Bài giảng chăm sóc sức khỏe người lớn có bệnh ngoại khoa giảng viên nguyễn cẩm duyên biên soạn

Nhiem vu dieu dwffng chay ngoai - Bo sung dungcu phau thuat, vat tu tieu hao va cac phuong tien khac dung cho - Linh mau hoac che phammau khi duoc yeu cau, khi linh ve phai ban giao true

GIANG VIEN: NGUYEN CAM DUYEN

(Luu hanh npi bp)

BO GIAO DUG DAO TAO

TRUONG DAI HOC GIFU LONG

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MUC LUC

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Trang Noi dung

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Cham socbenhnhan tac ruot

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lid

1.1 DAICUONG

benh, chuyeu la phluthuat Vay nen nguoidi8u duong r4tcanco tac phong nhanhnhen,chinh xac, khintruong cSp cuu ngubi benh Tuyet doi co y thuc vo khuSn trong cac thuthuat ngoai khoa, trong cham soc nguoi benh Dong thoi co tinh can than, ty mi khi su

dung va bao quan cac loai may moc, dung cu yhoc hiendai de thuchien cac ky thuat y

thuoc

- Thubng xuyen co y thuc va tac phong vb khudntrong thuc hien cac ky thuat va,cham soc ngubi benh

thubc de nhan dinh dung tinh trang cua ngubi benhvagiai quyet tbt cac nhu caucham soc

1.1.1 NHIEM VUDIEU DUCfNG NGOAI KHOA

phuong phap gay me va phduthuat thich hop cho tung ngubi benh Tuy theo tung benhvien, tuy tung khoa dibu dubng se du bubi hop thong qua mb mbi ngay hay moi tuan

chuongtrinh mb Di^u dubng khoa ngoai edn co kign thucvbbenh,v6 phuong phapphdu

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nguai dieu dudngkhoa ngoai con phai chuanbi ngubi benh truoc mo va cham soc ngubi

benh sau mb Noi den ngoai khoa la noi den vb khuan Ngubi dieudubng lubn phai cap

khoatuyet dbi trong cham sbe ngubi benhnhu cham soc vet mb, dan luu Phong ngua

dong sau mb Dinh dubng sau mb cung rat quan trong, ngubi benh can duoc cung cap

dinh dubng nhung tuy tung benhly, tuy timg phuong phap phau thuatma dieu dubng se

ketquachinhxac

giam nhung trieu chung tam thbi, de co thbi gian nang cao the trang, giam tinh trang

- Dieutri phbng ngua Trongnhung trubng hop benh ly co nguy co cao trb thanh ac

hon

-Taitao chinh hinh Ngubibenhduocchinh laicor quan bi khuybt tat do di dang bam

• !

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-Ghep ccf quan Ngucri benh duac ghep mot bophan cua ngubi khac de thay the bo

phandamatchucnang cua minh

1.1.3. CAC VAN DE CO BAN KHI CHAM SOC BENH NHAN NGOAI KHOA

' f

!1.1.4 CHUC NANG CUA CAC DIEU DUONG PHONG MO

Tiepnhanvaduangubibenh vao bubngphauthuat theo ylenh ghi trong ho

thuatvathubng true detrinhtrubng khoa duyet

Kiem tra, don doc cac thanhvien trong khoa thuc hien nghiem chinh quy che khoaphauthuat- gay me hoi sue

thuatc&p cuu Nhungdungcuhong, vb phai linh bb sunghoac thay the kip thbi

benh sau ph£u thuat khi con b trong khoa, bao cao kip thbi trubng khoa cac viec dot

4

Tham giaphucvucac cuocphau thuat va thuong true

buongphau thuat vadua nguoi benhtu buong phauthuatvekhoa

- Giupphauthuat vien thuc hien cuocphauthuat chuan bi vasapxepdungcu day

du, duadungcu cho phauthuat vien dungdongtacva phu hopcac thaidiemcua cuoc

- Xu ly dungcuphauthuat, trang thiet bi y te va vat tu tieu hao da su dung cho caphauthuat theo quydinh cuabophanphauthuat;

- Khong tu ybo ra ngoaikhi chuaduoc su dongy cuaphau thuat vien

Nhiem vu dieu dwffng chay ngoai

- Bo sung dungcu phau thuat, vat tu tieu hao va cac phuong tien khac dung cho

- Linh mau hoac che phammau khi duoc yeu cau, khi linh ve phai ban giao true

mon vaky nangve cham soc trong hoi sue cap cuu, su dung thanh thao cac may moc,

dung cu hoi sue, trau doi kienthuc ve chong nhiem khuan trong benh vien Luonap

cua thudc hdi sue Bi6t danh gia ngudi benh du lieu chuan de chuyen ngubi benh ve

quan, thd may; ngudi benh khdng the giao tiep bang idi noi ma chi bang dieu bova

1.1.5 TdCHLTCKiPMO

- Luong gia ngudi benh trudc mo Luong gia tinh trang ngudi benhve dau chung sinh tdn, tri giac, tarn ly, tong trangngudi benh Xet nghiem tiSn phau, ten ngudi benh,

- Canthiep didu dudng trong md Duy tri su an loan chongudi benh, dung cu, tu the,

Thuc hien dung nhiem vu dieu dudng duoc giao trong mot cuoc mo: dieu dudng vong

haophduthuat cho ngudi benh trongsudt thdi gian phauthuat Ngudi diSu dudng ludn ap

may mdc, dua dung cu dung quy trinh Phuc trinh lai day du diSn tien va nhung bat

phdng hoi suenhu: dau chungsinh tdn, tri giac, chay mau Di chuyen ngudi benhan loan

vS phdng hdi sue Ban giao ngudibenhcung diSu dudngphdng hdi sue

each su dung va cham soc may mdc, biSt each xu tri cac loai may trongphdng md giup

- Ngudi benh bi anh hudng gay tac hai thudng xuyen.

te

BAO QUAN CAC DUNG CU PHAU THUAT

Phai su dungdungloaidungcu cho timg muc dich su dung

Khdngapdungcac chat cdtinh bam dinh len tren dungcu vi selamhongbe

7 •>

- Khdng su dungddude bdi Iron dung cu;chi su dung cac chitbdi tron cdthd

- Phai bao quandungcu d ncri kho rao

vuotqual370C

1.1.8. CACLOAI KIM THLTOfNG DUNG

Kim phauthuatduocthietke de dansai chi xuyen

qua to chuc sao cho dd dang va it gay ton thuemg to

chuc nhat Nd cd ba thanh phan chinh la Id kirn, than

cd Idkim md (kim bat chi hay kim kieuPhap) de xau

chi nhung cd lo kim to nen gay ton thuong to chuc

•

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Kim co 16 kirn rap khuon (mot dau soi chi duoc rap cam true tiep vao 16 khuon a duoi

- Mui kim: co the la loaimui cat, mui thon nhonhoac mui tu Mui cat dupe dung de

khau xuyen qua cac to chuc chac nhu da Mui thon nhon dupe dung 6 nhung to chuc

Viec lua chon kim khau phai dua vao nhieu yeu to: loai to chuc can dupe khau, dac

1.1.9 CAC LOAI CHt THlTONG DUNG

a Cac loai chi tieu dicffc

Catgut chromic (trong thanh phan co themmuoi chromium) co thbi gian tu tieu cham

khau

tieu saumo khoang 60-90 ngay No thuong dupe dung de khau cac to chuc co, can,

gan va dong da dubi bieubi So vbi catgut thi chi Dexon codp dai cao hon va it gay

khongco chi nhiet to)

- Chi polyglyconate (chi Maxon): la loaichi tutieu don spi, co do an loan va dp

dai cua moi bupc tot nhat so vbicac loaichi tu tieu tong hop khac No thuong dupe

dung dekhau cactochucphanmem, thuc quan,rupt, khi quan

polyglycolic acid nhung dp dai hoi kem hon Thbi gian tu tieu sau mo khoang 60

ngay

CAU HOI LVONGGIA

2 Neu duacchuc nangcua dieu duong ngoai khoa?

3 Neu cac loaichingoaikhoa thuong dung?

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- Chi polydioxanone: la loai chi don soi tu tieu tong hop co do dai rat cao, thoi

buoc rat tot Mac du la loai chi khong tieu nhung chi to van co the thoai hoa trong to

chuc o cac muc do khac nhau

- Chi polyester: la loai chi ben tong hop co do dai rat cao Chi polyester thong

polyester dupe phu ngoai boi teflon (tevdek), silicone (tri-cron) hoac polybutilate

lan so voi hailan doi voi chi thep vaba lan doi voi cac loaichi to, cotton, polyglactic

- Chinylon: la loai chi tong hop donspihoac ben, cd do dai cao varattron No co

khi cho chup MRI, co the gay dau do benhnhan bi man cam vdi nikel trong thanh

CH L ONG 2: NHIEM TRUNG NGOAI KHOA

Trinh bay duac dinh nghTa nhiem (rung ngoqi khoa.

Trinh bay dtcqc dien lien cua cdc nhiem triing ngoqi khoa.

2.1 KHAINIEM

Nhiem trung la su xam nhap cua vi sinh vat vao ca the va sudap ung cua ccr the doi

vai thuongtondo vi sinh vat gaynen (vi sinh vat co the la: vi khuan, sieuvi khuanhoac

Nhiemtrung ngoai khoala bien chungthudngxayrasauchan thuong kin, vet thuong

hoac sau khiphauthuat Khac vdi nhiem trung noi khoa, d daythudng cdmot dthuan loi

2.2 DIEN BIEN CUA MOT NHIEM TRUNG NGOAI KHOA

phan ung tai chd nhung lai tiet ramot ngoai doc to (exotoxin) rat manh tac dong lente

quavetthuongda rat nhd nhumotvetxay xathoac chddap gai, thudng xam nhapvaohethongbach mach gay viem bach mach cap tinh,viem hachbach huyet cap tinhhoac viem tay lan tda

Nhiem trung ngoai khoathudng dien bien qua 4 thdi ky:

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- Then ky nung benh la thai gian tu luc vi khuan xam nhap vao ca the den khi bat

dan co trieuchung lam sang

- ThM ky khdi dauvai nhungtrieuchung sum nhudau nhuc, sot,do

- Thoi ky toan phat: Nhiem trung xuat hien vol day du trieu chung chinh Trong

+ O nhiem trung di chuyen: viem bach mach cap tinh viem hachbach huyet captinh

! +Nhiem trung toan than: nhiem khuan huyet (septicemic), nhiemkhuanmuhuyet

- Thoi ky dien bien va ket thuc: dien ra theo 1 trong 3 kha nang:

+ Dien bidn tdt: Nhidm trung duoc giai quy6tnhung co the nguoi benh suy sup va

co khanang nhiem trung tai phat (vi du:nhot o mong)

•>

+ Didn bi£n xiu: Co nhidu bien chung nang nhu nhiem khuan huyet, nhiem khuan

2.3 CAC THUONG TON THVONG GAP

2.3.1 Ap xe nong

chanthuongbi nhiem trung, mun nhot, vet mo nhiem trung hoac mot viem tay

Ap-xe nong duoc tao ra boi su xam nhap duoi da cua nhung vi khuan lam munhu tu ciu khuin (Staphylococcus epidermidis) hoac tu cau khuan vang

yem khi)

d Dien bien cua dp xe ndng

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mach cap tinh, viem hach mu hay nhung bien chung loan than nhu nhidm khuan

huyet, nhiem khuan mu huyetcd the dua den tu vong

Hinh 1 Ap xe ndng

A Ty mu co gkri h$n rS cap tinh (sung, ndng, <Jd dau), 8 Ofiu chuy&n s6ng

hoiu dong banh avien ngoai baygio so thay mem hem trung tarn cd the phat hien

6mu, khi anben nay ngdntay ben kiabixd day (hinh IB)

trung loan than nhusotcao dm lanh, ue oai, nhucdau Kham cd 4 trieu chung co

do hoac viem bach mach viem hach bach huyet cap tinh Hoi ngubi benh cd the

- Giai doan tu mil (sau vdi ngay): dau nhdi, budt mat di, nhubng chd cho cam

e Cham soc

I

Dieu du&ng theo doi nhiet do, neu ngudi berth sot qua cao nen chubm mat va

cho ngucri benh tu the cung rat quan trong tranhtham khamthudng xuyen, tranh

de can len6 ap-xe Khang sinh theo y lenh, thuc hien khangsinh dung gid, dung

tim tu the giam dau sau rach,tranh decan hay bang qua chatlen viing vet thucng

Thay bang thuc hien ngay 2 lan hay cd the mho giot lien tuc de ruavet thuong Dan luu can duac theo doi so luong, mau sac,tinh chat dich thudng xuyen Trongkhi thay bang dieu dudng can quansat va nhan dinh tinh trang vet thuong de giup

daxung quanh Cachlytdt vdi nhungvet thuong khac va nhung ngudi benhxungquanh

| 2.3.2 Ap xelanh

Ap-xe lanh la mot 6 mu hinh thanh cham, thudng chi cd trieu chung sung,

honcdthe do nam hoac true khuan thucng han

Trieuchung tai cho:Ap-xe lanh dien bien qua 3 giai doan:

- Giai doan cd mu: dan dan khdi u mem lai Khamcd dau hieu chuyen song,

t

Trieu chung toan than: vi ap-xe lanh la mot bien chung cua benh lao, do do

hacho vung lan can Thtr xet nghiem mau VS tang, bachcanco the tang hoac binh

thudng, ty le tan bao tang do tinh trang nhiem trung mantinh Phan ung trong da

sinh mu co the xam nhap vao 6 ap-xe gay boi nhiem va luc do se co trieu chung

Chu yeu la dieu tri noi khoa, khong rach thao mu doi vai ap-xe lanh vi no se

duai

(L Cham soc

donhung dot viem cap Ap-xe lanh chu yeu la dobenh ly man tinh nhu lao, nam

dong, cho gia dinh nen viec giaodue ngudi benh tu cham soc va tranhlay lan trong

edngdong la nhiem vu quan trong

2.3.3 Viem tay lan toa (Phlegmon Diffus = Cellulite)

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Vi khuan gay viem tay lan toa thucmg gap nhat la loai lien cau khuan

r

cL Bien chumg

Viemkhbpco mu viem tac tinhmach sau nhiem triing lan ra Viem mu mang

Noi khoa: khang sinh lieu cao b giaidoan khbi dau, mothaomu va dan luu b

giai doan hoai tu

Dieu duong lau mat khi ngubi benh sot cao, theo doinhiet do,thuc hien thubc

Viem tiy lan toalam ngubi benh dau nhieu, dieuduong nen giupngubi benh tim

nang, vet thuong rach phuc tap va rbng nen can thuc hien khang sinh dung lieu,

soc vet thuong khang sinh va dinh dirong Viec nang cao the trang ngudi benhlamot khau quan trong Ngudi benh luon duoc cung cap du protide, vitamin nhtr

2.3.4 Viem bach mach va viem hach bach huyct cap tinh

Viem bach mach cap tinh la nhiem trung cap tinh cuacac mach bach huyetdo

Khdi dau qua vet thuong vi khuan lotvao nhungmach bach huyet nong d da

song songvdi mach mau

c Trieu chirng

Dau nhuc mot ngdn tay hoac ngdn chan noi bi vet thuong, dau doc len theo

chitren) sung to, di dong, an dau, sdnong (viem hach bach huyetcap tinh) Hach

Cham sdc ngudibenh sdt, ghitinh trang sdt theo bieu dd Ngoaicac bien phap

can cham sdcvet thuong dungkythuatvd trung

quanh, duuc loai ra ngoai dudi dangmot cui nhot (bourbillon).

- Nhotchum la nhidu nhot k6t dinh vdi nhau bditinh tranglam mu d chan bi,

Nhot

- Giai doan tre: sau 5-6 ngay, d dinh nhot xudt hien mot mun mu Sau do, mun mu vd, chay ra mot it mu cung vdi mot cui nhot mau xanh hoacvang Dau

Nhot chum: thudng thay d sau gay (do do con goi la hau bdi) Trieu chung

va dau Sau vai ngay ngudi benh sotcao hon, dau nhuc vung gaynhieu honkhien

Xet nghiem can lam sang thay bach cdu tang, dudng huydt tang (ndu cd tieududng)

- Nhot: tranh nan nhot hay pha vd nhot bangtay hay nhung dungcukhdngvdkhudn, tranh tinh trang nhiem trung viem tay nang.Nhung mun nhot thudng xay ra

dd nhung mun nhot ngay Giao due ngudi benh khi phat hien cd nhung mun nhd

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rahOjuuy2?HL*.e£MbVRT|

sau nen -kham^arth'ayhhuoc ngay, khong tu y xu tri tai nha Giao due nguai

b^nft ve^sirjh d^^^sQ.Jhildngxuyen

- Nhot chum: cham soc vet thuemg sau khi rach nen phoi nang, nang cao the

2.3.6 Nhiem khuan huyet (Septicemic)

- Nhiem khuan huyet la tinh trang nhiem trung loan than, do su phong thich

vi khuan, doc to cua vi khuan vao mau tungdot tumot 6 nhiem trung trong co the

- Nhiem khuan mu huyet: tuong tu nhu nhiem khuan huyet, nhung co su di

Nhiemkhuan huyet co2trieuchungcoban la ret run va sot cao

danh bo cap (claquement desdents), cam giac lanh thau xuong, long ngoai dadung

remittente) hoac sot ngat quang (fievre intermittente) Nhung neu nhiem nhuan

v.v co khi nguai benhkhongsothoac nhiet do thap han binh thuang

- Cac dau hieu kem theonhu dau hieu nhiem doc than kinh, nhuc dau du doi,

sang: bachcau tang cao (chu yeula Neutrophil) hoac khong tang (n6ucothe teliet

do vi khuan Iran ngap trong mau) Cay mau tim vi khuan trong mau (co ban de

CAU HOI LVONG GIA

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1 Trinh bay 4 dien tien cua mot nhiem trung ngoai khoa?

3 Trinh bay cac giaidoancua mot apxe nong?

t 2.3.7 Nhiem khuan mu huyet

Co 4 trieu chung co ban: Con ret run manh liet va tai dien nhieu lan rat giong

hoac nhieu lantrong ngay Trieu chung nhiem doc loan than: mat hoc hac, luoi khb

Dieutrivacham soc giong nhu nhiemkhuan huyet

CHVONG 3: CHAM SOC M.I OI BENH TRI OC MO

MUC TIEU

NOI DUNG

K

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2 Luang gid duac cdc chi so ngudi benh truac phdu thudt.

i

3.1 CHUAN BI BENH NHAN MO PHIEN

3.1.1 Tham kham lam sang

Chieucao, can nang

b Than kinh trung uang

c Kham tim mach

Huyet ap

d Kham ho hap

e Kham tieu hoa

nhungbenhnhancap cuu

f Kham tiet nieu

Co suy than khong.

Chuc nang than

Co thai khong,neu co la thang thu may

Co chuangoai th cung khong

j Dau, mat, co, rang mieng

Cd ngan, Id hau khong

Luoitokhong

’ 3.1.2 Can lam sang

a Xet nghiem thuong quy

Huyet hoc: Cong thuc man, huyetsac to,Hematocrit,mau dong, mau chay

Sinhhdanucrctieu: Duong,protein

Dientim

b Xet nghiem bo sung theo benh

J

%

3.1.3. Bank gia tinh trang benh nhan

Di ung do ca dia: Thay ddi thai tiet bi khd thd (henphe quan), diung thuc an

(haisan), di ung phan hoa, long thu, nhua latex

f *

Hut thudc la, thudc lao: nen kieng thudc 2 den 4 tuan trudc md de giam cac

Nghienthudcphien

Nghien ruou, bia

tri

Cac thudc uc che Canxi (Nicardipin, Nifedipin) dung dieu tri suy vanh va cao

huyetapcantieptuc duy tritrudc, trong va sau md

Cac thudc Reserpin, Guanethedinnenngung trudc md 1 tuan

Thuoc laitieunen ngung trudcmd 24 gid de tranh giam khdi luong tuan hoan

e Tien sw gia dinh

3.1.4 Dieu chinh cac roi loan

Neu thieu mau, suy kiet: De nghicho truyenmau, dam

Roi loan dien giai: chu y Kali

Khang sinh dir phong: tuy theo chuyen khoa

3.1.5 Chuan bi mot ngay trirtfc mo

phauthuat, vua gay nhiem khudn vungmo Tdt nhat nen hudng dan ngudi benh cdi bo

quan, gayhay sort rang gia,di vat dudngthdneu rang rdt vao khi quan

I

- Tam ly tmdc md: de tranh ngudi benh lo au, cang thang, dieu dudng cho ngudi

benh gap gdngudi nha, khuyen ngudi benh ngu sdm, cd the thuc hien thudc an than

3.2 CHUAN BI BENH NHAN MO CAP CUT)

3.2.1 Chuanbi

Bac si phai hoi sue benhnhan cho den khi benhon dinh DHST

•» f

Giay cam doanchapnhan md ciia benhnhanhoac than nhancuabenhnhan

Dieududng thuc hien cac y lenh khantmong

Hd so benh an Bac si va dieu dudng neu khdng lam kip se hoan chinh sau khi

phauthuat

3.2.2 Phan loai cap cihi

Ly do den kham cap cuu:Neu cd the dune, cac nhan vien khoacapciru phai thong

nhat va chuan hoa cac ly do thudng gap khien ngudi benh den kham cap cuu va phan

25

ly do can coi la cap cmi + Thu thap cac chucnangsong: Mach HA, nhip thd,SpO2

f /

+ Dang ve chung: Nguoi benh trong co ve 6m yeu, da trong co ve kem tudi mau;

co cac dau hieukietnude

Luong gia ve chucnang tim mach ngudidieu dudngcan tham kham venhunggi?

CHlTONG 4: CHAM SOC NGVCH BENH SAU MO

Chdm soc dupe ngudi benh tai khoa ngoai.

Phdng ngua phdt hien va xu Pi dupe cdc bien chung sau mo.

4.1 CHAM SOC CHUNG

4.1.1 Van chuyen benh nhan

Sau mo khi doi tu the van chuyen benhnhan phai nhe nhang Thay doi tu the dot

nhan canh ban mo va chuyen benhnhan nhe nhang sangxe day

Muc tieu chdm soc cuaphdng hauphau la cham sdc ngudi benh cho den khi hdt

thudc me, dau chung sinh ton ondinh, ngudi benh khdng con chay mau, ngudi benh

Vi tri phdng md thudng ndi vdi phdng hdi sue banghanh lang kin, bang phang,

kham ngudi benh lien tuc va di chuyen ngudi benh an toan sau khi md Trong giai

hap,vet mo, nguyco,chay mau cao

Sau mo, giaidoan hoi tinh nguai benh rat de bi Rich thich bdi tac dongben ngoai

nhtr anh sangchoi, tieng dong Vi the thuong phong hoi snc dtrac thietke laphong

tarn

nhat hoa lien tuc ve su dung may moc, phuemg phap mai de cham soc ngudi benh

Khoahoc cung gop phan rat Iontrong dieu tri benhtat, vi thephong hoi sue luon

- Trang bi dung cu cho ho hap: oxy, mayhut dam, may soithanh quan, ongnoi

khi quan, bo mo khi quan, may the, bo cap cuu ho hap tuan hoan, may do nong do oxy

Tu the ngudi benh sau mo cung rat quan trong, vi the giudng hau phauphai di

bang ca nen van mach ngudi benh cung dao dong, do do cd nguy co tut huyet ap tu the,

4.1.3 Cac dau hieu sinh ton

da, niem mac

(huyetapIren 90/60mmHg)J saudo moi gibmotlan

vet thuong

4.1.4 Van dong cua benh nhan

1^1 r

duocxoay tra moi 30 phut cho den khi tucudongduoc

4.1.5 Lirong dich xuat nhap

Cho chithi nhin hay che do an sum

4.1.6 Ong dan lira

4.1.7 Thuoc

mb

4.1.8 Thu’c hien y lenh

Co ba each cho tho oxy chinh: Dung mat na cho benh nhan chua tinh hoac

benh nhan chi the bang mieng Dung ong thong mui don hay ong thong mui hai

•)

b Giam dau sau mo

Du phong va dieu tri dau sau mo la motvan de Ion trong cham soc sau mo,

nhieu ky thuat co the ap dung tuy theo muc do dau danh gia dupe ma co the ap

Danh gia muc dp dau la dua vao lam sang, dung thang diem danh gia EVA

•>

4.1.10 Che do dinh dirong sau mo

Trong nhung ngay dau benh nhan khong an uong gi dupe, viec hoi sue bang

X /dubngtinh mach lacan thiet

chao; Con neumo o dubng tieuhoa thi chotrung tien (su luu thong rupt trb lai) moi

dupe cho an Tuy nhien 6 gib dau sau mb co the cho benhnhan uong motit (5-10ml)

nude cho do khb mieng

4.2.1 Dephong roi loan ve tuan hoan

Chu y de phong viem nhiem cho tiem tinh mach, cho benhnhantap cir dong som,

4.2.2 Vet mo

4.2.3 Bien chung hohap

thd Khi dieu dudng phat hien cac dau hieukhd thd, ri rao phe nang giam, khd khe,

y lenh, hudngdanngudi benh each ho, hit thd sau 5-6 14n/gid, thuc hien y lenh giam

Dieu dudng phong ngira xep phoi bang each hudng dan cho ngudi benh ngdiday

nhu dong ruot (-), dieu duong can dat dng thong da day, cho ngudi benh ngdi day,xoay trd, tap thd Phong ngira nen nghe nhu dong ruot moi 4 gid, danh gia muc do

thuat dudng tieu hoa Huong dan ngudi benh hit thd sau, tap bung, xoay trd va thuc

4.2.5 Bien chuug dircmg tiet nieu

ndng Datdng thong tieu khi cac bien phap tren that bai cd the dat lai sau 6-8gid neu

4.2.6 Bien chung ve man

Chay maunguyen phat (xay ratrong luc md), chay mautrung gian (trong nhung

32

ngtreri benhphauthuat cap cun

4.2.7 Bien chung khong dacbiet

Sot: thuong phai giai quyet nguyen nhantrubc Neu nhiet do tren 400Cphai dung

Idn (nach, ben, cd), lau loan than bang con 700 de lam bdc hai giam nhiet do, dung

thudcha sot

got , dnhungngudi gia, suy dudng khongduuc san sdc, nhung ngudi tieu tien khong

De phdng: bien phap tot nhat la san sdc ky, xoa nan vung da sat xuang, cac diem

tide, cu dongsdm, thayddi tu the, nudi dudng tot Obenhnhan nam lau phai quan sat

Dieutri

khd da benhnhan Nudi dudng tot,kiem soat vande nhiem khuan rat canthietde lam

lanh vet loet

4.3.1 Khi don ngirdi benh tir phdng mo ve

i

33

Ho hdp: tinh trang thong khi, tinhchAt tho, tinh trangkho tho, d£u hieu thiSu

oxy, hgheph6i,tinh trang dam nhm Ngudibenhtutho,tinh trang da niem

t

Tranh thay doituthedot ngot

Nhttngvande can can thiep doi vdibenhnhan sau mo bao gom:

Nhietdo

tap tho,taphova cu donghaichan hai tay

hop benhnang hoac bi bi tieu, khbng cd nude tieu trong 6-8 gib sau mo, cd su dung

r •>

thudc loi tieu

Ong dan luu: Theo doi tich chat, mau sac cua dich, dau hieu chay mau vet mo

Giam dau sau mo: Giam dau sau mo la mot viec lam het sue quan tronggiup cho

benh nhancd the nhanh chdng hoi phuc Danh gia thang diem dau va su dung thudc

Ngoai ra, benh nhan cung cancdmot che do an phii hup Trong nhung ngay dau

cdthdbenhnhankhbngduoc anma chu yeu nubidubng bang dubng tinhmach Benh

4.3.2 Cham sdc benh nhan sau mb

1

trung

r

Thudcdang su dung

b Chan dodn vd can thiep dieu duv’ ng

♦♦♦ Dirdng thd’ khong thong

ngudibenh hit thd sau, xoay trd, chongdi day Khi ngudi benh ngdi day co hoanh

rat dau, nhat lanhungngudi benh mo nguc, mo bung, cot song, vi the dieu dudng

r

cua ngudi benh

❖ Ngirdi benh khong thoai mai sau mo

muc do tram trong cua phau thuat, cua chan thuong thuc the Dau sau mo phu

thudc vao tarn sinh ly, muc do chiu dung ngudibenh, ban chat phauthuat, muc do

Dieududng cd the thuchien thudc ngu, thudc giamdau, tu the giam dau, edng tac

Nguyennhan ngudi benh vat vala do tu th6 khong thoai mai tren giudng benh,

phan ung cuaco theluc hdi tinh, do dau, do bang qua chat, do cd dinh ngudibenh

Cham soc ngiccri benh non

35

day cd dinh, giaiquyet bl tieu

Non do nhieu nguyen nhan nhu do lac dung phu cua thuoc me thuoc te, do

rupt, da day u dong dich, Sau mo, ngubi benh nen nam tu the dau bang, matnghieng mot ben de tranh khi non dich khong tran vao dubng tho Neu co ong

nhan la dotlch luy khi b ruot, thao tac tren rupt gay mat nhu dong rupt, do thuoc

dong rupt, thubng khoang 15-30 giay co 1 nhu dong la binh thubng Dieu dubng

di chuyen theo khung dai trang theo each nhusau: ngubi benh nam ngua, ke gbi

r

khbngkhi dpt ngbt ao vao phoi Nguyennhanco thatkhiquan la do klch thich cua

thin kinh hoanh Nguyen nhan true tibpdo klchthich cua ban than thin kinh nhu

da day cang chuong Nguyen nhan gian tiep do nhiem dbc Nac cung do nguyen