh vien Idp trudc giam sat: khi di thuc tap tai benh vien, sinh vien se gap cac anh chi sinh vien hoc trUdc va nhd ho quan sat giup. - Nhan vien giam sat: khi di thUc tap tai benh vien, se co nhan vien benh vien giam sat viec pha thuoc cua sinh vien. Vay sinh vien phai co kha nang ap dung cac kien thiic da hoc va thiic hien dung quy trinh ky thuat. OITA THUOC QUA OLfONG MIENG - AM DAO - TRL/C TRANG Dua thuoc vao cO the ngUdi benh la cong viec pho bien cua dieu dUOng va can thiet cho ngudi benh. No doi hoi ngUOi dieu dudng phai co kien thiic hieu biet co ban ve thuoc, cach sii dung de dua thuoc an toan vao cO the ngUdi benh. Hon the nUa, dieu dudng con phai hieu ve ngUdi benh. Ngoai muc dich de tranh nham lan ngudi benh, con phai thUc hien dUdc ky thuat dat den mUc an toan va ngUdi benh hap thu thuoc hieu qua nhat. Neu nham ten thuoc, tinh lieu thuoc sai, thuc hien khong dat yeu cau ve ky thuat hay thdi gian, tat ca deu co the gay anh hiidng den ket qua dieu tri va ngiidi benh. Tuy mUc do sai sot, co the la tai cho hay nguy hiem hon la anh hudng den toan than va co the gay tii vong. Co nhieu dudng dua thuoc vao co the: - Dudng mieng - Dudng qua niem mac mat, tai, mui, am dao, trUc trang - Dudng sii dung ngoai da Tuy theo chi dinh cua dieu trj, ap dung dudng dUa thuoc vao cO the cho thich hpp, moi dudng co nhUng yeu cau khac nhau. NgUdi dieu dudng can phai thanh thao ve ky thuat, de thuc hien hay hudng dan cho ngUdi benh tu sii dung thuoc an toan. 1. MUC TIEU KY NANG 1. Liet ke cac diidfig diia thuoc vao cd the. 2. Trinh bay chi dinh cac diidng dung thuoc. 3. Thao luan cac yeu cau cua moi diidng dung thuoc. 4. Chuan bi thich hdp cho moi diidng dung thuoc. 5. Thiic hien cac yeu cau nhan dinh khi diia thuoc vao cd the theo tiing diidng. 6. Thiic hien cac diidng dung thuoc an toan va dung ky thuat. 7. Thao luan va tu ren luyen ve thdi do va cach tiep xuc ngiidi benh khi thiic hien. 2. LY THUYET LIEN QUAN DEN KY NANG Ky thuat dUa thuoc vao cd the tuy theo chi dinh cua bac si dieu tri va yeu cau cua tu'ng loai thuoc tac dong d cac cd quan khac nhau. Do do, ngu'di dieu dudng can phai biet thanh thao ve thuoc nhu tac dung chinh, tac dung phu. dupe tinh, lieu dung, dudng thai, doc tinh cua thuoc, va ky thuat dung thuoc. Ngoai ra, dieu du'o'ng cung can hieu ro ngudi benh ve tinh trang hien tai, kha nang sii dung thuoc cung nha cac van de lien quan khac trong qua khU nhU cac benh man tinh. tien su di ling, de giai thich hudng dan ngudi benh tin tUdng vao viec dua thuoc vao cd the ho an toan. 3. CAC Dl/dNG DUNG THUOC 3.1. DUa thuoc vao difdng mieng Day la dudng thong dung, de thuc hien, ngudi benh thong thudng co the tu uong, it co tac dong tarn ly s0 hai. Thuoc cho vao dudng mieng co nhieu dang, tuy moi loai co dac tinh va cach dung khac nhau, ngoai ra thuoc qua dudng mieng cung co nhieu cach khac nhau nhtf: uong, ngam dudi ludi, nhai. Vi vay, dieu dudng can phai biet de chuan bi va hudng dan cho ngUdi benh. - Chong chi dinh cho thuoc dudng mieng: + NgUOi benh rdi loan tieu ho&. + NgUdi benh mat kha nang nuot. + NgUOi benh dang hut dich da day. - Nhan dinh: + Tuoi, can nang. + Kha nang nuot cua ngUdi benh, phan xa trao ngUdc. + NgUdi benh dang ho. + Tam ly khi dung thuoc cd lo lang, sp dung thuoc. - Yeu cau giup uong thuoc an toan: + Xac dinh kha nang uong dUdc cua ngudi benh. + Chuan bi thuoc cho de uong. + Tao dieu kien de ngudi benh tu uong la tot nhat. + Nen cho uong luc ngu'di benh dang thuc, tinh tao thoai mai, co the uong giiia bua an. + Khong nen pha thuoc loai dang, mui vi kho uong vdi nhieu nUdc. + NgUdi benh cd nguy co hit sac, trao ngUdc thi khong nen cho bang dudng uong. + Ngu'di benh bi liet mat, mieng meo, dat thuoc ben mieng khong liet. + Khong nen uong thuoc dang hay cd mui vi kho uong ngay sau khi an no. + Thuoc ldi tieu nen tap trung lieu vao buoi sang. + Thuoc cd tinh acid (Aspirin): dan ngudi benh khong dung thUc an nhieu chat beo nhu banh snack de giam kich thich da day, khong nen dung luc bung doi. + Thuoc anh hudng den tuan hoan, ho hap dieu dudng can theo doi dau sinh hieu trudc va sau khi dung thuoc. 3.2. Cho thuoc qua ong thong da day hay ruot non - Khong diidc dung cac thuoc co do pH < 0,4. - Can xac dinh tinh chat cua thuoc co bi anh hiidng bdi thiic an, neu co can phai ngiing cho an 1-2 gid triidc khi cho thuoc vao ong thong. - Khong bao gid diidc do triic tiep vao ong thong, can phai hoa thuoc vdi dung dich hay niidc theo hiidng dan cua nha san xuat. - Kiem tra chi dinh cac thuoc triidc khi nghien, nhiing loai ngam diidi liidi, ngam trong mieng, thuoc co Idp vo bao ben ngoai giup chi tan d ruot thi khong diidc nghien. Thong thiidng cac thuoc diidc phep nghien thi se hoa khoang 30ml niidc am va cho uong moi thuoc rieng biet, khong nen hoa chung cac loai thuoc vdi nhau khi chiia biet ro sii tiidng tac giGa cac thuoc. Nen do 30ml niidc gida hai loai thuoc qua ong thong. - Trang ong sau moi lan cho thuoc. 3.3. Thuoc dat am dao Thuoc co tinh chat dieu tri dac hieu cho cac benh ly phu khoa, thuoc thiidng lam dang hinh triing, hay co mot dau tron, ngoai ra con co dang cream hay bot (foam). Thuoc diidc ngam qua niem mac am dao de co tac dung tai cho hay toan than. - Yeu cau nhan dinh: + Tinh chat dich tiet: mau sac, mui, co chay mau. + So" liidng dich tiet: tang hay giam neu tiep tuc dat thuoc. + Tac dung phu cua thuoc. + Tam ly ngiidi benh. . - Cham soc tai nha: + Nhan dinh kha nang ngiidi benh tii dat thuoc. + Hiidng dan tac dung cua thuoc, cach dat thuoc, lieu thuoc va thdi gian dat. + Ve sinh bo phan sinh due triidc khi dat thuoc. + Khi dat thuoc, NB phai ngiing giao hdp trong thdi gian dieu tri. + Bao cao vdi bac si hay tai kham khi thay dau vung bung diidi, chay mau, dich tiet bat thiidng. 3.4. T h uoc dat hau m on Thuoc thiidng dang vien nen hay dang sap co hinh dang nhii vien dan, thuoc diidc dat vao triic trang se tan va diidc hap thu qua niem mac true trang de co tac dung tai cho hay toan than. . - Ngiidi benh khong uong du'dc, dang non oi. - Thuoc gay kich thich diidng tieu hoa tren. - Thuoc can tac dung tai cho vung triic trang. 39 - Nhan dinh. - Niem mac hau mon true trang khong co ton thudng. - Ti'nh chat phan. - Nhu dong ruot. - Tac dung phu cua thuoc. 4. QUY TRiNH KY THUAT 4.1. Cho ngifc/i benh uong thuoc Tru'dc 10 Cac budc tien hanh 1 Chuan bj - Rira tay thudng quy Chuan bj thuoc Chuan bj khac - Lay thuoc vien - Lay thuoc dang nirdc, dung djch PhUdng phap tien hanh Theo quy trinh rira tay noi khoa Chon thuoc dung theo yeu cau: - Doc ten thuoc - Han sir dung, chat ludng thuoc - Ham lUdng thuoc - Coc co chia vach - Ly nUdc uong thuoc - Thia khuay, thia do liTdng - Ong hut - Giay lau - Khay dem thuoc - Li/di cua - Hop thuoc ca nhan - Md nap chai dem thuoc vao khay hoSc nap hop thuoc, cho vao hop dung thuoc cua NB hay md vi thuoc cho vao tifng ngan - L ie deu chai thuoc trUdc khi rot - Rot thuoc vao coc co chia vach, hay dung vat mau de do luting, co the dung bdm tiem bo kim de rut thuoc - Dung giay lau ben ngoai co chai thuoc Ly do - Giam sU lay nhiem vi sinh vat - An toan ve thuoc - Moi NB co hop dung thuoc rieng dupe phan thanh nhieu cu1 uong trong ngay - Thuoc dupe tron deu cac thanh phan trong chai - Tinh lieu chinh xac - Tranh nhiem ban Ip thuoc va lam Udt nhan thuoc Nhung diem can luu y -ThUc hien theo quy trinh - Chu y mong tay, ke ngon tay - Thuoc con nguyen bao bi - Thuoc sir dung nhieu lan phai bao quan nhiet do mat hay theo quy djnh cua nha san xuat -Tinh dung lieu thuoc theo y lenh - Tranh cham tay vao thuoc, han che nhiem ban thuoc - Hop dung thuoc ca nhan co ghi ten NB, co phan gid uong thuoc - Thuoc vien nang bot hay hat cai, khong nen thao rdi Idp vo - Doc hudng dan ciia nha san xuat thuoc trudc khi tinh lieu va rot thuoc - Khong do thuoc thi/a trd lai vao chai thuoc Hinh anh minh hoa Rira tay thudng quy Lay thuoc khong cham tay vao thuoc Hop dung thuoc ca nhan Mm Cho thuoc vao ngan uong theo gid - Thuoc dang bot - Thuoc vien dang sui bot - Giup thuoc hoa tan de - Xe mieng bao thuoc - Cho thuoc vao coc co s in mot it nUdc am - Dung thia khuay deu - Cho thuoc vao ly co nifdc uong di/dc - Chd thuoc sui bot tan hoan toan - Li/png nirdc giup hoa tan thuoc phu hop vdi li/ong bot, khong nen dac hay long qua se kho uong, tot nhat la theo hi/dng d in cua nha san xuat - Khong diTdc uong vien thuoc khi thuoc chi/a tan Rot thuoc nirdc, dung djch vao coc cd chia vach Kiem tra lirong thuoc Lay thuoc bang bom tiem Thuoc dang sui bot 2. Kiem tra lai thuoc 3. Dem thuoc den gitfdng benh Doc nhan thuoc lan 3 tri/dc khi cat thuoc hay bo vo thuoc - So sanh lai giCra y lenh thuoc, phieu thuoc va chai thuoc Mang khay thuoc hoac xe thuoc Giam sai sot - Dieu di/dng thi/c hien vdi tinh than trach nhiem cao, khong chu quan Giup tien nghi 41 Trong 4. Kiem tra gid dung thuoc 5. Doi chieu dung ngudi benh 6 Giai thich vdi ngi/di benh 7. Chuan bi tu the phu hop 8. Oifa thuoc vao dudng mieng * Uong -Thuoc vien - Ooc chi dinh cua bac sT dieu tri - Ooc hudng dan chi dinh thuoc cua nha san xuat Kiem tra ten trong phieu thuoc vdi ten NB d dau giUdng dong thdi vdi hoi NB - Thong bao vdi ngu'di benh: Muc dich, tac dung, tinh chat, cach dung - NhCrng dau hieu cua di irng, tac dung phu cua thuoc - Cho ngudi benh ngoi neu khong co chong chi dinh hoac n im dau cao - Oifa va gidi thieu thuoc cho NB tu cam tren tay hay co coc dung - Lira chon ni/dc uong thuoc thich Phan bo thuoc hop vdi tinh chat diroc ly cua thuoc Dem lai sU an toan cho NB - Cung cap kien thUc cho NB -Tang kha nang tu dung thuoc - Giup NB tin tudng vao dieu tri Giam nguy co hit sac - Giup NB lam quen vdi thuoc - Giup NB thoai mai, Thuoc duoc dung dung theo gid yeu cau cua bac sT dieu tri trudng hop cap hoac trong vong 30 phut trudc hoac sau chi dinh Dung ten, tuoi, so giUdng - Hoi de NB tu tra ldi neu dupe NgUdi benh hay than nhan chap nhan viec dung thuoc Doi chieu va giai thich vdi NB Ngudi benh ngoi, lung tua vao thanh ghe hay dau giUdng, mat hudng ve trirdc - Nen cho NB uong tC/ng vien thuoc - Kiem tra trong mieng khong con thuoc, mdi uong vien thU hai Cho NB uong thuoc 12 - Thuoc dang ni/dc, dung djch hay nhu tifdng hop: nu’dc chin, nude trai cay, ni/dc ngot co ga neu khong co chong chi dinh - OUa coc dt/ng thuoc de NB tu uong - Uong them vdi mot it nirdc chin sau khi uong xong thuoc khong so uong thuoc - Khong nen pha nirdc them vao thuoc se lam thuoc cham hap thu vi pha loang - Luu y doi vdi tre con, nen cho lan thuoc vao trai cay, hay uong vdi nUdc ngot - Sd ludng nude uong tuy ti'nh chat cua thuoc, thudng nen uong vdi nhieu nirdc - Thuoc vien bao tan trong ruot khong dupe nhai -Thuoc danq bot -Thuoc ngam dudi lifdi Thuoc trong mieng -Thuoc dang nhai 9. Theo doi - Khuay deu thuoc trade khi uong - Uong them vdi nirdc Dat thuoc vao diTdi ludi NB - Hudng dan NB ngam den khi thuoc tan hoan toan Dat thuoc vao mieng, goc trong cua mieng - Dan NB ngam cho den khi thuoc tan hoan toan - Dat thuoc giifa hai rang, hudng dan NB nhai nhuyen vien thuoc - Uong them nUdc sau khi nhai - Kiem tra so lUpng - Khuay den khi thuoc tan deu giup NB de uong - Thuoc tac dong tai cho vung mieng, hap thu qua niem mac diTdi lifdi - Thuoc tan dan hap thu qua niem mac ma va da day - Thuoc can cd nUdc bot de de hap thu Bao dam Uong nUdc trang mieng sau khi uong thuoc - Dan NB khong nhai thuoc Hifdng dan NB khong nuot thuoc vi thuoc se bi pha huy bdi dich vi hoac nhd nirdc bot se mat tac dung cua thuoc Hirdng dan khong nhai hay nuot thuoc Tranh thuoc dinh vao ke rang Chu y NB tarn than Dat thuoc dudi ludi Thuoc ngam trong mieng den khi NB uong xong thuoc 10. Danh gia dap Ong cua thuoc Sau thuoc da uong - Yeu cau ngudi benh ha mieng de kiem tra - Hoi NB ve ket qua dung thuoc - Nhan dinh cac dau hieu cua tac dung phu cua tUng loai thuoc - Quan sat dau hieu di Ung thuoc thuoc da dUOc uong du lieu Giup danh gia ket qua dieu tri giup thay thuoc dieu chinh hay thay doi thuoc thuoc » s m hay NB sp uong JL I - Kiem tra NB uong xong thuoc - Ghi nhan chinh xac cac dau hieu di ifng vao ho sd, thong bao theo quy dinh - Bao ngay vdi bac sT dieu tri khi co dau hieu bat thudng 43 4.2. Dat thuoc vao am dao tien hanhLy doNhurng diem TrUdc Cac budc thuc hanh 1. Kiem tra y lenh thuoc 2. Nhan dinh tien sCf di ting PhUdng phap Doc y lenh tti ho sd, so sanh vdi phieu thuoc ca nhan NB chinh xac: - Ten ngudi benh - Ten thuoc - Lieu lupng thuoc - Dudng dung thuoc - Thdi gian dung thuoc - Chi dinh thuoc - Hoi ket qua, kinh nghiem dung thuoc trudc day cua NB co cac dau hieu noi man, ngUa, kho thd, dn lanh, phu - Hoi NB co dj Ung vdi chat cao su nhu gang hay cacloai phan(ben ngoai cua gang - Ky thuat can cd y lenh cua bac si - Tranh nhung sai sot lam mat an toan cho ngUOi benh Bao ve NB khong bj di Ung bat cU loai gi can luu y Hinh anh minh hoaj - NB cd the trung ten, nen kiem tra ca tuo’i, so giUdng - Dung thuoc: gom ten va dang thuoc - Dung lieu: can cir vao ham lifdng thuoc de tinh chinh xac lieu theo y lenh - So sanh dudng dung cua y lenh vdi chi djnh cho phep trong hifdng dan cua nha san xuat - Thdi gian dung thuoc phai phu hop vdi thdi gian thai thuoc, va dieu kien cua NB - Doc chi dinh trong toa thuoc neu thay khong phu hop can trao doi vdi bac si dieu tri | Khai thac va lin g nghe tat ca cac trudng hop lien quan - Bao cao vdi bac sT khi NB di Ung vdi thuoc 3. Rifa tay Theo quy trinh rifa tay noi khoa Giam sU lay nhiem vi sinh vat -ThUc hien theo quy trinh - Chu y mong tay, ke ngon tay j ^ r t— i LUu y cach h o l“ Ba ten gi ?“ khong nen hoi cd phai ba ten la ...? Hay Ai ten la ...? Rifa tay thudng quy Co the thuc hien tri/dc 44 4 Xac dinh dung ngu’di benh 5 Nhan dinh bo phan sinh due ngoai So sanh ten trong phieu thuoc, ten dau giUdng va hoi NB Tinh chat dich tiet, so luong Tranh nham lan ngirdi benh Phan anh tinh trang hay dien tien benh 6. Giai thich ky thuat vdi NB 7. Chuan bi 7.1. Chuan bi thuoc -Thuoc vien dat - Thuoc dang cream hay foam 7.2. Chuan bi cac dung cu khac Trong 8. Che binh phong 9. Chuan bi tirthe phu khoa 10. Che vung bung va dui Oat tarn lot vung mong 11. Kiem tra du anh sang 12. Mang gang sach 13. Ve sinh vung am ho - Bao muc dich, tac dunq tinh chat cua y > thuoc - Ta the NB phai chuan bi Kiem tra thuoc theo y lenh: ten thuoc, ham lapng, dang thuoc, han dung, chat ludng thuoc Gang sach Khan hay vai dap Khan rifa, savon, dung dich rifa (neu can) Chat tron Dung cu dat thuoc Phieu thuoc Den chieu Vai cao su hay giay lot Binh phong Keo man hay binh phong cach ly Giup NB nam ta th e chan chong tren gia (neu co) va bet rong ra Dung khan Idn hay vai dap che vung bung va dui - Tam lot ttf vung mong den chan Anh sang ta nhien, den phong hay den chup hoi tu Ky thuat mang gang sach Dung khan lau sach vung am ho neu can Cung cap thong tin ve thuoc cho NB - Giup NB hop tac tot hon Tranh nhang sai sot ve thuoc, dam bao an toan cho NB Giup NB tien nghi va an toan Tao sa rieng ta De dang thao tac khi dat thuoc vao sau , trong am dao Gia NB dapc kin dao Gia ve sinh, tranh lay nhiem cheo Bao dam vung am dao daoc thay ro Han che lay nhiem khi tiep xuc dich tiet theo tieu chuan CDC (NIOSH, 1999) Tranh nhiem trung ta ngoai vao trong - Kha nang nhan thac cua NB - Chon cac phaong phap giai thich phu hpp Quan sat mau sac cua thuoc, neu co doi mau cung khong nen dung cho du thuoc con han dung - Thuoc thadng dapc bao quan noi mat - Nen thac hien tai phong thu thuat neu co - Hadng dan NB ta rifa neu ho ta lam dapc Chat tron tan trong nadc Te nhi va tran tinh ngadi benh Giai thich de NB hpp tac M6i NB dung mot tarn lot (mot mat tham, mot mat khong tham) Thadng dung den hoi tu h6 trp - Kiem tra mong tay trade khi mang gang - Gang khong thung Cho NB rira bo phan sinh due trade neu dadc Dung cu dat thuoc Sh Ta the phu khoa Mang gang sach 45 Sau 46 14. oat thuoc 14.1. Dang vien 14.2. Dang cream hay foam Dan NB nlim nghi tai giirdng it nhat 10 phut Mac bang ve sinh khi NB di lai van dong Don dep dung cu Thao gang, rifa tay Nhan dinh dich tiet, - Mcf thuoc - Lam trdn dau thuoc - Lam trdn ngon gang 2 va 3 - Tay khong thuan vach moi be - Tay thuan kep thuoc giCfa ngon 2 va 3 difa theo chieu dai ngon tay vao am dao, hoac dung dung cu dat - Rut ngon tay va tha tay vach moi be - Lay du lieu thuoc vao dung cu - Tay khong thuan vach moi be -Tay thuan difa dung cu bom thuoc vao am dao, day nong de thuoc vao sau - Rut dung cu bom, tha tay vach moi be - Lau thuoc dong bo phan sinh due ngoai - Xir ly dung cu - Giup NB nam lai tien nghi - Hudng dan NB thi/c hien Phan loai dung cu XiT ly theo quy trinh khir khuan - Phan biet gang da nhiem - Theo quy trinh rira tay Hudng dan NB quan sat mau s ic , mui, so ludng giCra hai lan sir dung - Chat trdn trong nirdc khong lam bam dinh dich tiet, tranh gay nhiem khuan Dung tay thuan de dat hieu qua dat thuoc - Khi dung cu vao du do sau mdi bom thuoc De thuoc duoc hap thu Sau khi thuoc tan, mot phan se tham ra ngoai am dao, do vay can bang ve sinh de giCf ve sinh bo phan sinh due (BPSD) Tranh lay nhiem Tranh lay nhiem cheo Danh gia hieu qua cua thuoc - Chon dau tron cua thuoc - Lam trdn b ln g chat trdn tan trong ni/6c - Lam lo ro lo am dao .- Oat doc thanh sau cua am dao sau 7,5 10cm - Dira dung cu vao thanh sau am dao sau 5 h- 7,5 cm - Khong gay nhiem khuan cho NB Tranh ngoi hay dung lien sau khi dat, thuoc s§ rot ra ngoai GiCf ve sinh ca nhan Khir khuan dung cu theo quy dinh Gang sau khi thao xong phai bo vao thung rac - Rira tay va lam kho - Ghi chep vao ho so ro rang - Bao vdi bac sT dieu tri ket qua dung thuoc Dat thuoc vao am dao Dung cu dat thuoc vao am dao 4.3. Dat thuoc vao hau mon Cac budc tien hanhLy doNhung diem thuc hanh 1. Kiem tra y lenh thuoc PhUdng phap Doc y lenh tU ho so, so sanh vdi phieu thuoc ca nhan NB chinh xac: - Ten NB - Ten thuoc - Lieu lUOng thuoc - DUOng dung thuoc - ThOi gian dung thuoc - Chi dinh thuoc - Ky thuat can co y lenh cua bac si - Tranh nhting sai sot lam mat an toan cho nguOi benh can luu yHinh anh minh hoa - NB co the trung ten, nen kiem tra ca tuoi, so giUOng - Dung thuoc: gom ten va dang thuoc - Dung lieu, can cti vao ham lupng thuoc de tinh chinh xac lieu theo y lenh - So sanh duong dung cua y lenh vdi chi dinh cho phep trong hudng dan cua nha san xuat - Thdi gian dung Tru'dc J # Cac dang thuoc dat 2. Nhan Quan sat NB: - Can xac thuoc phai phu hpp vdi thdi gian thai thuoc va dieu kien cua NB - Doc chi dinh trong don thuoc, neu thay khong phu hpp can trao doi vdi bac sT dieu trj - Sau md tri, NB cd djnh ngUOi benh 3. RCfa tay 4. Chuan bi - Chuan bi thuoc Kiem tra ho so - P hlu thuat vung true trang - Chay mau, ton thUOng vung trUc trang - Tien sir di ting thuoc Theo quy trinh rCra tay noi khoa - Kiem tra thuoc theo y lenh: ten thuoc, ham lUOng, dang thuoc, han dung, chat luong thuoc dinh ro loai phau thuat - Chong chi dinh dat thuoc Giam sU lay nhiem vi sinh vat Tranh nhung sai sot ve thuoc, dam bao an toan cho NB the cd chi dinh dat thuoc hau mon - Bao cao vdi bac si khi NB di ting vdi thuoc - Thuc hien theo quy trinh - Chu y mong tay, k§ ngon tay Thuoc thudng dUPc bao quan noi mat 18°C - 25°C 47 % RCra tay thudng quy - Dung cu khac 5. Xac dinh dung ngifdi benh 6. Giai thich ky thuat vdi ngifdi ' benh 7. Che binh phong 8. Chuan bi tir the nam Sim's hay n im nghieng - Gang sach - Khan hay vai dap - Chat trdn - Phieu thuoc - Binh phong So sanh ten trong phieu thuoc, ten dau giUdng va hoi NB - Bao muc dich, tac dung tinh chat cua thuoc - TU the NB phai chuan bi Keo man hay binh phong cach iy - Nghieng sang trai, tay trai dua ra sau lung, chan phai co len bung - Hoac nam nghieng sang trai chan phai co len Giup NB tien nghi va an toan Tranh nham lin NB Cung cap thong tin ve thuoc cho NB - Giup NB hdp tac tot hdn Tao su rieng tu Lo ro vung hau mon - Thuoc con nguyen ven - Chat trdn tan trong nUdc Nen de NB tu tra ldi ten • - Kha nang nhan thUc cua NB - Chon cac phUdng phap giai thich phu hdp Te nhi va tran an NB Giai thich de NB hdp tac - NB thoai mcii / - v . ,_ _ L / \ . _ _ Trong T u th e nam nghieng 9. Mang bung Ky thuat mang Han che lay / - Kiem tra mong tay gang sach 10. Tham gang sach - Thoa trdn vao nhiem khi tiep xuc dich tiet theo tieu chuan CDC (NIOSH, 1999) Giup kham trudc khi mang gang - Gang khong thung Mang gang sach - Bao v6i bac si khi kham vung true trang neu can ngon gang - Kham niem mac thanh true trang de, NB khong dau, giam kich thich co mau I - Co chay mau, dinh phan de gay nhiem trung, han che tac dung cua thuoc - Thay gang neu co dinh dich tiet B ladder \ A )gk I N .R e ctb rr P - Vung cd mong khi ngUdi benh nam nghieng: (Ventrogluteal) day la vting cd bap sau va khong cd mach mau ldn hay than kinh di qua. Vi tri nay thudng dung de tiem thuoc dau hay thuoc kich thich mo dudi da cho tre nho va ca cho ngUdi ldn. De xac dinh vi tri tiem, ngUdi dieu dudng dat got cua ban tay len chom cua xUdng dui, ban tay phai de len mong ben trai, ngon tro dat d gai chau trUdc tren dong thdi keo dang ngon gitia ra toi da doc theo canh chau, hinh chti V dUdc tao bdi ngon tro, ngon gitia va mao chau, trong tam cua hinh tam giac nay la vi tri tiem. - Vting cd rong ben cua dtii (Vastus Lateralis): day la vi tri cd bap phat trien, thUdng dting de tiem bap cho ngUdi ldn va tiem phong cho tre nho. Mot phan ba mat ngoai cua dtii la vi tri tiem. - Cd Delta: la vi tri cd kem phat trien doi vdi mot so ngUdi ldn. Vi tri nay cting cd nguy cd gay ton thudng do cd nhieu day than kinh va mach mau di qua, do vay ngUdi dieu dudng chi co the tiem d vi tri nay mot liidng thuoc nho khoang 0,5 -7- lnil hoac dung de tiem phong cho tre nho. Khi tiem, ngUdi dieu dUdng nen hudng dan ngu'di benh tu the chong tay vao hong de cho cd delta dUdc tha long, vi tri tiem cach u vai 3 5cm. - Vting cd mong khi ngUdi benh nam sap: (Dorsogluteal) day la vi tri ma tru'dc day chung ta thudng dung nhung ngay nay co rat nhieu nghien ctiu da chting minh rang khi tiem bap vao vi tri nay thudng cham day than kinh toa gav Het cho ngu'di benh. Do vay, vi tri nay ngay nay khong con dude dting de tiem b;ip ntia. Cd kim: 21 -r 23 G dai 2,5 -r 4cm. 59 Vj tri Tre di/di 18 thang Tre tren 6 tuoi Ngirdi ldn Co delta n A 0,5 ml 1 ml ■ j f r* Cd thSng dui' Co thing iliii % \ 0,5 ml 1,5 ml 2 ml Cd rong ngoai dui ijP ^ ^ V c o rong ngoai dui w h Cd mong (dorsdgluteal) Cd mong (Ventrogluteal) 0,5 ml 1,5 ml 5 ml 1,5 ml 3ml 0,5 ml 1,5 ml 3ml 2.1.2. Tiem dudi da (Subcutaneous: S/c) la tiem vao mo lien ket long leo dtfdi da: ■ j p 60 Ldp mo dudi da mang ludi mach mau rat it, do vay viec tiem vao mo dudi da se co tac dung cham hon la tiem vao mo bap co. Co kim: 25 G; dai: 1 -r 1,6 cm. Goc do tiem: trung binh 45° so vdi mat da. Ngudi benh tren 80 kg: goc do tiem 90° so vdi mat da. Ngudi benh < 30 kg: goc do tiem 15 -f 30° so vdi mat da. Vi tri tiem: tiem vao mo lien ket long leo dudi da - Co delta: dau dudi cO delta. - Hai ben ba vai. - Hai ben ron cach ron 5cm. - 1/3 gitia mat ngoai, trUdc cua dtii. Khi tiem dudi da, ta phai rtit nong kiem tra mau de xac dinh kim khong vao mach mau, nhung dac biet trong tiem thuoc heparin va insulin thi khong can phai rut nong de thti mau vi co the tao cuc mau dong noi vting tiem. Dac biet trong tiem insulin la loai thuoc dting dieu tri kiem soat dudng huyet cho ngudi bi dai thao dudng, do vay can phai thay doi vi tri tiem. Nen chon vting tiem doi xting giup duy tri ItiOng thuoc deu trong cO the. Thdi gian hap thu thuoc tuy thuoc vao tting vi tri tiem, nhanh nhat la tiem tren vting co th&ng bung roi den co delta, dtii va vting mong. Do vay, ngtfdi dieu dudng phai biet nhan dinh chinh xac tinh trang dudng huyet, thdi gian an cua ngudi benh de co ke hoach dting thuoc cho phti hpp. Ngoai ra, trong tiem dudi da con cd tiem heparin, day cting la mot loai thuoc dac biet: heparin dting dieu tri chong dong mau. Do vay, ngudi benh dtipc dieu tri bang heparin de co nguy cd bi xuat huyet,'ngudi, dieu dudng phai thong bao cac dau hieu do cho ngUPi benh giup phat hien cac tai bien xay ra nha'chay mau chan rang, dom xuat huyet dudi da, de bi tao mau bam v.v... 2.1.3. Tiem trong da (Intra dermal: I/d) la tiem vao Idp dudi thUdng bi Thtidng sti dung de tiem chung hoac thti phan ting thuoc. Thudng thuoc dupe tiem vao Idp dudi thudng bi, noi cd it mang lifdi mach mau di qua va se lam thuoc co tac dung cham. Co the ngUPi benh cd the cd phan ting vdi loai thuoc tiem vao va phan ting nay xay ra nhanh hdn khi thuoc hap thu vao mau, do dd tren nhting ngudi benh co cO dia di ting cang can phai thti phan ting trUdc khi tiem. NgUPi dieu dtidng can phai quan sat phan ting cua ngUPi benh vdi thuoc qua noi tiem, do vay vting difpc chon de tiem trong da la ndi khong cd seo, ton thUPng va it cd long. Khi tiem trong da ludng thuoc tiem vao-rat it, khoang tti 0,01 t 0,1 ml va noi tren da hinh anh mun nude, do vay sau khi tiem ma khong thay noi mun nUdc hoac thay mau chay ra khi rut kim la do tiem vao mo dudi da va phan ting se cho ket qua khong co gia tri. Va khi tiem cung khong can rut nong thti mau de xac dinh vi trong do chi cd he mao mach. 61 Cd kim: 26 -r 27 G dai: 0,6 4- 1,3 cm. Goc do tiem: 5 h- 15 do so vdi mat da. Vj tri: tiem vao vung diidi thiidng bi, chon vung da it va cham. trang, khong seo, long. - 1/3 tren mat trong ckng tay (thong dung nhat). - Hai ben cd ngiic ldn. - Hai ben ba vai. 2.1.4. Tiem tinh mach (Intravenous: IV) la tiem thuoc troJc tiep vao tinh mach Liidng thuoc di triic tiep vao mau va co nguy cd gay phan ting rat nhanh, khi tiem tinh mach ngiidi dieu diidng phai chti y quan sat ngiidi benh ky hdn de phat hien sdm tai bien xay ra va dac biet la ti'nh lieu thuoc cho chinh xac de tranh nham lan. . • Cd kim: 19 h- 21 G dai: 2,5 -h 4 cm. Goc do tiem: 30 -h 40 do so vdi mat da ttiy theo vi tri tinh mach. Vi tri tiem: cac tinh mach ngoai bien. Uu tien chon cac tinh mach: - To, ro, it di dong. - Mem mai, khong gan khdp. 0 *> 0 0 * 2.2. Ap dung 3 kiem tra 5 doi chieu va 5 dieu dung Trong suot qua trinh dting thuoc, de tranh cac tai bien do nham lan thuoc gay ra 3 Kiem tra: 1. Ten ngiidi benh 2. Ten thuoc 3. Lieu thuoc 5 Doi chieu: 1. So" giiidng, so" phong 2. Nhan thuoc 3. Chat lufdng thuoc 4. Diidng tiem thuoc 5. Thdi han dting thuoc Dieu dung: 1. Dting ngiidi benh 2. Dung thuoc 3. Dung lieu 4. Dung diidng dting thuoc 5. Thdi gian 62 2.3. Muc tieu ky nang - Nhan dinh cltfdc tinh trang chung cua ngUdi benh tniclc khi tiem thuoc. - Trinh bay elude ky nang kiem tra thuoc trU6c khi dung cho ngiidi benh. - Trinh bay dUdc ky nang ap dung 5 dung khi dung thuoc cho ngiidi benh de phong nham lan thuoc. - ThUc hien dude ky nang tiem thuoc qua 4 dudng tiem an toan va hieu qua. - Hudng dan cho ngUdi benh nhan biet cac dau hieu bat thudng sau khi tiem thuoc. - Y thiic dUdc tam quan trong cua viec dung thuoc chinh xac va an toan cho ngUdi benh. 3. QUY TRiNH KY THUAT I 3.1. Ky thuat chuan bi tiem thuoc STT Cac budc tien hanh Ly do Nhung diem thu’c hanh 1 Chuan bi thuoc 2 Chuan bi khay tiem PhUdng phap Sao phieu thuoc. Lay thuoc theo y lenh Mang khau trang, rCra tay Trai khan len khay sach Tranh nham lan thuoc Han che sU lay nhiem cho ky thuat Han che nhiem khuan cho cac dung cu tiem can lUu y Hinh anh minh hoa Sao phieu thuoc dung y lenh td ho sd benh an Kiem tra thuoc: ten thuoc, ham lUdng, chat lifdng dudng dung, han dung Mang dung quy cach, che ca mui va mieng RUa tay sach cac mat cua ban tay Dung khan vo khuan trai theo cach sach \ . j jm / E Chon bdm tiem Phu hdp vdi lUdng thuoc can tiem Chon kim tiem Phu hdp vdi dudng tiem va vj tri tiem GiCf bdm tiem dUdc vo khuan tuyet doi GiCf kim tiem dUdc vo khuan tuyet doi N6ng — ; GC vd trung NhCrng phan khong de cham tay khi tiem 63 Chon kim pha — k CD •I rvj OKim khong di/dc nho qua thuoc Bong cau dung sat trung da o Lam sach vung da tn/dc khi tiem 1 gay nguy co rut khong het thuoc Bong cau hoac gac dung be ong thuoc (neu thuoc ong) Dung cu sat trung da De tranh con rdt vao ong thuoc va tranh ton thi/dng tay do mieng cua ong thuoc Ngi/a boi nhiem cho da Dung bong cau kho hoac gac | Neu dung binh ken thi mot ngi/di benh la mot khay ti£m 3 Chuan bj ben ngoai khay tiem Hop thuoc chong shock X if tri shock kjp thdi Hop thuoc chong shock luon di/dc kiem tra va du cd so de s in sang cho viec cap cifu i ; Day that mach Neu tiem tinh mach Giam nguy cd Day that phai bang day cao su de de khir khuan va tranh boi nhiem cho nhan vien y te Gang tay sach Chai dung djch rifa tay nhanh Binh chQa rac thai sac nhon. Tui rac chi/a chat thai y te Tui rac chi/a chat thai sinh hoat tiep xuc vdi mau va djch tiet Dung sat khuan tay Quan ly vat sSc nhon Phan loai rac thai theo dung quy djnh ■ Sat khuan tay tru’dc khi cam bdm tiem vo khuan Binh nhi/a ci/ng mau vang mot chieu Mau vang dung cho rac thai y te, mau xanh cho rac thai sinh hoat 3.2. Ky thuat rut thuoc ong STT Cac bi/dc thifc hanh Phi/dng phap tien hanh Ly do Nhufng diem can Iuxi y Hinh anh minh hoa■ 1 Rifa tay RCfa tay thudng quy (noi khoa) Giam si/ lay nhiem Rifa tay sach cac mat cua ban tay 2 Sat khuan ong thuoc 64 Sat khuan dau ong thuoc, kiem tra lan 2 Han che si/ nhiem khuan, an toan khi dung thuoc Kiem tra thuoc Sat khuan cd ong thuoc tri/dc khi be 3 Rut thuoc tii ong thuoc Dung bong cau kho lau va be ong thuoc Rut thuoc vao bdm tiem Kiem tra thuoc lan 3, bo vo ong thuoc Che than kim an toan, dat bdm tiem tren phieu thuoc vao khay tiem thuoc an toan Tranh lam ton thadng tay, gia an toan cho ong thuoc Gia he thong bdm tiem va thuoc dapc vo khuan tuyet doi Tranh sa nham lan thuoc Gia cho bdm va kim tiem dapc an toan va vo khuan. Tranh nham lan thuoc Dung bong cau kho che tron ven cd ong thuoc trade khi be ong thuoc Tay khong cham than kim va nong trong cua bdm tiem khi rut thuoc Kiem tra thuoc Bo ong thuoc vao thung chaa vat s ic nhon Tranh cham tay vao than kim, nong trong cua bdm tiem, dat ong tiem ngay tren phieu thuoc 3.3. Ky thuat rut thuoc trong lo STT Cac bade thac hanh Phadng phap tien hanh Ly do Nhang diem can lau y Hinh anh minh hoa 1 Raa tay - Rifa tay thadng quy (noi khoa) Giam sa lay nhiem Raa tay sach cac mat cua ban tay 2 Sat khuan lo thuoc 3 Rut thuoc pha tiem 4 Rut thuoc ta Ip thuoc Md nap Ip thuoc, sat khuan n ip lo (kiem tra lan 2) Rut nude pha tiem bang kim pha thuoc Dam kim vao giaa Ip, bdm nadc cat vao Hut khi tra lai, rut kim an toan, lie cho thuoc hoa tan Han che sa nhiem khuan, an toan khi dung thuoc Giup hoa tan thuoc trade khi tiem cho ngadi benh Giup pha thuoc an toan, giup quan binh ap lac ben trong va ngoai Ip thuoc Kiem tra thuoc Sat khuan n ip lo trade khi rut thuoc Kim pha 20 18G Rut lapng thuoc pha vaa du theo yeu cau cua tOng loai thuoc, dadng dung thuoc va lieu dung thuoc Lapng khi rut ra bang lapng dich da bPm vao lo kin, tranh mat thuoc Bdm khi vao Ip Giup quan binh ap lac ben trong va ngoai Ip thuoc BPm lapng khi vaa du b in g lapng thuoc se rut ra Rut thuoc vao bdm tiem du lieu Kiem tra thuoc lan 3, bo vo Ip thuoc Thay kim tiem thich hpp Gia he thong bdm tiem va thuoc dapc vo khuan tuyet doi Tranh sa nham lan thuoc Han che ton thadng cho ngadi benh Tay khong cham than kim va nong trong cua bdm tiem khi rut thuoc Kiem tra thuoc Bo ong thuoc vao thung chaa vat sac nhon Thay kim sau phi pha thuoc, han che ton thadng do thuoc dinh tren than kim 6 ‘ ------- Che than kim an G iucho bom va kim Tranh cham tay vao than toan, dat bdm tiem duoc an toan kim, nong trong cua bdm tiem tren phieu va vo khuan, tranh tiem, dat ong tiem ngay tren thuoc vao khay nham lan thuoc phieu thuoc tiem thuoc an toan 3.4. Ky thuat tiem trong da ■j STT Cac bUdc thuc hanh PhUdng phap tien hanh Ly do Nhung diem can iuu y Hinh anh minh hoa 1 Nhan dinh tinh trang ngudi benh 2Nhan dinh kien thuc ve thuoc cua ngirdi benh 3 Kiem tra doi chieu Tri giac? Tuoi: gia, tre7 Ldp md dudi da day hay mong Loai thuoc tiem Xac dinh xem ngUdi benh co di Ung vdi cac loai thuoc nao? Nhan dinh xem ngu'di benh co kien thu’c ve viec dung thuoc khong? Kiem tra lai y lenh ve thuoc cua bac sT: 5 dung Doi chieu ten ho, tuoi ngu'di benh, so giUdng, so phong Chon lUa dung cu tiem (ong tiem va kim tiem) cho phu hdp Phong ngUa ngu'di benh di Ung vdi thuoc Hudng dan cach theo doi cho ngifdi benh De c h ic chan dung thuoc dung y lenh De chac chan dung thuoc khong nham ngi/di benh Chu y chon vung da trln g , phang, it va cham, khong co seo hoac long. Khong dung lai loai thuoc ma ngudi benh da bi di Ung Dung tU ngif de hieu i Dung ngudi benh, dung thuoc, dung lieu, dung thdi gian, dung dudng dung Yeu cau ngudi benh noi ten 4 Chuan bi ngadi benh Bao va giai thich Tien hanh dUdc thuan ldi va an toan Ngudi benh an tam hdp tac Dung tU ngCf de hieu 5 RCfa tay Mang khau trang, rCfa tay thudng quy Han che si/ nhiem trung cho ngudi benh. Dam bao an toan khi thuc hien ky thuat vo khuan Toe gon gang Khau trang che kin mui, mieng RCfa tay sach het cac mat cua doi tay 6 Xac dinh vi tri tiem Xac dinh dung vi tri tiem: 1/3 tren mat trong cang tay Mat tru'dc cua canh tay Hai ben cd ngi/c ldn Hai ben ba vai Tranh cac tai bien do tiem sai vi tri Chon vung da it va cham, trang, khong seo, long • 7 Mang gang tay Mang gang tay sach 6 6 Bao ve cho nhan vien y te tranh sU lay nhiem tu ngudi benh Mang gang tay theo cach sach, cd gang phu hdp de thao tac dUdc gon gang 8 Sal khuan vung tiem Dung bong cau con vo khuan de sat khuan rong vung tiem Han che s ii nhiem khuan tii vung da xung quanh GiCf an toan ndi vi tri dam kim Sat khuan rong ti/ trong ra ngoai 5cm vdi bong cau con 70° hoac con iot 9 Sat khuan lai tay Sat khuan tay lai vdi dung djch rifa tay nhanh Giam sii lay nhiem cheo Sat khuan ky lai cac dau ngon tay 10 Tiem thuoc Duoi khi Kiem tra lai lieu thuoc chinh xac, ngi/a tai bien do khi gay ra De bdm tiem th ing difng, Icai bo khi trong ong tiem tranh lam mat thuoc 1 Cang da, de mat vat kim len tren, dam kim goc 15 do so vdi mat da Bdm 1/10 ml thuoc Tiem vao vung dudi thifdng bi Liidng thuoc phu hdp vdi diidng tiem Tiem dung vi tri, lifdng thuoc khong qua 0,1ml i jp iJ V *® '! ^ ii A Khi bdm thuoc co dau hieu ndi phong da cam Rut kim nhanh Han che sii ton thifdng mo Rut kim nhanh theo hirdng dam vao Co dinh kim Co dinh kim an toan Tranh nguy cd gay lay nhiem do vat sac nhon Bo h ln bdm va kim tiem vao thung nhiia cifng mau vang, khong diidc day nap kim bang tay V J n Chuan bi ngu'di benh Dan ngiidi benh khong diidc cham vao vung tiem Thong bao, giai thich cho ngiidi benh biet viec da xong, giup ngu'di benh tien nghi Ndi vung tiem de bi kich ung, giup viec doc ket qua chinh xac neu thu1 phan utig Giup ngifdi benh difdc tien nghi Khong dude cao gai, cha xat vao vung tiem Dung tif ngCfde hieu thai do phai niem nd, an can, vui ve khi giao tiep 11 Ghi ho sd Ngay gid dung thuoc Lieu dung Phan irng cua ngudi benh neu : CO Tinh trang ngu'di benh Danh gia tinh trang sau khi dung thuoc cua ngu'di benh Ghi chu can than nhiing dap ifng va cac phan ifng cua ngiidi benh khi dung thuoc qua diidng tiem 67 3.5. Ky thuat tiem bap --------------s—:-----------------------r~ STT Cac budc thuc hanh PhUdng phap tien hanh Ly do NhOmg diem can luu y Hinh anh minh hoa 1 Nhan dinh tinh trang ngirdi benh 2 Nhan dinh kien thiic ve thuoc cua ngudi benh 3 Kiem tra doi chieu Tri giac? Tuoi: gia, tre? Ldp md dudi da day hay mong. SU van dong di lai cua ngudi benh. Yeu liet? So lUdng va loai thuoc dung, thuoc pha? Xac dinh xem ngUdi benh cc di Ung vdi cac loai thuoc nao? Nhan dinh xem ngUdi benh co kien thUc ve viec dung thuoc khong? Kiem tra lai y lenh ve thuoc cua bac sT: 5 dung Doi chieu ten ho, Chon lua dung cu tiem i ong tiem va kim tiem) cho phu hdp Phong ngUa ngudi benh di Ung vdi thucc HUdng dan cach theo doi cho ngudi benh De chac ch in dung thuoc dung y lenh De chac chan Neu ngudi benh yeu liet ben nao thi ta khong nen tiem thuoc ben dd vi cd vung dd kem phat trien Khong dung lai loai thuoc ma ngudi benh da bi di Ung Dung tU ngCf de hieu L Dung ngUdi benh, dung thuoc, dung lieu, dung thdi gian, dung dudng dung Yeu cau ngUdi benh noi tuoi ngUdi benh, so giUdng, so phong dung thuoc khong nham ngUdi benh ten . 4 Chuan bi ngi/di benh Bao va giai thich Tien hanh dUdc thuan ldi va an toan Ngudi benh an tam hdp tac Dung tU ngU de hieu 5 Rifa tay Mang khau trang, nia tay thudng quy Han che sU nhiem trung cho ngudi benh. Dam bao an toan khi thuc hien ky thuat vo khuan Toe gon gang Khau trang che kin mui, mieng Rifa tay sach het cac mat cua doi tay 6 I Xac dinh vi tri tiem i Tiem bap nong: cd delta cach u vai 5cm Tranh cac tai bien do tiem sai vi tri Ludng thuoc tiem bap nong khong qua 1ml va tiem bap sau khong qua 5ml Cd tam Vi tri ^ tiem I vJw- \ Vi tri tiem bap nong 7 Mang gang Tiem b£p sau: - Dui: 1/3 gi&a mat ngoai dui - Mong: 1/3 tren ngoai difdng ndi giiira gai chau trudc tren vdi xifdng cung Mang gang tay Bao ve cho Mang gang tay theo / \ Chau / ___JGai chau / ' tru'dc tren w r 1 / ( / ? i v' ,n tay sach nhan vien y te tranh sir lay nhiem tCf ngi/di benh cach sach, cd gang phu hdp de thao tac diroc gon gang MAu , / chuyen ldn xi/ong dui . i K l ' i v, ' M V V ' ; ; btTr f: 1.1 I tr i ' \tY •/, tifim \ 'Hr du' \ Ldi cAu \ \yC ngoAi ' xuong dui • y t 8 Sat khuan Dung bong cau con Han che sir 1 I 1 ij. Sat khuan rong tir trong vung tiem 9 Sat khuan lai tay vo khuan de sat khuan rong vung tiem Sat khuan tay lai vdi dung dich rCra tay nhanh nhiem khuan tif vung da xung quanh GiOf an toan ndi vi tri dam kim Giam si/ lay nhiem cheo ra ngoai 5cm vdi bong cau con 70° hoac con iot Sat khuan ky lai cac dau ngon tay 9r«s# 10 Tiem thuoc Dudi khi Kiem tra lai lieu thuoc chinh xac, ngira tai bien do khi gay ra De bdm tiem thang difng, loai bo khi trong ong tiem tranh lam mat thuoc Cang da, dam kim goc 90° so vdi mat da Rut nong kiem tra khong co mau Tiem vao bap cd Xac dinh chac chan vi tri kim nam trong b lp cd Tiem dung vi tri Rut nong neu thay mau chay ra la dam kim vao mach mau, phai rut kim ra. 69 L j ............ . \------ -------- - Bdm thuoc cham Giam bdt kich thich cho ngudi benh Rut kim nhanh Han che sU ton thadng mo Phai quan sat s ic mat ngudi benh khi bdm thuoc de phat hien sdm cac phan Ung bat thudng Rut kim nhanh theo hudng dam vao ^ > x ^ \ Co dinh kirn i 1 Chuan bi i ngudi benh Sat khuan lai vi tri tiem Co dinh kim an toan Thong bao, giai thich cho ngUdi benh biet viec da xong, giup ngudi benh tidn nghi Tranh si/ lay nhiem qua Id chan kim Tranh nguy cd gay lay nhiem do vat sac nhon Giup ngadi benh dUdc tien nghi Dung bong cau con massage nhe vung tiem Bo han bdm va kim tiem vao thung nhua cUng mau vang V J t k ' J h J Dung tU ngU de hieu Thai do phai niem nd, an can, vui ve khi giao tiep Ghi ho sd Ngay gid dung thuoc Lieu dung Phan Ung cua ngudi benh neu cd Tinh trang ngudi benh 3.6. Ky thuat tiem clu’ofi da Danh gia tinh trang sau khi dung thuoc cua ngUdi benh Theo doi va quan ly ngudi benh Ghi chu can than nhung dap Ung va cac phan Ung cua ngudi benh khi dung thuoc qua dudng tiem Cac budc thuc hanh PhUdng phap tien hanh Ly do Nhung diem can luu y Hinh anh m inh hoa Tuy theo kich thudc, can nang cua ngudi benh ma ta cd goc dd tiem khac nhau Phong ngUa shock phan ve khi tiem thudc Khong dung lai loai thuoc ma ngudi benh da bi di Ung Dung tU ngU de hieu 7 0 Nhan dinh tinh trang ngUdi benh Nhan djnh kien thUc ve thuoc cua ngadi benh Tri giac? Tuoi: gia, tre? Ldp md dudi da day hay mong So ludng va loai thuoc dung, thuoc pha? Xac dinh xem ngudi benh cd di Ung vdi cac loai thuoc nao? Nhan dinh xem ngudi benh co kien thuc ve viec dung thuoc khong? Chon lua dung cu tiem (ong tiem va kim tiem) cho phu hdp Phong ngUa ngudi benh di Ung vdi thuoc Hudng dan cach theo doi cho ngadi benh Kidm Ira doi chieu Chuan bi ngudi benh Rifa tay Xac dinh vi tri tiem Mang gang tay Sat khuan vung tiem Sat khuan lai tay Kiem tra lai y lenh ve thuoc cua bac sT: 5 dung Doi chieu ten ho, tuoi ngUdi benh, so giUdng, so phong Bao va giai thich Mang khau trang, rCra tay thudng quy Dau dudi cd delta Hai ben ba vai Hai ben ron each ron 5cm 1/3 giUa mat ngoai, trudc cua dui Mang gang tay sach Dung bong cau con vo khuan de sat khuan rong vung tiem Sat khuan tay lai vdi dung dich rUa tay nhanh De chac chan dung thudc dung y lenh De chac chan dung thudc khong nham ngUdi benh Tien hanh dUdc thuan ldi va an toan NgUdi benh an tam hdp tac Han che sU nhiem trung cho ngudi benh. Dam bao an toan khi thuc hien ky thuat vo khuan Tranh cac tai bien do tiem sai vi tri Bao ve cho nhan vien y te tranh su lay nhiem tU ngUdi bentt Han che su1 nhiem khuan tU vung da xung quanh GiU an toan ndi vi tri dam kim Giam sU lay nhiem cheo Dung ngUdi benh, dung thuoc, dung lieu, dung thdi gian dung dudng dung Yeu cau ngudi benh noi ten Dung tu ngU de hieu Toe gon gang Khau trang che kin mui, mieng RCfa tay sach het cac mat cua doi tay LUdng thuoc tiem dudi da khong qua 1ml Mang gang tay theo cacti sach, cd gang phu hdp de thao tac dUdc gon gang Sat khuan rong tU trong ra ngoai 5cm vdi bong cau con 70° hoac con iot Sat khuan ky lai cac dau ngon tay 10 I Tiem thuoc Dudi khi Kiem tra lai lieu thudc chinh xac va ngUa tai bien do khi gay ra De bdm tiem thang dung, loai bo khi trong ong tiem tranh lam mat thuoc Veo da, dam kim goc 45 do so vdi mat da Rut nong kiem tra khong co mau Tiem vao mo lien ket long leo dudi da Xac dinh chSc chan vj tri kim nam trong b lp cd Tiem dung vj tri • ■ r a • * J f Rut nong neu thay mau chay ra la dam kim vao mach mau, phai rut kim ra. Bdm thuoc cham Giam bdt kich thich cho ngudi benh Rut kim nhanh Han che sU ton thUdng mo Phai quan sat sac mat ngudi benh khi bdm thuoc de phat hien sdm cac phan Ung bat thudng Rut kim nhanh theo hudng dam vao Sat khuan lai vj tri tiem 11 Co dinh kim Co djnh kim an toan Tranh sif lay nhiem qua lo chan kim Tranh nguy cd gay lay nhiem do vat s ic nhon Dung bong cau con massage nhe vung tiem Bo han bdm va kim tiem vao thung nhua cOng mau vang 12 Chuan bj ngudi benh Thong bao, giai thich cho ngudi benh biet viec da xong, giup ngifdi benh tien nghi Giup ngudi benh dUdc tien nghi Dung tU n gif de hieu Thai do phai niem nd, an can, vui ve khi giao tiep n 13 Ghi ho sd Ngay gid dung thuoc Lieu dung Phan ifng cua ngudi benh neu co Tinh trang ngu'di benh Danh gia tinh trang sau khi dung thuoc cua ngUdi benh Theo doi va •quan ly ngudi benh Ghi chu can than nhifng dap Crng va cac phan ifng cua ngudi benh khi dung thudc qua dudng tiem 3.6. Ky thuat tiem tinh mach STT Cac budc thuc hanh PhUdng phap tien hanhLy do Nhung diem can luu y Hinh anh minh hoa 1 Nhan dinh tinh trang ngudi benh 2 Nhan dinh kien thUc ve thuoc cua ngudi benh 3 Kiem tra doi chieu Tri giac? Tuoi: gia, tre? Ldp md dudi da day hay mong. Sd lUdng va loai thudc dung, thudc pha? Xac dinh xem ngudi benh cd dj Ung vdi cac loai thudc nao? Nhan djnh xem ngudi benh cd kien thCrc ve viec dung thudc khong? Kiem tra lai y lenh ve thudc cua bac si: 5 dung Doi chieu ten ho, tuoi ngudi benh, sd giUdng, sd phong Chon lira dung cu tiem (ong tiem va kim tiem) cho phu hdp Phong ngUa ngudi benh dj Ung vdi thudc Hudng dan cach theo doi cho ngUdi benh De chac chan dung thudc dung y lenh De chac chan dung thudc khong nham ngudi benh Tuy theo kich thudc, can nang cua ngudi benh ma ta cd goc do tiem khac nhau Phong ngUa shock phan ve khi tiem thudc Khong dung lai loai thudc ma ngudi benh da bi dj Ung Dung tU ngu de hieu Dung ngudi benh, dung thudc, dung lieu, dung thdi gian, dung dudng dung Yeu cau ngudi benh ndi ten 4 Chuan bi ngudi benh Bao va giai thich Tien hanh dUdc thuan ldi va an toan NgUdi benh an tam hop tac Dung tU ngU de hieu 5 RCra tay Mang khau trang, rCra tay thudng quy Han che sU nhiem trung cho ngudi benh. Dam bao an toan khi thuc hien ky thuat vo khuan Toe gon gang Kha’u trang che kin mui, mieng RCra tay sach het cac mat cua doi tay 6 Xac dinh vi tri tiem 7 Mang gang tay Chon tinh mach to, ro, it di dong Mang gang tay sach Tranh cac tai bien do tiem khong vao tinh mach Bao ve cho nhan vien y te tranh su lay nhiem tU ngudi benh Nen chon tinh mach tren tay khong thuan trudc de ngudi benh tien nghi hdn Mang gang tay theo • cach sach, cd gang phu hop de thao tac dUdc gon gang 8 Buoc garo That garo phia tren tinh mach Giup tinh mach ndi ro Buoc garo cach ndi tiem 10 15 cm 73 9 Sat khuan vung tiem 10 Sat khuan lai tay Dung bong con vo khuan de sat khuan rong vung tiem Sat khuan tay lai vdi dung dich rUa tay nhanh Han che sU nhiem khuan tu vung da xung quanh GiU an toan ndi vi tri dam kim Giam su lay nhiem cheo Sat khuan rong tU trong ra ngoai 5cm (hoac sat trung doc theo tinh mach tU dUdi ten va ra hai ben) vdi bong cau con 70° hoac con iot Sat khuan ky lai cac dau ngon tay -------------------------------— \ v S ^ -------------- y 11 Tiem thuoc Dudi khi Kiem tra lai lieu thuoc chinh xac va phong tai bien do khi gay ra De bdm tiem thang dUng, loai bo khi trong ong tiem tranh lam mat thuoc ^ > De mat vat kim len tren, cang da, dam kim goc 30 + 40 do qua da vao tinh mach Rut nong kiem tra co mau, thao garo Tiem vao tinh mach Xac dinh chac c h in vi tri kim n lm trong tinh mach Tiem dung vi tri, goc do tiem tuy theo vi tri tinh mach ' - A Rut nong neu thay mau chay ra la xac dinh dung kim nam trong tinh mach Bdm thuoc cham Giam bdt kich thich cho ngUdi benh Rut kim nhanh Han che sU ton thudng mo va mach mau Phai quan sat sac mat ngudi benh khi bdm thuoc de phat hien sdm cac phan Ung bat thudng| Rut kim nhanh theo chieu dam vao Sat khuan lai vi tri tiem 12 Co dinh kim Co dinh kim an toan Tranh sU lay nhiem qua lo chan kim Tranh nguy cd gay lay nhiem do vat sac nhon Dung bong cau con massage nhe vung tiem Bo han bdm va kim tiem vao thung nhua cUng mau vangJ 13 I I Chuan bi ngu'di benh Thong bao, giai thich cho ngu'di benh biet viec da xong, giup ngudi benh tien nghi Giup ngUdi benh dUdc tien nghi Dung tu ngu1 de hieu Thai do phai niem nd, an can, vui ve khi giao tiep W l 14 Ghi ho so Ngay gid dung thudc Lieu dung Phan Ung cua ngu'di benh neu CO Tinh trang ngUdi benh Danh gia tinh trang sau khi dung thuoc cua ngudi benh Theo doi va quan ly ngudi benh Ghi chu can than nhung dap Ung va cac phan i/ng cua ngUdi benh khi dung thuoc qua dudng tiem | 4. TU DANH GlA VA HUAN LUYEN 4.1. Danh gia triicJc huan luyen Phan biet dung sai cac cau sau bang cach tich (V) vao cot I) cho cau dung, cot S cho cau sai SIT Noi dung D S 1 Tiem hdp nong la tiem vao cd rong ben d dui 2Thuoc dung qua diidng tiem se co tac dung nhanh chong, do vav khong nen dung trong cac triidng hdp benh man tinh 3 Ap xe lanh la do tiem thuoc vao mo lien ket long leo dudi da •1 Tiem thuoc tii tii v6i toe do khoang 10 giay/ 1ml phong tai bien shock phan ve 5Khi tiem bat cii diidng tiem nao deu khong dUdc dam het than kim. 6 Khi tiem thuoc can phai mang theo hop thuoc chong soc. 7 Tiem dudi da la tiem vao mo lien ket long leo 8 Tiem bap d dui, goc do tiem la 90 do so vdi mat da 9Ap xe nong la do khong ap dung dung ky thuat vo khuan khi tiem thuoc 10 Tai bien gay chet ngu'di khi tiem la shock phan ve 11 Tiem bap d cd delta, goc do tiem la 60 do so vdi mat da 12Ap xe lanh la do khong ap dung dung ky thuat vo khuan khi- tiem thuoc 13 So lifdng thuoc dung de tiem bap nong khong qua 1ml 11Khong nen tiem ludng thuoc qua nhieu so v6i vi tri quy dinh de phong tai bien ap xe lanh 15Khi tiem nen dam va rut kim cung mot goc de ngua ton thiidng mo 4.2. Huan luyen co giao vien hiidng dan va lam mau Tru'dc khi bat dau phan hudng dan thuc hanh. giao vien co trach nhiem thong bao nhung veu cau chinh can dat dude trong buoi huan luyen: - Phai chac chan sinh vien hieu ro diidc moi van de trong buoi huan luyen. Khi bat dau buoi huan luyen, nen lam ro cac cau hoi, nhung dieu ma sinh vien chiia nam ro va chu y den nhung dieu ma sinh vien co the dai duoc sau buoi huan luyen. - Tom tat nhiing van de can chu y. Triidc khi giai thich va thiic hanh, can de cap den nhiing bu6c quan trong trong ky nang. Giao vien can phai noi ro tiing bu6c trong phan quy trinh ky thuat. - Giao vien giai thich va lam mau: Giao vien se thiic hien toan bo cac budc cua ky thuat, sau do se lam lai tiing budc mot cua ky thuat va giai thich ly do tai sao phai thiic hien nhiing biidc ky thuat nay. Trong khi do, sinh vien se quan sat va lam theo, sinh vien co the dat nhiing cau hoi va nhan xet va tham chi co the yeu cau giac? vien thiic hien trd lai biidc quy trinh ma sinh vien khong nam ro. - Kiem tra sii tiep thu cua sinh vien: -Mdi mot sinh vien len trinh dien lai ky nang viia day, dong thdi cac sinh vien khac se quan sat va cho nhan xet. - Thiic hanh theo nhom: + Cac sinh vien se diidc thiic hanh tren mo hinh theo tiing nhom nho theo quy trinh ky thuat. Giao vien dieu chinh thao tac giup sinh vien quen dan vdi cac ky nang. Giao vien chu y nhiing sai sot khi sinh vien thiic hanh, hiidng dan lai giup sinh vien thiic hien cho de dang va dat yeu cau. + Cac ban sinh vien khac cung quan sat ban thiic hien thao tac trong ky thuat, cung dong gop y kien va rut kinh nghiem khi giao vien stia sai. 4.3. Tti ltiofng gia: sti dung bang kiem (checklist) Bang kiem liidng gia ky thuat dung thuoc qua difdng tiem bap STT Noi dung Tot Oat Sai Khong Ghi lam chu 1 Nhan dinh tinh trang ngu'di benh 2 Nhan dinh kien thiic ve thuoc cua ngirdi benh 3 Kiem tra' doi chieu 4 Chuan bj ngu'di benh 5 Riia tay 6 Xac dinh vi tri tiem 7 Mang gang tay 8 Sat khuan rong vung tiem 9 Sat khuan lai tay 10 Tay cang da, dam kim goc 90 do so vdi mat da 11 Rut nong bdm ti§m kiem tra mau 12 Bom thuoc tii tii va quan sat sac mat ngu'di benh 76 Rut kim theo hudng dam vao, sat khuan lai vj tri tiem 13 14 Co dinh kim 15 Thao gang tay 16Cho ngifdi benh nSm lai tien nghi, theo doi sif dap ung thuoc cua ngu'di benh 17 Ghi ho so Bang kiem lifOng gia ky thuat dung thuoc qua di/dng tiem di/di da STT Noi dung Tot Dat Sai Khong lam 1 Nhan djnh tinh trang ngudi benh 2 Nhan dinh kien thCrc ve thuoc cua ngudi benh 3 Kiem tra doi chieu 4 Chuan bj ngudi benh 5 Rifa tay 6 Xac dinh vj tri tiem 7 Mang gang tay 8 Sat khua’n rong vung tiem 9 Sat khua’n lai tay 10 Tay veo da, dam kim goc 45° so vdi mat da 11 Rut nong kiem tra mau 12 Bom thudc tiftif va quan sat sac mat ngudi benh 13 Rut kim theo hudng dam vao, sat khuan lai vj tri tiem 14 Cd djnh kim • 15 Thao gang tay 16Cho ngudi benh nam lai tien nghi, theo doi sif dap ifng thudc cua ngudi benh 17 Ghi ho so Bang kiem Itfdng gia ky thuat dung thuoc qua dudng tiem trong da STT Noi dung Tot Dat Sai Khong lam 1 Nhan djnh tinh trang ngudi benh 2 Nhan djnh kien thifc ve thudc cua ngudi benh Ghi chu Ghi chu 77 3 Kiem tra doi chieu 4 Chuan bj ngu'di benh 5 Rifa tay. 6 Xac djnh vj tri tiem 7 Mang gang tay 8 Sat khuan rong vung tiem 9 Sat khuan lai tay 10 Tay c3ng da, dam kim goc 15° so vdi mat da 11 Bom 0,1 ml vao Idp trong da 12 Rut kim theo hirdng dam vao 13 Co djnh kim 14 • Thao gang tay 15Cho ngu'di benh nam lai tien nghi, theo doi si/ dap ung thuoc cua ngudi benh 16 Ghi ho so Bang kiem li/dng gia ky thuat dung thuoc qua di/dng tiem tinh mach STT Noi dung Tot Dat Sai Khong Ghi lam chu 1 Nhan djnh tinh trang ngudi benh 2 Nhan djnh kien thuc ve thuoc cua ngudi benh 3 Kiem tra doi chieu 4 Chuan bj ngudi benh 5 Rifa tay 6 Xac djnh vj tri tiem 7 Mang gang tay 8 Cot garo cach vi tri tiem 10 ^15cm 9 Sat khuan rong vung tiem 10 Sat khua’n lai tay 11Tay cang da, dam kim goc 30 4- 40° so vdi mat da, luon kim vao tinh mach 12 Rut nong bom tiem kiem tra mau 13 Thao garo 14 Bom thuoc tCr tir va quan sat sac mat ngudi benh