Monitoring of the most important indicators of the patient's condition
Some research methods must include in general clinical examination plan.This is mainly the following methods of inspection: anthropometry, blood pressure measurement, body temperature calculation as possible the nature of the temperature curve, the general analysis of blood and urine, feces on worms analysis, X-ray examination of the chest, electrocardiography for persons over 40 years.
Laboratory diagnosis includes an extensive set of methods for the study of cellular and chemical composition;physico-chemical and biological properties of tissues and body fluids immunity indices, as well as methods for the detection of pathogens.Methods of laboratory study prepared in accordance with the conclusions allocated on the basis of the total survey.However, some types of laboratory diagnosis should be implemented regardless of the probability of disease.For example, in a hospital, in addition to general blood tests, urine, feces on eggs of worms, each patient bled to Wasserman, as well as qu
Manipulation is carried out to assess and control the physical development of children, adolescents and adults;prescribed by a doctor;in cases of suspected violation of the pituitary functions.Required equipment: a vertical stadiometer, accounting records, oilcloth, a container with a disinfectant solution.
Measuring growth standing
spreads oilcloth (napkin) on the height meter site.
nurse, while the side of the height meter, raises folding seat, moves the measuring bar above the patient's growth.Next, the patient (without shoes and headgear) stands on a platform height meter.He must touch the scale with four points: neck, shoulders, buttocks, heels.
Head position is checked on the line connecting the outer corner of the eye and the upper edge of the ear, it must be horizontal.The measuring bar is lowered onto the patient's crown and pressed against the measuring scale stadiometer.Readings are taken at the right (bright) side of the scale stadiometer after the patient leaves the height meter site.Then close the folding seat and the bar is lowered.
measurement data are entered in the accounting records.Oilcloth placed in a disinfecting solution.
measurement of growth in the sitting position
Nurse is located on the side of the height meter.On the jump seat is spread oilcloth.The measuring bar is raised above the patient's growth.The patient sits on a folding seat, touching the three points: neck, shoulders, buttocks.The head is fixed at a position at which a line connecting the outer corner of eye and top of the ear, to be horizontal.The measuring bar is lowered onto the top of the head of the patient and pressed to scale the height meter.Readings are taken on the left (dark) side height meter scale after the patient rise with folding seat height meter.The bar is lowered, the measurement data are entered in the accounting records.Oilcloth placed in a disinfecting solution.
Measurement of body weight
This procedure is carried out in the morning on an empty stomach after a bowel movement and bladder.
Measurement of body weight is carried out to assess physical development.It is carried out by a doctor, in order to control the physical development of children, adolescents, adults;in diseases of the urinary, cardiovascular and endocrine systems.
To conduct the study needed medical scales, accounting records, oil cloth, rubber gloves, a container with a disinfectant solution.
before testing is necessary to adjust scales: open the shutter catch, check the balanced state of the balance beam.
In the case of finding the moving rocker below the fixed adjusting nut is rotated counter-clockwise, if higher, clockwise until equilibration.After finishing the adjustment, close the valve detent.In the pan put the oilcloth.The patient in underwear, without shoes, at the closed gate of detent stands at the center of the weighing plate.Initially kilogram weights set to said patient indicative of its weight.Opening the shutter catch, balance beam balance movement gram weights.Shutter detent closed.The patient leaves the weighing platform, fixed readings recorded in the accounting records.Oil cloths soaked in a disinfectant solution.
Measure chest circumference
is carried out to control the physical development of children, adolescents, adults, prescribed by a doctor for diseases of the respiratory system.
To conduct the study needed tape measure with a loop and records.
patient should undress, stand up straight and dissolve hand in hand.Measuring tape covering the chest of the patient (in this case the right hand nurse holds a noose, and the left - the free edge of the tape).The tape is applied to the following benchmarks: in front of children and men on the lower edge of areola and women - on the upper edge of the level IV ribs over the breast on the bottom rear corners of the blades.
Then the patient has to give up, to make the maximum breath.Nurse with the voice of the patient obtained at a maximum inspiration testimony.The patient then makes the maximum exhalation, and a nurse voiced readings on the centimeter tape at that position.
following measurements are carried out in a calm state, this patient is asked to slowly say your full nameThe results are recorded in the accounting records.The difference between the readings at the maximum inhalation and maximum exhalation corresponds to the span of the chest.
Measurement of muscle strength
is carried out by a doctor in order to control the physical development of children, adolescents, adults.
For dynamometer needed procedures and records.Nurse owes most lucidly explain the algorithm of the dynamometer.
Arrow dynamometer shall be fixed at 0. The patient is standing straight, taking the dynamometer in the right arm, the muscles need to be on a moving bar dynamometer.The patient removes the straight arm to the side, and puts it forward as much as possible compresses fingers.It is necessary to take readings and return the arrow mark on the dynamometer 0. muscle strength of the right hand is measured twice.In the accounting records entered the maximum result.A similar procedure is carried out in the measurement of muscle strength of the left hand.
measurement of lung capacity
prescribed by a doctor monitored the physical development of children, adolescents, adults;respiratory system diseases.
nurse, explained in detail in advance patient manipulation algorithm carefully washes his hands, putting on gloves.Taking a sterile forceps, open container for clean mouthpieces.Replacement mouthpiece should be removed with a sterile forceps beyond the edge of the shoulder, close the container.The mouthpiece is fixed on the spirometer.Align the zero division of the scale with an arrow by turning the moving part of the spirometer.Spirometer give the patient so that the fingers do not block the fan spirometer.Replacement mouthpiece on the spirometer covered with sterile gauze.Then the patient is asked to turn his head to the side and take a deep breath, then exhale.Next, the patient should breathe again, to take a spirometer mouthpiece in his mouth, his lips tight embrace, holding his nose and slowly exhale all the air.Record the readings spirometer scale return to zero division direction by the above method.Repeating the examination twice, maximum results are recorded in the accounting records.Used tissues and a removable mouthpiece is placed in a disinfecting solution.
pulse study carried out to assess the functional state of the cardiovascular system.It is carried out by a doctor for diseases affecting the cardiovascular system.
nurse sits opposite the patient.Forearm and wrist of the patient should be relaxed.The nurse takes the patient's arm, freely lying palms down, left, right hand, left - right.At the base of the big toe of the patient hands exploring II, III, IV fingers groping pulsating radial artery.He felt the pulse, slightly compress the artery with your fingers so that it is clearly palpated.
pulse characterization given by one hand while the synchronous pulse (synchronicity - a coincidence pulse beats on both hands).
• rhythmic pulse - even alternation of the pulse wave.Arrhythmia called pulse in which the alternation of the pulse wave is uneven;
• Heart Rate - the number of pulse beats in 1 minute.
When rhythmic pulse of the need to count the number of beats for 15 (30) and multiply by 4 (2), arrhythmic pulse number of strokes is counted for 1 minute.The norm is considered to 60-80 beats per minute, more than 80 punches - tachycardia, less than 60 beats per minute 1 - bradycardia.
nurse should be prepared in advance for a given set of manipulation:
• Dry-air spirometer;
• a set of clean removable mouthpieces;
• sterile forceps;
• sterile gauze;
• medical gloves;
• disinfectant solution;
• accounting records.
pulse voltage is directly proportional to the force to be applied to the complete cessation of fluctuations of the radial artery pulse.There are moderate, intense, soft pulse.
Filling pulse - filling arterial blood.There are full, weak and thready pulse.
The leaf temperature measurements made by the following: heart rate - horizontal dots in red, date - vertically.Connection points gives a "curve of the dynamics of the heart rate."
is carried out to determine the functional state of the cardiovascular system, diseases of the cardiovascular, endocrine systems.To carry out this manipulation needed sphygmomanometer and stethoscope.
During the measurement, the patient should sit or lie down, straightened his arm must be put up his hand free.Tonometer is placed on the same level as the patient's hand.
cuffs encircle the bare shoulder of 2-3 cm above the elbow, but pulls - between the cuff and the patient's skin should fit your finger and the cuff tube should be directed downwards along the side surface of the forearm.Check the connection of the cuff tubing with manometer apparatus.On palpation determined elbow ulnar artery pulsation.To this point apply stethoscope tight, but without pressure.When closed the valve balloon is gradually inflated with air at 20 mm Hg.Art.higher than expected patient blood pressure.
valve opens and slowly releasing the air, mark on the scale gauge:
• the first to listen to the tone that indicates on the scale gauge the level of systolic blood pressure;
• to listen to the tone of the last - the level of diastolic blood pressure.
Pulse pressure is determined by calculating the difference between systolic and diastolic pressure.
Further, disconnecting the tube, remove the cuff to the patient.
in temperature results for notes in the form of the shaded rectangle in red, the upper limit of which is the systolic pressure and the lower boundary - diastolic.
is carried out for diagnostic purposes, routinely 2 times a day - in the morning from 6.00 to 8.00 and in the evening from 17.00 to 19.00 and on prescription.
To perform this procedure requires the following set: Medical mercury thermometer, gloves, watch, pen, leaf temperature, gauze with antiseptic solution container.
nurse washes his hands, putting on gloves and wipe dry with a cloth axillary cavity of the patient.Pre-check the integrity of the thermometer and shake the mercury to below 35 ° C.The thermometer is placed in the axillary region of a patient so that between the mercury reservoir and the body was not undergarments.
The patient is asked to press the shoulder to the chest.Indications assessed 10 minutes.Then shake the mercury below 35 ° C.Thermometer cloth gloves and placed in appropriate containers with liquid disinfectant.Wash hands.The measurement results are entered in the individual patient's temperature sheet of blue dots.By connecting all the points obtained by "temperature curve".
To determine the life-threatening condition of the patient, and the pathological changes of physiological functions that are not recognized under the simple observation of the patient due to the suddenness and rapidity of their occurrence, a method of constant monitoring of a number of parameters of human physiological function using specialized instruments equipped with monitors.This method is called moni- supervision.Monitor surveillance conducted but indicators such as heart rate, respiratory rate, heart rate, arterial and venous pressure, body temperature, cardiac output, electrocardiogram and electroencephalogram, gas content in the blood and exhaled air, blood pH and OE
monitormonitoring prescribed by the physician, and carries its nursing staff.
Nurses specialized departments, wards and intensive care stations, intensive care units are required to undergo special training to conduct surveillance and monitor the provision of intensive care.
to monitor surveillance used several types of monitors:
• equipped with an alarm, activated when a deviation value of a monitored parameter of the limits set by the doctor;
• equipped with microprocessors, capable to accumulate, analyze and interpret the results of measurements over time and containing information about the changes specified parameters in graphical or tabular form.
most common monitor observation of the main functions of the heart with the help of stationary bedside cardiomonitors.Pulse Monitors allow you to monitor the ECG and other cardiac parameters simultaneously in several patients with central monitor post.The central position of the monitor is in the intensive care wards, intensive care units, toxicology departments in the operating and recovery rooms, in mikropediatricheskih offices, etc.Control over the large number of parameters is limited and monitored one or two most significant at this time.
There are monitors that do not require a special cable liner to the central post of the monitor, they are used in any ward as a mobile bedside ECG monitor for monitoring critically ill.
Circulated as long monitor surveillance using portable monitors.Portable monitors are needed to register for diagnostic purposes an electrocardiogram, blood pressure, or other indicators in the hospital and in the community for 24-48 hours. This type of monitoring allows you to monitor indicators of interest to compare the patient's complaints, subjective feelings, his physical activity level, various vital processes (such as sleeping, eating, etc.), and make timely adjustments to therapy when needed.
Following the appointment of a physician monitor monitoring nurse patient monitor post connects to the monitor by attaching the electrodes or other sensors monitor system, starts the instrument, check the quality of the electrical contacts and begins visual observation of the performance monitor.
Booth post can not be abandoned as a nurse without adequate replacement (under any circumstances).
Upon detection of the dynamics of the investigated parameter or an automatic alarm signal is triggered nurse is obliged to:
• without delay to ensure the registration of the investigated indicator;
• promptly, efficiently analyze and evaluate the prognostic significance of the detected changes;