Encyclopedia of Family Medicine

Chapter 17 Home Nursing Technology (2)
In order to avoid the deterioration of urine for a long time, the urine container should be placed in a cool place, and preservatives should be added to the urine according to the inspection requirements.Commonly used for formaldehyde, concentrated hydrochloric acid, toluene and so on.

(3) Cultivate specimens: Ask the patient to take a sitting or lying position, put a bedpan on it, and after disinfecting the vulva (both men and women should be disinfected), instruct the patient to urinate on their own, discard the front urine, and take the middle urine with a sterile test tube, plug it Tighten the cap of the test tube and send it for testing.

3.Collect sputum samples
Sputum is the secretion of the alveoli, trachea or bronchi.When the trachea, bronchi, and lungs are affected, the mucous membrane of the respiratory tract is irritated, the secretions increase, and phlegm may be coughed up.The purpose of collecting a sputum sample is to check for cells, bacteria, parasites, etc. in the sputum.

(1) Routine specimens: instruct the patient to rinse his mouth after getting up in the morning, then cough forcefully, cough out the sputum deep in the trachea, and put it in a clean container for testing.

(2) 24-hour sputum samples, from 7:7 am to 24:[-] am the next day, keep [-]-hour sputum, avoid mixing saliva, saliva, nasal mucus, etc.

Ultrasonic nebulization inhalation

The ultrasonic nebulizer uses ultrasonic sound energy to turn the medicinal liquid into a fine aerosol, which enters the respiratory tract as the patient inhales.Commonly used in chronic respiratory inflammation, asthma, endobronchial tuberculosis, lung abscess, lung cancer, etc.It has the functions of anti-inflammatory, antitussive, expectorant, relieve bronchospasm, and make the respiratory tract unobstructed.Also used before and after chest surgery to prevent infection.

[How to operate]
(1) Add 250ml of cold distilled water or cold boiled water to the sink, and the liquid level is about 3cm.To submerge the transparent membrane at the bottom of the atomizing tank.

(2) Put the liquid medicine in the atomization tank to dilute to 30~50ml, tighten the tank cover, put the atomization tank in the water tank, and close the tank cover tightly.

(3) Turn on the power supply, first turn on the filament switch to preheat for 3 minutes, and then turn on the atomization switch. At this time, the liquid medicine has been sprayed out in mist.

(4) Adjust the amount of fog according to the needs. Among the three levels of large, medium and small, the middle level is generally used.Put the "mouth in mouth" into the patient's mouth.Let the patient close his lips and take a deep breath to achieve the purpose of treatment.Each treatment takes 15-20 minutes.After treatment, first turn off the atomization switch, and then turn off the power switch.Pack up the machine.

[Precautions]
(1) Check whether the machine is in good condition before use.

(2) Never add warm water or hot water in the water tank and atomizer tank.

(3) If it is used continuously, there must be an interval of half an hour in between.

(4) After each use, the atomizing tank and the "mouth in mouth" should be soaked and disinfected with chlorhydrinate.

Oxygen inhalation therapy
Oxygen inhalation therapy is a treatment method to maintain the life activities of the body. By giving oxygen, the partial pressure of oxygen in the alveoli can be increased, the hypoxic state caused by various reasons can be corrected, and the metabolism can be promoted.When there is difficulty in breathing, heart failure, etc., oxygen is urgently needed.Most of the oxygen used at home is oxygen bag, health care oxygen, and a few people who have the conditions use oxygen cylinders, as well as household oxygen generators.Whether it is an oxygen cylinder or an oxygen bag, the more important thing is to master the oxygen supply method. There are many oxygen supply methods, including nasal cannula method, nasal obstruction method, mask method, face mask method, oxygen pillow method, and oxygen tent method.Oxygen tent families generally do not have this condition, so I will not introduce them.

[Oxygen supply method]
1.nasal cannula

Nasal cannula oxygen supply method can be divided into unilateral nasal cannula and bilateral nasal cannula oxygen supply method. The basic methods are the same, but the materials used are more complicated on both sides.Only the unilateral nasal catheter method is introduced here, which is also the most commonly used.This method has simple equipment, convenient method, and saves oxygen. Its disadvantage is that it irritates the nasal mucosa, and the patient feels uncomfortable if used for a long time.

[use item]
Oxygen bag or oxygen cylinder: a catheter, tape, cotton swab, spare glass tube.

[How to operate]
(1) Move the oxygen bag or bottle to the patient's bedside, take the patient's lying or sitting position, clean the nostrils with a wet cotton swab, dip the nasal catheter in water, and gently insert it from the nostrils to the nasopharynx.About two-thirds of the length from the tip of the nose to the earlobe. If there is no coughing phenomenon, immediately fix the nasal catheter on both sides of the nose and cheeks with adhesive tape.

(2) Turn on the flow switch and adjust the flow to achieve the purpose of oxygen supply. When the oxygen is stopped, remove the nasal cannula and turn off the switch.

2.mask law
Use a funnel instead of a nasal catheter to connect the rubber tube of the oxygen bag or bottle, cover the patient's mouth and nose with the funnel, and fix it with a bandage or adhesive tape to prevent movement.This method is simple and does not have the disadvantage of the catheter irritating the mucosa, but it consumes a lot of oxygen, so it is mostly used in infants or patients after tracheotomy.

3.mask law
Cover the patient's mouth and nose with the mask, fix the oxygen tube with tape, and the rest are the same as the mask method.

4.nasal congestion
A ball made of plexiglass with a lumen is plugged into the nostril on one side of the patient to replace the nasal catheter for oxygen.Then turn on the oxygen, the depth of the nasal congestion should be just enough to block the nostrils, and it should not be too tight or too deep.This method is suitable for patients who need oxygen supply for a long time, and it feels comfortable and easy to use.

5.How to use oxygen pillow

The oxygen pillow is similar to the oxygen bag, in which a humidification bottle is connected. When using it, fill the pillow with oxygen first, then connect the humidification bottle, catheter or funnel, and adjust the flow to give oxygen.Let the patient rest on the oxygen pillow and force the oxygen out by gravity.This method is mostly used to transfer patients.

enema

An enema is to pass a certain amount of solution through the anal canal, from the anus to the colon through the rectum, to help the patient expel feces and accumulated gas.Drugs can also be injected for treatment, and are often used for constipation treatment, inspection, bowel preparation before surgery, etc.Due to the different purposes of enema, it is divided into retention enema and non-retention enema.

1.retention enema

The drug is injected from the anus, retained in the rectum or colon, and absorbed through the mucosa to achieve the purpose of treatment. It is often used for sedation, hypnosis and intestinal inflammation.

[use item]
Enema container, anal canal, vascular forceps, paraffin oil, plastic sheeting, bedpan, IV pole, toilet paper.

[How to operate]
(1) Prepare supplies, spread plastic cloth on the bed, and instruct the patient to defecate to clean the intestinal tract and facilitate drug absorption.

(2) It is advisable for patients with intestinal diseases to infuse before going to sleep at night. During the enema, the buttocks should be raised by 10 cm, so that the liquid can be easily retained.The supine position depends on the condition, such as chronic dysentery disease in the sigmoid colon and rectum, it is appropriate to use the left lateral position.Amoebic dysentery disease is mostly in the ileocecal area, so the right lateral position should be adopted to improve the curative effect.

(3) Coat the anal canal with liquid paraffin oil, slowly insert it into the anus, about 10-15 cm, release the vascular clamp, the liquid will flow in, the speed should be slow, and the pressure should be low, so as to facilitate the retention of the liquid.

(4) After pulling out the anal canal, gently massage the anus with toilet paper, and ask the patient to keep it for more than 1 hour to facilitate drug absorption.The longer the retention time, the better.

(5) Note: Retention enemas are not suitable for patients after anal, rectal and colon operations, and patients with bowel incontinence.

2.no retention enema
Non-reserving enemas can be divided into three types according to different enema purposes: large non-reserving enemas, small non-retaining enemas and clean enemas: large non-retaining enemas, 500-1000ml for adults each time, and 200-500ml for children.A small amount of unretained enema is generally 150-250ml, and it is mostly used for the elderly, infirm, children or pregnant women.Cleansing enema is to remove feces in the colon. It is often used in the preparation of rectum and colon examination or organ imaging, radiographs and preparations before intestinal surgery to clean the intestinal tract, facilitate inspection, and prevent surgical site infection.The specific operation methods are similar, so no detailed introduction is given.

[Enema Precautions]
(1) If there is abdominal distension or the desire to defecate during the enema, ask the patient to take a deep breath.Do not defecate immediately after the enema, but keep the liquid for at least 10-15 minutes.

(2) Master the temperature, concentration, flow rate, pressure and amount of the solution. The enema solution for typhoid fever patients should not exceed 500ml, and the pressure should be low.

(3) For high fever cooling enema, use isotonic saline at 28-32°C, keep it for 30 minutes before expelling, and measure body temperature every half an hour after defecation.

(4) Soapy water enema is forbidden for patients with hepatic coma to reduce the production and absorption of ammonia.

(5) Pay attention to observe the patient's condition during the enema process. If you find rapid pulse, pale complexion, cold sweat, severe abdominal pain, palpitation and shortness of breath, stop the enema immediately.Prevent intestinal perforation and transfer to hospital if necessary.

(6) Enema should not be used for patients with pregnancy, acute abdomen and gastrointestinal bleeding.

Catheterization

Catheterization is a procedure in which a sterile catheter is inserted from the urethra into the bladder to drain urine.It is often used for urinary retention, such as prostatic hypertrophy, before pelvic organ surgery, coma, urinary incontinence patients, and after surgery for urinary system diseases.

[use item]
Sterile catheterization kit (including catheter, vascular clamp, cotton ball, hole towel), sterile gloves, small medicine cup, liquid paraffin oil, bromogeramine, rubber sheet, bedpan, etc.

[How to operate]
(1) Prepare all kinds of items, take the patient in the supine position, and place the rubber sheet under the buttocks.

(2) Disinfection of the vulva, piercing towel, and short urethra for women, about 3 to 5 cm.The male adult urethra is about 18-20 cm long and has two bends. The anterior bend is movable and the lower bend is fixed. There are three narrow parts (ie, the external orifice, the membrane part and the internal orifice). These anatomy should be mastered during catheterization. Features, so that the catheter can be inserted smoothly.

(3) Lubricate the front end of the catheter to 1/2 with paraffin oil.Use the left hand to separate and fix the labia minora (for men, use the left hand to fix the penis), use the right hand to hold the catheter at the urethral opening and gently insert it into the urethra, 4-6 cm for women and 20-22 cm for men, see urine flowing out Insert another 1-2 cm, release the left hand, fix the catheter, and introduce the urine into the sterile tray or bedpan.

[Precautions]
(1) Materials must be strictly sterilized to prevent infection.

(2) When catheterizing female patients, if the catheter is mistakenly inserted into the vagina, the catheter should be replaced and reinserted.

(3) Choose a smooth and appropriate thickness of the catheter, intubation action should be gentle, so as not to damage the urethral mucosa.

(4) If the bladder is highly inflated and the patient is extremely weak, the first urination should not exceed 1000ml.A large amount of urination can lead to a sudden drop in intra-abdominal pressure, and a large amount of blood stays in the abdominal blood vessels, causing a sudden drop in blood pressure and collapse.Sudden decompression of the bladder can also cause rapid congestion of the bladder mucosa and hematuria.

Dressing method

Skin and subcutaneous tissue wounds, boils, or surgical incisions require dressing changes to promote tissue repair and recovery.

The dressing change should be carried out by the patient himself, family members or medical staff depending on the location and extent of the wound or boil.

[use item]
Sterilized dressing changing bowls, tweezers, scissors, external medicines, sterile gauze dressings, alcohol, iodine cotton balls, bandages and adhesive plasters.

[How to operate]
(1) Fully expose the dressing change site, disinfect the surrounding area with alcohol cotton balls, then rinse the wound with hydrogen peroxide (for wounds with purulent secretions), and gently dry the wound.

(2) For fresh trauma wounds, anti-inflammatory powder, Yunnan Baiyao, etc. can be applied; for wounds with secretions, Vaseline gauze can be applied to the wound surface; To facilitate the discharge of pus.

(3) If the boil is swollen, the drainage strip should be inserted into the bottom of the abscess cavity. Be careful not to stuff it too tightly, otherwise the drainage will be poor.Gentamicin gauze can also be used to change dressings for infected wounds.

(4) After the wound is treated, the gauze dressing may be thicker in winter and slightly thinner in summer.

（5）化脓性创口应每天换药1次，直到炎症消退，分泌物干净，创面修复为止。无感染创口冬季3~5天换药1次，夏季2~3天换药1次。

[Precautions]
(1) Strict disinfection, aseptic and bacterial wounds to prevent cross infection.

(2) Iodine tincture cannot be used to disinfect the wound, and red mercury and iodine tincture cannot be used together.

(3) Do not forcibly tear the dressing from the previous dressing change on the wound surface to avoid pain and bleeding from the wound. It should be moistened with normal saline or hydrogen peroxide for a few minutes, and then gently peeled off.

Nasal feeding

For those who cannot eat through the mouth, such as coma, oral disease, oral surgery, or those who cannot open their mouth due to tetanus, a gastric tube can be inserted into the stomach through the nasal cavity, and liquid food, water or medicine can be perfused from the tube to ensure the nutritional supply of the patient , This method of feeding is called nasal feeding.

[How to operate]
There are two types of nasal feeding tubes, rubber and silicone tubes, with length marks on them. Before intubation, sterilized gastric tubes, treatment trays, tweezers, paraffin oil, clips, adhesive tape, 50m1 syringes, etc. must be prepared.

(1) The patient takes a sitting or lying position and cleans the nasal cavity.

(2) Lubricate the front end of the nasal feeding tube with paraffin oil, hold the gastric tube with gauze in the left hand, and clamp the front end of the gastric tube with tweezers in the right hand and insert it slowly along one nostril.When it reaches the throat, instruct the patient to swallow while sending down the gastric tube.If the patient feels nauseated, pause for a while, ask the patient to take a deep breath or swallow, and then insert quickly.When the insertion is not smooth, check whether the gastric tube is in the mouth.If there is coughing, dyspnea, cyanosis, etc. during the intubation process, it means that it has strayed into the trachea. It should be pulled out immediately and reinserted after a rest.

(3) If a coma patient is intubated, the patient's head should be tilted back before the intubation due to the disappearance of the swallowing and coughing reflexes. The manubrium of the sternum to increase the curvature of the throat passage and facilitate the insertion of the tube to the predetermined length.

(4) After the gastric tube is inserted into the predetermined length, the syringe is withdrawn first, and the gastric juice is drawn out, which means that the gastric tube is already in the stomach, or the end of the gastric tube is inserted into the water without bubbles, indicating that the gastric tube is in the stomach.Then fix the gastric tube with tape on the side of the nose.Pour in a small amount of warm water, and then slowly pour in the prepared liquid or medicinal solution.

(5) The amount of each nasal feeding should not exceed 50ml, and the interval should not be less than 2 hours, 5-7 times a day. After each nasal feeding, inject a small amount of warm water to rinse the gastric tube to avoid food accumulation in the lumen and deterioration. Cause gastroenteritis or block the lumen.

(6) After each nasal feeding, fold the end of the gastric tube, wrap it with gauze, clamp it with a clip, and fix it with a pin beside the patient's pillow. The time and amount of each nasal feeding should be recorded, and the materials should be washed after each nasal feeding. It should be disinfected once a day.

(7) Food preparation for nasal feeding is currently sold in medical stores and hospital pharmacies. The ingredients contained are relatively comprehensive and can ensure heat supply. Heating according to the instructions and boiling can be used. The temperature during nasal feeding can be 39~41°C.

(8) Check whether the gastric tube is still in the stomach every time you feed food through the nose. You can inject 10ml of air with a syringe, and then use a stethoscope to listen to the sound of air passing through the stomach, indicating that the gastric tube is still in the stomach.

(9) When nasogastric drugs are required, the tablet should be crushed, dissolved into a liquid and then injected.For long-term nasogastric tube feeding, oral hygiene should be performed every day, and the gastric tube should be replaced once a week and inserted through the other nostril the next morning.

intravenous infusion

Intravenous infusion to treat diseases, also known as fluid therapy, is currently widely used.Through intravenous infusion, water and electrolyte imbalance can be corrected, acid-base balance can be maintained, nutrition can be supplemented, drugs can be injected to maintain heat, etc., so as to achieve the purpose of treating diseases.

[How to operate]
(1) Prepare infusion sets, iodine, alcohol swabs, adhesive tape, tourniquets, etc.

(2) Hang the drug-filled infusion bottle on the infusion stand, insert the disposable infusion set, exhaust the air, turn off the switch, and prepare for the patient.

(3) Select the vein, ligate the tourniquet, and disinfect the skin at the puncture site with iodine tincture and alcohol swab.Tighten the skin with the left hand, and insert the needle in the right hand according to the direction of the vein. After seeing blood return, insert the needle a little more, loosen the tourniquet, turn on the switch of the infusion set, observe whether the solution is dripping smoothly, fix the needle with adhesive tape, and cover it with sterile gauze.

(4) Adjust the drip rate, according to the condition, age, and drug properties, adjust the drip rate, generally 40-60 drops per minute for adults.Children 20-40 drops per minute.It should be slow for the elderly, infirm, infants and patients with cardiopulmonary diseases.For those who are severely dehydrated and have good cardiopulmonary function, the drip rate can be appropriately accelerated.

(5) Nursing of intravenous infusion usually takes several hours at a time. Some patients are treated at home, and the nursing is performed by non-nursing staff.The following points should be noted:

① Pay attention to observe whether the dripping pot in the middle of the infusion set is instilled normally. If the liquid level in the pot is too high to hinder observation, you can pull out the infusion set for a few seconds, and then insert it into the infusion bottle. When the liquid drips, the liquid level in the dripping pot will naturally drop.

②The dripping speed can be adjusted by the switch on the leather strip. If you find that there is air in the leather strip, you can flick the leather strip to let the air rise into the dripping pot.

③Whether there is subcutaneous swelling caused by liquid spillage at the puncture site, if the swelling is severe, the infusion should be stopped immediately, or pulled out and punctured again.

④If the patient feels unwell during the intravenous infusion, and develops fear of cold, fever and palpitation, the infusion rate should be slowed down first, and if there is no improvement after observing for a few minutes, the infusion should be stopped immediately, and the infusion reaction may be considered, and the doctor should be contacted.

⑤ When the liquid needs to be replaced in the infusion, the switch should be turned off, the infusion set should be pulled out, the other bottle cap should be sterilized and inserted, and then the switch should be turned on.After the infusion is completed, press the eye of the needle with a sterile cotton swab and pull out the needle.Press with a cotton swab for 2 to 3 minutes, do not rub the local area, so as not to cause local blood stasis.

(End of this chapter)