Algorithm for performing the manipulation “Inserting a gas outlet tube. Technique for installing a gas outlet tube for an infant Necessary equipment when using a gas outlet tube

Gas outlet pipe - rubber tube 40 cm long, internal diameter 5-10 mm, the outer end is slightly widened, and there are holes on the rounded (inner) part of the tube in the center and on the side wall. Removal of gases from the intestines is also possible with a cleansing enema. If performing a cleansing enema is undesirable, and flatulence (increased gas formation in the intestines, accompanied by bloating), despite a special diet, taking activated charcoal or chamomile infusion, causes significant anxiety to the patient, a gas outlet tube is inserted into the rectum.

Contraindications: gastrointestinal bleeding, rectal fissures, acute inflammatory or ulcerative processes in the area of ​​the large intestine and anus, tumors of the anal canal and rectum.

Possible complications:
– injury to the rectal mucosa with subsequent bleeding;
– perforation (from Latin . perforatio- perforation; hole) of the intestine with the subsequent development of peritonitis (from the Greek. peritonion– peritoneum; inflammation of the peritoneum) and bleeding.

Use a gas outlet tube with the accumulation of a large amount of gas in the intestines. The gas outlet tube is a soft, thick-walled rubber tube 30 - 50 cm long and 3-5 mm in diameter, its outer end is slightly expanded, and there are holes on the rounded (inner) part of the tube in the center and on the side wall.

The nurse, wearing gloves, places the patient on his left side with his legs pressed to his stomach and spreads his buttocks (if the patient is contraindicated in lying on his left side, the gas outlet tube can be placed in a supine position). An oilcloth is placed under the patient’s buttocks, and a diaper is placed on top of it. Having bent the gas outlet tube, clamp the free end with 4 and 5 fingers, and the rounded end like a ballpoint pen. The gas outlet tube, lubricated with Vaseline, is carefully inserted into the anus with rotational movements. The nurse slightly lifts the sacral area with her left hand, and with her right hand inserts a gas outlet tube 20-30 cm so that the outer end is lowered into the bedpan, since feces particles can leave the intestines along with gases. The duration of the procedure is determined by the doctor. The gas outlet tube can be kept for no more than 2 hours. In case of accumulation of feces in the intestines, the patient is given a microenema with glycerin or chamomile before inserting a gas outlet tube. After removing the tube, wipe the circumference of the anus with cotton wool or toilet paper, and in case of irritation, lubricate it with Vaseline.

Vilet9
1. sterilization concept methods and modes of sterilization. physical and chemical methods of sterilization
Sterilization ensures the death of vegetative and spore forms of pathogenic and non-pathogenic organisms on sterilized products. Sterilization must be confirmed by all products in contact with the wound surface. With blood or injection. Drugs, medical instruments, which during operation come into contact with the mucous membrane and can cause damage to it. Physical metal (steam, air, radiation) Chemical (gas, sterilant solutions)
Air method (carried out with dry hot air. Processing is carried out in air sterilizers-dry-heat ovens. I sterilize metal and glass products: surgeon, gynecologist, dentist. Instruments, parts of devices and apparatus. Loading and unloading from air sterilizers is carried out at T in the chamber 40-50 degrees.
The steam method - autoclaving involves the use of saturated water steam under excess pressure. Sterilization is carried out in autoclaves. Products for sterilization. Placed in a sterilization room. Boxes (boxes) or in special. Containers.in a sterile container.
Chemical sterilization is carried out by completely immersing dry products in a solution, detachable ones in disassembled form. Channels and cavities are filled with a solution after sterilization. All manipulations are carried out under conditions of strict asepsis. The products are removed with sterile tweezers, the solution is removed from the channels and cavities. And then they are washed with a sterile liquid and dried with wipes. The products are used immediately for their intended purpose or placed in storage. Gas and radiation sterilization allows the processing of thermolabile disposable products applications, suture material, optical systems, drugs. Mandatory conditions for maintaining the sterility of disposable medical products: integrity of packaging, expiration date.
Gas sterilization is used for most honey. Products (catheters, syringes, drip systems). Radiation is used for polymeric materials, vaccines, serums and drugs. Sterilization agent. Gamma and beta rays.
2. Classification of problems by priorities.Primary - require urgent measures, are life-threatening (shortness of breath, suffocation, disorder of consciousness), those problems that are mainly resolved by a doctor or medical team. Intermediate - do not require emergency measures, are not life-threatening - these are problems that will be dealt with by the medical .nurse (loss of appetite due to illness, lack of knowledge about their health status, urinary incontinence) Secondary - not directly related to the disease and prognosis (intestinal dysfunction in a patient with bronchitis or lack of knowledge about healthy eating in a patient with a broken leg)
3.Patient education of various forms Medicines enterally, sublingually. 1. Motivate the patient to correctly carry out drug treatment, using the rules of bioethics and deontology. 2. find out the body’s possible reaction to certain drugs. 3 make a list of all drugs prescribed by the doctor. 4. note the peculiarities of drug administration (sublingual, rectal, intranasally) 5. pay attention to possible reactions of the body during treatment: dizziness, weakness, rash, etc. Enterally, i.e. orally (medicinal products are absorbed into the gastrointestinal tract through the mouth, under the tongue, through the rectum) Sublingually (under the tongue) The drugs are well absorbed through the mucous membrane of the sublingual area and quickly enter the bloodstream, bypassing the liver and without being destroyed by the digestive tract. Enzymes.
4.Catheterization of the bladder. Goals, contraindications and possible complications. Catheterization of the bladder with a soft catheter in women. Catheterization of the bladder - the procedure for inserting a catheter through the urethra into the bladder. for the purpose of removing urine in case of urinary obstruction. paths, urine retention in the bladder, laboratory diagnostics of urine for microflora, administration of X-ray contrast agents during instruments. study of the patient, drug treatment. Goals: emptying the bladder in case of acute urinary retention; excretion of urine in case of urinary incontinence/incontinence; washing the bladder; administration of drugs; urine collection during examination. Complications: risk of infection of the bladder; trauma to the urinary tract. Catheterization of the bladder in women. Before the procedure, hygiene of the external genitalia is carried out. Patient position: lying on the back , legs bent at the knees, apart at the hip joints. Sequence of actions: wash and dry your hands; put on gloves; substitute a pan; treat the gloves with an antiseptic; take a gauze ball with a clamp, moisten it with an antiseptic (furatsil.) and treat the urethral area; discard use. Ball; take the catheter with tweezers, wrap the working end with lubricant. separate the labia minora and majora, insert the catheter into the urethra to a depth of 3-5 cm, gradually advance the catheter with tweezers until urine appears. Lower the outer end of the catheter into the vessel. Press with your left hand into suprapubic area for more complete emptying of the bladder. Remove the catheter when the stream of urine weakens, dump the catheter into a container with a disinfectant. The last portion of urine washes the walls of the urinary tract in order to prevent ascending infection. Remove gloves, wash your hands. Ensure the patient’s comfort.

Ticket 13. Medical and protective regime is a set of preventive and therapeutic measures aimed at providing assistance, treatment and returning patients to society as its full-fledged members who have mastered a lifestyle that is more appropriate for maintaining health. Target: The environment of the medical institution should provide the patient with mental and physical peace, helping to overcome the unfavorable factors of hospitalism: fear and anxiety before research, treatment, experiences of parting with the usual home environment, difficulties in adapting to the new environment, surrounding medical workers and roommates. Elements of the medical and protective regime: 1. Appropriate physical activity; 2. Psychological comfort of the patient; 3. Daily routine of the medical department. The feasibility of physical activity Mobility (mobility) is the patient’s ability to move in space. When caring for a patient, the nurse ensures the patient's safety through the effective use of muscle strength, coordination of movements, and body weight. Types of physical activity regimes The physical activity regime is prescribed to the patient by the doctor depending on the severity of the disease. Strict bed - prescribed during the onset of severe acute conditions (acute myocardial infarction, concussion) - the patient is not allowed to move independently in bed. All basic human needs are violated, the nurse carries out independent and dependent activities for the patient in order to prevent potential problems. 1. Bed – limited physical activity is allowed: turning, sitting in bed, next to the bed, performing therapeutic exercises independently or with the help of a specialist. The nurse encourages the patient to become independent and assists him in self-care activities. 2.Semi-bed – They are allowed to sit on a bed, a chair, and perform the morning toilet with the help of a sister or relatives. The patient experiences a relative lack of self-care. 3. Ward – are allowed to move within the ward, care is provided independently within the ward. 4.General - allows free movement within the medical department, walks around the territory of the health care facility, complete self-care. Monitoring the patient’s compliance with physical activity is the responsibility of the nurse.Position of the patient in bed

Active– free and arbitrary movement in bed - the patient independently turns, sits, stands up, serves himself. Can voluntarily change its position, although it experiences painful or unpleasant sensations Passive– the patient cannot independently turn around or change position due to severe weakness with high intoxication, bleeding, in the postoperative period; often such patients are in a serious or unconscious state. Forced- the patient takes a position to alleviate or improve his condition, depending on the characteristics of the disease: 1. with abdominal pain, the patient bends his legs, avoids any touch to the stomach; 2. with colic in the abdomen, the patient is restless, rushes about in bed or is stiff. 3. in the presence of inflammatory fluid in the pleural cavity - lies on the affected side to reduce pain; 4. in the event of an attack of suffocation due to bronchial asthma - sits in bed, resting his hands on the bed. Psychological comfort of the patient The nurse must perceive each person as an individual, regardless of the severity of the condition and social status. Recommendations for the nurse in communicating with the patient: 1. Support and encourage the desire for recovery in the current situation. 2, Be patient and correct when performing intimate procedures. 3, Take into account the level of personal maturity. 4, Speak in a language he understands.5, Observe the principle of informed consent: explain the significance of the treatment procedure, aim for positive results.6, Help the patient become an active participant in the treatment process. Daily regime. Compliance with the daily routine is strictly mandatory for both patients and all hospital workers. The nurse introduces him to patients admitted to the department and their relatives, participates in all activities and monitors the implementation of the established regime in the department. A safe hospital environment is not possible without strict adherence to other internal regulations. They are aimed at reducing the risk of various poisonings and injuries. Threats to health can be posed by: infection, improper use of potent and toxic substances and disinfectants, high and low temperatures, various radiations, violations in the operation of electrical equipment and oxygen installations. In a hospital setting, how Patients and medical workers may be poisoned and injured as a result of falls, burns, or electric shock. The risk of accidents is especially high in children and elderly patients. Compliance with these rules will ensure: conditions for the most effective way to satisfy all the basic needs of the patient, and therefore quality care; the ability to organize the work of the entire medical team and use everyone’s working time more efficiently; prevention of various accidents, the risk of which in a hospital setting is quite high for both the patient and the medical worker.

Information about the patient must be complete and unambiguous. Collecting incomplete, ambiguous information leads to an incorrect assessment of the patient’s needs for nursing care, and, as a result, to ineffective care and treatment
Sources of information when examining a patient 1) from the patient himself; 2) relatives, acquaintances, roommates, random people, witnesses of the incident; 3) doctors, nurses, members of the ambulance team, nurses; 4) from medical documentation: inpatient records, outpatient records, extracts from medical histories of previous hospitalizations, examination data, etc.; 5) from special medical literature: care guides, standards of nursing procedures, professional journals, textbooks, etc.
Based on the data obtained, one can judge the patient’s health status, risk factors, characteristics of the disease, and the need to provide nursing care to the patient.

Patient - the main source of subjective and objective information about yourself. In cases where he is incapacitated, comatose, or an infant or child, the main source of data may be his relatives. Sometimes they are the only ones who know about the characteristics of the patient’s condition before and during the illness, about the medications he is taking, allergic reactions, seizures, etc. The main medical documentation necessary for nursing staff is an inpatient or outpatient card. Before starting to interview the patient, nursing staff familiarize themselves with such a card in detail. In case of re-hospitalization, previous medical histories are of interest; they are requested from the archive if necessary. This is a source of valuable data regarding the characteristics of the course of the disease, the volume and quality of nursing care provided, psychological adaptation, the patient’s reactions to hospitalization, negative consequences associated with the patient’s previous hospital stay or seeking medical help. In the process of getting the nursing staff acquainted with the patient's medical history, hypotheses may arise about the possible causes of his problems (work in hazardous work, family history, family troubles). There are two types of patient information: subjective and objective.
Subjective information - This is information about the patient’s feelings regarding health problems. For example, complaints of pain are subjective information. The patient can report the frequency of pain, its characteristics, duration, location, intensity. Subjective data include patient reports of anxiety, physical discomfort, fear, complaints of insomnia, poor appetite, lack of communication, etc.
Objective information - results of measurements or observations. Examples of objective information include indicators of measuring body temperature, pulse, blood pressure, identification of rashes on the body, etc. Objective information is collected in accordance with existing norms and standards (for example, on the Celsius scale when measuring body temperature). Survey as the main method of collecting subjective information about the patient A nursing examination usually follows a medical examination. The first step in a nursing examination of a patient is the collection of subjective information using a nursing interview (collection of primary information about objective and/or subjective facts from the words of the interviewee).
When conducting a survey, it is necessary to use specific communication skills in order to focus the patient’s attention on his state of health, to help him understand the changes that are occurring or will occur in his lifestyle.

Objectives of the survey: establishing a trusting relationship with the patient; familiarizing the patient with the course of treatment; developing an adequate patient attitude towards states of anxiety and anxiety; clarifying the patient's expectations from the medical care system; obtaining key information that requires in-depth study.
At the beginning of the interview, you must introduce yourself to the patient, state your name, position, and state the purpose of the conversation. Then find out from the patient how to contact him. This will help him feel comfortable .

Patient position. It depends on the general condition. There are three types of patient position: active, passive and forced.
The patient, who is in an active position, easily changes it: sits down, stands up, moves around; serves himself. In a passive position, the patient is inactive, cannot independently turn around, raise his head, arm, or change body position. This situation is observed when the patient is unconscious or in a state of hemiplegia, as well as in cases of extreme weakness. The patient takes a forced position to alleviate his condition. For example, when there is pain in the stomach, he tightens his knees, when he is short of breath, he sits with his legs down, holding his hands on a chair, couch, or bed. Patient's height and weight. They find out what his usual body weight is and whether it has changed recently. The patient is weighed, normal body weight is calculated, his height is measured, and it is determined whether he has weakness, fatigue, or fever. . Assessment of the condition of the skin and visible mucous membranes When examining, palpating (if necessary) the skin and visible mucous membranes, you should pay attention to the following characteristics.
Coloring of the skin and mucous membranes. Examination reveals pigmentation or its absence, hyperemia or pallor, cyanosis or yellowness of the skin and mucous membranes. Before the examination, you should ask the patient if he has noticed any changes in his skin. Assessment of the state of the senses. Organs of vision, hearing, smell Upper body assessment A Head. First of all, you need to find out if the patient has complaints of headaches, dizziness, or whether there have been injuries. Headache is a very common occurrence in patients of all ages. It is necessary to find out its nature (is it constant or pulsating, sharp or dull), localization, whether it first appeared or has a chronic course Neck. Upon examination, various swellings, swollen glands, goiter, and pain are revealed. Assessment of the condition of the mammary glands. Assessment of the condition of the musculoskeletal system To determine the state of this system, you must first find out whether the patient is bothered by pain in the joints, bones and muscles. Respiratory system assessment First of all, you need to pay attention to the change in the patient’s voice; frequency, depth, rhythm and type of breathing; excursion of the chest, assess the nature of shortness of breath, if any, the patient’s ability to tolerate physical activity, find out the date of the last x-ray examination. Assessment of the state of the cardiovascular system Pulse and blood pressure are determined, as a rule, before assessing the state of the cardiovascular system. When measuring the pulse, you need to pay attention to its symmetry in both arms, rhythm, frequency, filling, tension, deficit.
When a patient complains of pain in the heart area, it is necessary to clarify its nature, localization, radiation, duration. A characteristic sign of cardiovascular pathology is edema. They arise due to the accumulation of fluid in the tissues and cavities of the body. There are hidden (not visible during external examination) and obvious edema. Obvious edema is easy to identify by changes in the relief of certain areas of the body. When the leg swells in the area of ​​the ankle joint and foot, where there are bends and bony protrusions, they are smoothed out. Assessment of the state of the gastrointestinal tract (GIT) Based on the information obtained about the state of the patient’s gastrointestinal tract, one can judge the degree to which his needs for food, drink, and removal of waste products from the body are met.
It is necessary to find out from the patient whether he has disturbances of appetite, heartburn, nausea, vomiting (particular attention should be paid to bloody vomiting), belching, digestive disorders, problems with swallowing. It is advisable to begin the examination with the tongue - the mirror of the stomach. Assessment of the condition of the urinary system. During a nursing interview and examination, it is necessary to assess the nature and frequency of urination in the patient, the color of urine, its transparency, and identify disorders of the urinary system (qualitative and quantitative). Assessment of the state of the endocrine system. When assessing the endocrine system, nursing staff need to pay attention to the patient’s hair growth pattern, the distribution of subcutaneous fat, and visible enlargement of the thyroid gland. Often, endocrine system disorders associated with changes in appearance become the cause of psychological discomfort for the patient.

Target. Removal of gases from the intestines.
Indications. Flatulence.
Contraindications. Intestinal bleeding; bleeding rectal tumor; acute inflammation of the anus.

1. Preparation for the procedure:

1. Performing the procedure:

• End of the procedure:

The tube stay time should not exceed 2 hours to avoid the development of rectal bedsores.

If the patient is contraindicated in the lateral position, the gas outlet tube can be placed in the supine position with knees bent and legs slightly apart.

When performing the procedure, it is necessary to monitor the passage of gases and the patient’s well-being every 15 minutes, because the tube may become blocked with feces.

If the procedure is ineffective, repeat it after 1-2 hours using another sterile gas outlet tube.

In case of flatulence, limit the consumption of milk, black bread, legumes, flour dishes, potatoes, sauerkraut. Activated carbon, infusion of chamomile, dill, and mint are prescribed.

When inserting a tube into children, the depth of insertion of the gas outlet tube depends on the age of the child: for children under 1 year old - 5-8 cm; from 1 to 3 years -8-10 cm; from 3 to 7 years 10-15 cm; older children 20 – 30 cm;

For newborn children, the gas outlet tube is left in place for 30 minutes.

How to install a gas outlet pipe? This question arises in almost every new mother. After all, it is this remedy that helps babies get rid of painful gas. Also, sometimes placement of a gas tube is necessary for adult patients. Let's consider the algorithm of actions, as well as indications for using this tool.

Who needs to use the device? Indications for manipulation

Placement of a gas outlet tube is prescribed for patients who have anal fissures and cannot independently empty their bowels due to the accumulation of air and liquid feces. This procedure is also prescribed for inflammatory diseases of the stomach and intestines. It is worth noting that an enema is often recommended for adult patients. Placement of a gas outlet tube is indicated in cases where it is impossible to use an Esmarch mug or a siphon enema.

This device is often recommended for use in children in the first months of life. A gas outlet tube for newborns is sold in almost every pharmacy chain. This remedy helps get rid of the accumulation of gases and feces.

Preparation for the procedure

Before using the gas outlet tube, you must read the instructions. Each device is accompanied by a separate annotation. What does the instruction say? The gas outlet tube must be pre-washed and sterilized. It is especially important to complete this point when the device will be used on newborn children.

Before using the gas outlet tube, prepare the necessary material. You will need wipes, a tray to collect stool, disposable sterile gloves, and Vaseline or greasy cream to lubricate the tip. How is the gas outlet tube installed? Let's consider the algorithm of actions.

Patient position

Before inserting the device into the intestine, the patient must be positioned correctly. An adult should be asked to lie on his right side and tuck his legs toward his stomach. This position will allow air to leave the intestines faster.

The gas tube for newborns can be placed in any position. Often mothers place the baby on his back and lift his legs up. It is also allowed to place the baby on his side or tummy. It is worth noting that in the latter case the air will come out much faster, but in this case it will be inconvenient to insert the tube.

Cleaning your hands and preparing the instrument tip

Wash your hands thoroughly with antibacterial soap or use antiseptic gel. Dry your brushes and put on gloves. This method will help you avoid getting your hands dirty with feces. Gloves will also protect the patient’s tube and intestines from germs.

Apply lubricant to the very tip of the tube. This can be regular Vaseline lubricant, a special gel or a rich baby cream. Apply the compound liberally to the end of the fixture. Remember not to allow grease to get into the hole. Otherwise, your tool will simply become clogged and will not allow the gases to escape.

Insertion of a tube into the intestine

How should the gas outlet tube be inserted? Reviews from doctors say that you need to make spiral movements.

Spread your buttocks with your index finger and thumb of your left hand. When inserting the tube into the child, you can simply raise the legs. This manipulation will expose the anus. Carefully insert the tip of the tube into the intestines and begin to gradually turn it clockwise. First, the direction of the tip should go towards the navel. After this, lean back slightly and point the device parallel to the spine.

During insertion of the device, gases and feces may begin to escape. That is why it is worth placing a small tray at the other end of the device in advance. Some straws are equipped with lids. Until you remove this part from the opposite side of the device, air will not begin to escape from the intestines.

Removing gases is the purpose of the procedure

The tube must be inserted to a certain depth. For children, this distance should not exceed five centimeters. For adult patients, the tube can be inserted up to twenty centimeters. Most devices have a special engraving. Focus on it while inserting the device.

When the tube is inserted, you need to make several careful movements with it. Tilt the device several times in different directions. At this point, you will notice feces coming out of the tube. Place the tray and collect the intestinal contents into it.

Removing the gas tube from the intestine

When the manipulation is completed and the air stops coming out, you need to carefully remove the tube. You can do this in the following way.

Pull the device towards you. There is no need to make rotational movements. All your actions should be slow, never jerk the tube sharply. This can cause discomfort or even pain to the patient. Be prepared for the fact that after removing the gas outlet device, some more feces may spill out of the anus. That is why it is worth placing a waterproof diaper under the patient’s pelvis in advance.

Cleaning the gas removal device

When the tube is removed, you should wipe the baby's anus with a damp cloth or rinse it. An adult patient is recommended to take a shower or perform hygiene measures.

The tube for removing gases must be thoroughly washed in hot water and soap. After this, the device must be sterilized and placed in a storage container. Remember that separate tips or tubes should be used for different people.

An alternative to a gas outlet tube, or making it yourself

If you cannot find such a device on sale, you can make it yourself. Take a rubber syringe and cut it in half at its widest point. As a result, you will get a gas outlet tube with a small capacity. Outwardly, it resembles a funnel.

You need to use such a device in the same way as described above. Don't forget to lubricate the tip. Otherwise, you may damage the intestinal mucosa. After use, thoroughly clean and sterilize the device.

Results and conclusion

Now you know what a gas outlet tube is and why it is needed. Remember that it must be used as prescribed by a doctor. Frequent use of this device may lead to subsequent problems with peristalsis. Try not to abuse this procedure and carry out the manipulation correctly.

If the patient experiences pain immediately after insertion, it is necessary to immediately remove the device and consult a specialist for advice. If blood is released from the intestines, the procedure must be stopped immediately. Otherwise, serious pathology may develop. Listen to the advice of doctors. Good health to you!

Target: removal of gases from the intestines.

Indications: flatulence.

Contraindications: fissures in the anus, acute inflammatory or ulcerative processes in the colon or anus, malignant neoplasms of the rectum.

Equipment: gas outlet tube 40 cm long, 15 mm in diameter, one end slightly expanded, connecting glass tube, rubber tube, sterile Vaseline, vessel, oilcloth, gloves, screen.

1. Separate the patient with a screen, lay him on his back, placing an oilcloth under him.

2. Place a vessel between your legs (pour some water into it).

3. Wash your hands and put on gloves.

4. Lubricate the rounded end of the tube with sterile Vaseline.

5. With your left hand, spread your buttocks, with your right hand, insert the tube into the rectum to a depth of 20-30 cm (lower the outer end of the tube into the vessel).

6. Cover the patient with a sheet.

7. After an hour, remove the tube and clean the anus with a napkin.

8. Place the patient in a comfortable position and remove the screen and bedpan.

9. Disinfect the tube, vessel and oilcloth after manipulation.

10. Remove gloves, wash your hands.

Note:

The gas outlet tube cannot be left in place for more than 1 hour, as bedsores may form on the intestinal mucosa.

Blood pressure measurement

Target: assessment of the functional state of the cardiovascular system

Equipment: tonometer, phonendoscope, pen, temperature sheet.

Algorithm of actions of the nurse:

1. Inform the patient about the upcoming procedure and its progress 15 minutes in advance.

2. Wash your hands.

3. Free the patient's hand from clothing, placing it palm up, at heart level.

4. Apply the cuff to the patient's shoulder. Two fingers should fit between the cuff and the surface of the shoulder, and its lower edge should be located 2.5 cm above the cubital fossa.

5. Place the head of the phonendoscope at the lower edge of the cuff above the projection of the brachial artery in the area of ​​the ulnar cavity, lightly pressing it against the skin, but without making any effort.

6. Gradually inject air into the tonometer cuff with a bulb until the pressure in the cuff, according to the pressure gauge, exceeds by 20-30 mm Hg the level at which the pulsation of the brachial artery ceases to be detected.

7. Maintaining the position of the phonendoscope, open the valve and slowly begin to release air from the cuff at a speed of 2-3 mmHg. per second.

8. Remember on the scale on the tonometer the appearance of the first tone is systolic pressure and the cessation of the loud last tone is diastolic pressure.

9. Record the data obtained on the temperature sheet.

Setting up a sterile table in a treatment room

Target: maintaining the sterility of medical instruments, dressings, and linen.

Indications: preparation for the work of the treatment and dressing rooms, operating room.

Equipment: pack with sterile linen, dressings, gloves; disinfectant solution for cleaning the table, clean gloves.

Algorithm of actions of the nurse:

1. Treat the table surface with a 3% chloramine solution twice with an interval of 15 minutes.

2. Check the type of installation, the date of sterilization on the bix tag and the signature of the employee who performed the sterilization.

3. Enter the date, time of opening the box and your signature.

4. Put on a mask, wash your hands, sanitize, put on sterile gloves.

5. Ask an assistant to open the sterilizer lid or press the pedal of the bix stand, check the sterilization indicators.

6. Using sterile tweezers, fold the corners of the diaper to the sides and cover the edges of the diaper with it.

7. Take out a sheet folded in four layers, without touching non-sterile surfaces (including your gown), cover the table surface with it so that the bottom edge of the sheet hangs 20-30 cm below the table surface.

8. Lift the top two layers of the sheet and fold them like an accordion on the back surface of the table;

9. Take out the second sheet, folded in four or in half, and place it on two layers of the first sheet (the second sheet should hang 5 cm below the edge of the table);

10. Cover the second sheet with two layers of the first sheet;

11. Secure with sterile pins 2 layers of the top sheet and 2 layers of the inner sheet (for an eight-layer table) or 2 layers of the top sheet and 1 layer of the inner sheet (for a six-layer table).

12. Place sterile material or instruments on the inner surface of the second sheet, in the near right corner - a sterile napkin and tweezers (mini-table);

13. Holding the clips in your hands, close the sterile table so that the top layers cover the inner ones.

14. Attach a tag with the date, time of covering and full name. nurse

Additional information about the features of the technique.

Terms for maintaining the sterility of sterile tables:

Ø mini-table – 2 hours;

Ø in the treatment room – 6 hours;

Ø in the operating room - 24 hours, if the instruments were not used from the table;

Ø a sterile table is set in the treatment room, in the dressing room or in the operating room, in which bactericidal lamps must be turned on for at least 60 minutes before starting work;

Ø the sterile table should not be left open;

Ø the nurse should not take sterile instruments from the table with her hands, but only with sterile tweezers, which should lie in the right corner of the sterile table.

If the sterile table is set in In the operating room, the nurse first puts on sterile clothing.

Using a pocket inhaler

Target: obtaining a local effect or general effect

Algorithm of actions of the nurse:

Rules for handling a canister (inhaler).

1. Remove the protective cap from the can and turn it upside down.

2. Shake the aerosol can well.

3. Take a deep breath.

3. Place your lips tightly around the mouthpiece.

4. Take a deep breath and at the same time press the bottom of the can (the dose of the aerosol is determined by the doctor).

5. Hold your breath for a few seconds, then slowly remove the mouthpiece from your mouth and exhale slowly through your nose.

6. After inhalation, put the protective cap on the can.

Gastric lavage

Target: therapeutic and diagnostic

Indications: poisoning - food, medicinal, alcoholic, etc.

Contraindications: ulcers, tumors, bleeding of the gastrointestinal tract, bronchial asthma, severe cardiac pathology.

Equipment: sterile thick probe, 100-200 cm long, at the blind end 2 lateral oval holes at a distance of 45, 55, 65 cm from the blind end of the mark, sterile rubber tube, 70 cm long, sterile connecting glass tube with a diameter of 8 mm, sterile funnel with a capacity of 1 l., sterile vaseline oil, a basin for rinsing water, a 10-12 liter bucket of clean water at room temperature, a liter mug, rubber gloves, aprons.

Algorithm of actions of the nurse:

1. Wash your hands, put on gloves.

2.Assemble the flushing system: probe, connecting tube, rubber tube, funnel.

2. Put on aprons for yourself and the patient, and seat the patient in a chair with a backrest.

3. Treat the blind end of the probe with sterile vaseline oil or warm boiled water.

4. Place the blind end of the probe on the root of the patient’s tongue, offer to make swallowing movements, breathing deeply through the nose.

5. As soon as the patient swallows, slowly advance the probe into the esophagus.

6. Having brought the probe to the desired mark (length of the inserted probe: height minus 100 cm), lower the funnel to the level of the patient’s knees.

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

8. Slowly lift the funnel above the patient's head.

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

10. Pour the contents into the basin until the water passes through the connecting tube, but remains in the rubber tube and at the bottom of the funnel.

12. Start filling the funnel again, repeating all steps, rinsing until the water is “clean”.

13. Measure the amount of fluid injected and excreted.

15. Send the first portion of wash water to the laboratory.

16. Remove the probe using a napkin and ask how you feel.

Note:

If, when inserting the probe, the patient begins to cough or begins to choke, remove the probe immediately, as it has entered the trachea and not the esophagus.

Universal bix styling

Target: preparing material for sterilization

Algorithm of actions of the nurse:

1. Check the parts of the bix for leaks, determining how tightly the lid is closed; ease of movement of the belt.

2. Open the side holes of the bix.

3. Wipe the surface of the bix inside and out with a cloth moistened with a 0.5% ammonia solution.

4. Line the bottom and walls of the bix with a sheet or diaper.

5. In the bottom layer, place the dressing material vertically in sectors; in the second layer, place the surgical linen vertically, in sectors and clockwise.

6. Place sterility indicators in the bins in 3 levels.

7. Place a robe, mask, napkins, hand towel and control indicator on top of the sheet (1st layer).

8. Close the lid of the bin tightly and tie an oilcloth tag to its handle, on which indicate the compartment number, quantity and name of the items in the bin.

Note. Heterogeneous material is placed in one bin in the form of a set for one operation.

Installation of the gas outlet pipe. Target. Removal of gases from the intestines.
Indications. Flatulence.
Contraindications. Intestinal bleeding; bleeding rectal tumor; acute inflammation of the anus.
Equipment. A sterile gas outlet tube connected through a control glass to a rubber tube 30-50 cm long; petrolatum; a vessel with a small amount of water; oilcloth; diaper; latex gloves; gauze napkin; zinc ointment; container marked “For enema tips” with a 3% chloramine solution.

Technique for installing a gas outlet tube.

1. An oilcloth and diaper are placed under the patient.
2. Place the patient on his left side with his knees bent and legs pulled up to his stomach. If the patient cannot turn on his side, then he remains lying on his back, legs bent at the knees and spread apart.
3. Lubricate the rounded end of the gas outlet tube with Vaseline.
4. Wearing rubber gloves, spread the buttocks with the left hand, and with the right hand, taking the tube with a gauze napkin, insert it with rotational movements, observing all the bends of the rectum, to a depth of 20 - 25 cm. The outer end of the rubber tube - extension cord is lowered into a vessel with water placed on the bed or, better yet, at the patient's bedside on a stool.
5. After 1.0 - 1.5 hours, the tube should be removed, even if there is no relief, to avoid the formation of bedsores on the wall of the rectum.
6. After removing the gas tube, the patient should be washed. If the anus is red, lubricate it with a drying ointment, such as zinc.
7. After use, the system is immediately soaked in a 3% chloramine solution, then processed according to OST 42-21-2-85.

Notes. The tube can be inserted 2-3 times during the day. If the water in the vessel bubbles, gases are escaping. If there is no relief after inserting the gas tube, then it should be prescribed by the doctor.