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CHAM SOC NGUOl BENH HAP HOI - TLf VONG
Myc Tieu
1. Trinh bay diidc cac giai doan cuoi cuoc ddi cua ngitdi benh.
2. Trinh bay diidc nhitng bieu hien cua giai doan hap hoi va dau hieu cua cai chet.
,A ' it-I • * r’ , ' > * » *
3. Trinh bay diidc cdch chdm soc ngiicti benh d giai doan hap hoi- fi? vong.
1. CAC GIAI DOAN CUOI CUA CUOC D d i NGUCl BENH
1.1. Stf tvf choi
Giai doan nay ngUdi benh khong chap nhan cai chet, ngUdi benh thUdng
ngh! cai chet khong the xay ra vdi ho. Day la phan ting dau tien cua ngiidi benh.
1.2. Stf tvfc gian
Co the bieu hien b&ng sU gian dQ mot cach vo cd v6i nhan vien benh vien
hoac ngildi nha ngUdi benh vi mot ly do nao do.
1.3. Stf mac ca
6 giai doan nay ngildi benh mac ca vdi viec chQa benh, muon tim cach de
co sU thay doi khac ve ket qua cua sii viec. NgUdi benh co the yeu cau goi thay
cung, thay mo, muc sii... tham chi co sii trang troi lien quan den toi loi.
1.4. Stf buon rau
NgUdi benh rat lo l&ng buon rau vi biet cai chet sip den v6i ho. Ho tiec
nhflng ngay da qua di va mong muon diidc ke le, tam stf vdi ngtfdi than hoac
dieu dtfdng.
1.5. Stf chap nhan
Day la giai doan tuyet vong, ngildi benh da chap nhan cai chet. 6 giai
doan nay giao tiep v6i ngtfdi benh thildng kho khan, ngtfdi benh thtfdng tram
l&ng hofic lai n6i nhieu (khi hap hoi ngtfdi benh muon gap ngtfdi than de noi
ldi tr&ng troi, di chuc, cach bo tri tang ll).
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2. NHLfNG BIEU HIEN CUA GIAI DOAN HAP HOI VA DAU HIEU CUA
cAl CHET
- Chan tay lanh, sac mat nhdt nhat, mong tay tim tai (day la bieu hien cua
sii lilu thong mau giam).
- NgUdi benh co the va mo hoi dam dia (do roi loan van mach).
- Trildng lilc cd giam, cd the trd nen u ru, thieu sinh lilc, ham tre xuong,
mieng lech, mui veo, noi kho, nuot kho, dan dan mat phan xa hoan toan.
- Mat lom xuong, dd dai khong cut dong.
-r Ho hap thay doi: ngildi benh thd cham va kho thcl, li dong ddm va chat
nhay. Khi thd co the gay ra am thanh goi la “tieng nac hap hoi” .
- Mach nhanh nho, ro'i loan kho bat.
- Y thiic lu lan.
- TrU6c luc ngUdi benh ngting thd mach se md ddn di roi khong sd thay
mach nQa.
* Chu y:
Trong luc nay ngUdi dieu dvldng phai luon co mat d canh ngildi benh,
phat hien kip thdi cac dau hieu song va sii thay doi ve tinh trang ngildi benh
de bao cao ngay cho dieu diidng trilclng hoSc bac si biet. Sii co mat thildng
xuyen cua dieu dildng se la nguon an ui 16n doi vdi ho va than nhan.
3. CHAM SOC NGUOl BENH 6 GIAI DOAN HAP HOI - TtT VONG
3.1. Cham soc ngtfdi benh d giai doan hap hoi
3.1.1. Nguyen tac cham soc
- Chuyen ngildi benh den phong rieng, tranh gay on ao va tien cho viec
cham soc khong anh hilclng den ngildi benh khac.
- Giup dd ngildi benh ve mat tam ly, sinh ly va tinh than.
- Thilc hien khan trildng y lenh va bang moi cach lam giam dau kho, cac
trieu chCfng cho ngUdi benh.
- Tan tinh cham soc ciiu chfla ngildi benh den phut cuoi cung.
- Dam bad cho ngildi benh va than nhan khong bi ddn doc trong giai doan
cuoi nay.
- Khi ngildi benh hap hoi neu khong co than nhan ben canh, ngildi benh co
trang troi dieu gi dieu dtfdng phai ghi ch6p day du d ! bao cho than nhan
hdac cd quan biet.
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3.1.2. Dap ting nhu cau cho ngitdi benh
- Dap ting nhu cau ca nhan: t&m, lau ngUdi, ve sinh rang mieng cho ngiidi benh.
- Nhu cau tu the: luon thay doi tu the l't nhat 2 gid mot lan de ngiidi benh
thoai mai, ngan ngtia loet.
- Nhu cau giao tiep: benh nhan con tinh tao dieu dUdng luon d ben canh an
ui benh nhan, lUu y khong noi nhting dieu lien quan den benh.
- Nhu cau ve thi giac: phong benh sach se, thoang khi du anh sang.
- Nhu cau ve dinh diidng: benh nhan con an diidc cho an long de tieu,
chia nhieu btia trong ngay. Neu khong an diidc cho an qua sonde hoac
truyen dich.
- Nhu cau ve bai tiet:
+ Benh nhan tang tiet nhieu ddm rai phai hut ddm rai.
+ Benh nhan dai tieu tien khong tii chu phai thay qu&n ao, giti ve sinh
sach se.
- Nhu cau ve lieu phap oxy: thcl oxy qua sonde (neu can).
- Nhu cau ve tinh than: ton trong nhu cau tinh cam cua benh nhan, tuan
theo ton giao va nhting yeu cau tai thdi diem benh nhan chet.
3.1.3. Doi vdi than nhan
- Moi cong viec phai dtfdc thvtc hien mot cach nhe nhang, nhanh gon, co
hieu qua tranh ngiidi nha hieu lam.
- Khi benh nhan doi hoi dieu diidng chi diidc tra ldi nhting cau hoi trong
pham vi cho phep.
- Phai te nhi lich sii, nhe nhang cam thong vdi ngiidi nha.
- Doi khi phai thong bao va giai thich cho than nhan ve viec minh can lam
va yeu cau gia dinh benh nhan ra ngoai.
3.1.4. Ky thuat cham soc benh nhan d giai doan hap hoi
• Chuan bi benh nhan
- Chuyen ngiidi benh sang phong rieng, neu khong co phong rieng phai co
binh phong de tranh anh hiidng den ngiidi benh khac.
- Dong vien ngiidi benh va than nhan ho.
- Thong bao tinh trang cua ngiidi benh cho than nhan diidc biet, de ho khoi
bi sang chan tinh than.
• Chuan bi ngtfdi dieu diidng
- Dieu diidng c6 du mu, ao, khau trang.
- Rtia tay thiidng quy.
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• Chuan bi dung cu
- Chan, lo stfdi (neu ngiidi benh lanh).
- Dung cu hut ddm rai (neu co tang tiet ddm rai)
- Dung cu thd oxy (neu ngtfdi benh thieu oxy)
- Dung cu dem mach, nhip thd, do nhiet do, huyet ap
- Dung cu ve sinh ca nhan (ngtfdi benh tang bai tiet, roi loan van tim mach).
- Dung cu an uong (ngtfdi benh con an dtfdc).
• Ky thuat tien hanh
- Giup ngtfdi benh d tu the thuan ldi (trong ttf the nghi ngdi dieu tri).
- Dap chan, lo stfdi, u am de tang than nhiet cho ngtfdi benh (giut than
nhiet cho ngUdi benh).
- Tang tiet ddm rai phai hut ddm rai cho ngtfdi benh (bai hut ddm rai).
- Cho ngtfdi benh thd oxy neu thieu oxy (bai lieu phap oxy).
- Theo doi mach, nhiet do, huyet ap, nhip thd (bai dau hieu sinh ton).
- Cho ngtfdi benh an uong theo chi dinh (dap ting nhu cau dinh dtfdng).
• Thu don dung cu
- Dtfa cac dung cu dem xtf ly theo quy dinh.
- Ghi phieu cham soc.
3.2. Ky thuat cham soc ngtfdi benh of giai doan tuf vong
Khi bac si xac dinh ngiidi benh da chet, ngoai viec dap ting cac nhu cau
cua than nhan ngtfdi chet, dieu dtfdng phai chuan bi day du dung cu, phtfdng
tien de thtfc hien cac c6ng viec xi\ ly tii thi.
• Chuan bi dung cu, phiidng tien:
- Ho sd benh an, khay chtf nhat, gang tay.
- Tru c^m hai kim Kocher, keo, bang dinh.
- Bong, gac.
- Bo dung cu thay bang rtia vet thtfdng (neu la ngtfdi benh sau mo).
- Bong khong tham ntfdc, quan ao sach cua ngtfdi benh.
- Hai dai bang nho va ng^n, ba dai b&ng to ban.
- Khan bong, chau ntfdc am (ntfdc la thdm...).
- Vai phu, tui dung do ban.
- Cang ho&c xe day.
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Ky thuat tien hanh
- Yeu cau than nhan ra khoi phong, che binh phong (neu khong co phong rieng).
- Dieu dUdng mang gang tay.
- Dat ngUdi benh nSm tu the thuan ldi.
- Dung bong khong tham nUdc nut cac lo tu nhien (lo tai, lo mui, mieng,
hau mon, sinh due).
- Rut cac orig thong, ong dan lUu (neu co).
- Thao nep bot, bang cu, thay bang (neu co).
- Thao bo do trang stic tren ngUdi ngUdi benh.
- Dung gac tham nUdc am vuot hai mat cho khep lai.
- Khep kin mieng ngildi benh.
- Riia mat, ccfi bo ao cu, lau ntia ngUdi tren va mac ao cho ngUdi benh.
- Cdi quan, lau niia ngUdi phia dudi va mac quan cho ngUdi benh.
- De hai canh tay doc theo canh sUdn, long ban tay up len bung.
- Buoc hai ngon tay cai lai v6i nhau.
- De hai chan duoi thing, buoc hai ngon chan cai lai vdi nhau.
- Buoc hai dai bang cf cac vi tri: hai ba vai, hai mao chau, hai dau goi.
- Chuyen ngUdi benh nhe nhang len cang hoSc xe day.
- Phu vai kin ngUdi benh.
- Ghi ho sd ngay, gid ngUdi benh tik vong.
- Gai phieu ngildi benh len ngUc ben ngoai vai phu.
- Chuyen thi the ngildi benh xuong nha xac.
- Sap xep va xti ly dung cu dung quy dinh.
- NgUdi benh khdng co than nhan, tai san cua ngUdi benh phai lap bien
ban va giii tai phong tiep don.
CAU h6| T li LUONG GIA
Hoan thi$n cac cau sau bang cach chon tit, cum til thich hdp dien vao cho
trong:
v.
1. SiJ cha'p nhan la giai doan....A
......
ngUdi benh ch&p nhan cai chet.
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