Bai 12
CHO NGL/Ol BENH THd OXY
M yc TIEU
1. Neu dtfdc dinh nghia lieu phap oxy, cdc nguyen nhdn lam cho ngtfdi benh bi
thieu oxy.
2. Trinh bay cdc dau hieu, trieu chitng chinh cua thieu oxy.
3. Trinh bay dtfdc nguyen tac cd ban khi sit dung liqu phap oxy.
hiqn dtfdc quy trinh cho ngtfdi benh thd oxy bang phtfdng phap ong thdng
1. DINH NGHLA: lieu phap oxy la bien phap cung c&p khi thd co nong do oxy
ldn hdn 21%.
2. NGUYEN NHAN lAm CHO CO THE BI THIEU OXY
2.1. Cac chtfdng ngai vat dtfdng ho hap
- Khoi u diidng thd.
- Di vat diidng thd: sic thtfc an, nildc ...
- Do co that, phu ne, dich tiet bit tac dtfdng thd.
Vi du: viem tieu phe quan co that, hen phe quan, bach hiu hong - thanh quan.
2.2. Han che hoat dong cua long ngtfc
- Do than kinh: Lam liet cd ho hap.
+ Chan thiidng cot song co - ngtfc.
+ Viem nao, xuat huyet nao, mang nao.
- Do chan thtfdng long ngtfc: lam ton thtfdng c0 ho hap, xtfdng stfdn.
- Do benh ly phoi, mang phoi: cac trtfdng hdp viem phoi, m&ng phoi 1km
tran khi, tran dich mang phoi, lao phdi.
2.3. Cac benh gay can trd stf khuyech tan khi d phoi
- Viem phdi thuy.
- Phe quan phe viem.
- Phu phdi c&p.
96
2.4. Cac benh lam roi loan qua trinh van chuyen khi trong cd the
• Thieu mau: dac biet la
- Thieu mau cap tinh.
- Thieu mau nang.
• Tuan hoan
- Suy tim: suy tim cap, suy tim do II - III.
- Truy tim mach.
3. CAC DAU HIEU, TRIEU CHlTNG CHINH CUA THIEU OXY MAU
- Kho thd: ngtfdi benh cam thay kho chiu phai ngoi day de thd, co cam giac
nghet thd.
+ Tre em nhip thd nhanh.
- Ngtfdi benh bieu hien lo au, hot hoang, bon chon.
- Vat va kich thich.
- Giam tri nhd: tri nhd ngheo n&n, xa x&m, Ion xon.
- Giam thi lilc: nhin md, nhin doi...
- Giam trtfdng ltfc cd va stf phoi hdp cua cac cd.
- Trong giai doan dau: mach, huyet ap, nhip thd tang de dap ting nhu cau
oxy cho cd the.
- Giai doan sau: ngtfdi benh xuat hien tim tai ro (tre em co dau hieu rut
lom long ngtfc) co roi loan nhip thd, huyet ap giam, mach nhanh.
4. CAC NGUYEN TAC KHI TIEN HANH LIEU PHAP OXY
4.1. Lieu phap oxy dtftfc tien hanh theo chi dinh cua thay thuoc
- Phtfdng phap thd oxy.
- Thdi gian thd oxy.
- Ltfu ltfdng oxy: la the tich oxy can cung cap cho ngtfdi benh trong thdi
gian 1 phut.
+ Thd oxy qua ong thong mui hau: 1 - 5 lit/ phut.
+ Thd oxy qua m£t na: 8 - 12 lit/ phut.
- DAm do: Nong do oxy trong khi thd (ty le %).
+ Thd oxy qua ong thong mui hau: 22% - 30%.
+ Thd oxy qua mat n$: 35% - 60%
- Do £m: ty 1$ ph&n tr&m hdi ntfdc trong khi thd.
. ♦ 0
- Phtfdng phap l&m Am: sue khi oxy qua lo ntfdc sach.
97
4.2. Dam bao ve sinh phong chong nhiem khuan
- Sti dung cac dung cu sach, dung cu vo khuan dung quy dinh.
- Luon giti cho ong thong kho, neu thdi gian thd oxy keo dai can thay doi
sonde, ben lo mui cua ngtfdi benh 8h/lan (doi vdi trUdng hdp thd oxy qua
ong thong mui hau).
- Dam bao ve sinh rang mieng cho ngtfdi benh 3 - 4h/lan.
4.3. Phong tranh kho niem mac dtfdng ho hap
- Thtfc hien tot viec lam am oxy.
- Dam bao du ltfdng ntfdc uong hang ngay cho ngtfdi benh.
4.4. Phong chay no
- Treo bien “Cam lita”, “Khong hut thuoc” d khu vtfc co binh, he thong oxy.
- Nhic nhd ngUdi nha ngtfdi benh khong sti dung cac chat de chay d phong
co he thong oxy: hut thuoc, diem, bep...
- Binh dtfng oxy de ndi kho rao, sach se, gon g&ng v& phai dtfdc co dinh
chic chin.
- Khi can van chuyen binh oxy phai sti dung xe day rieng, di chuyen nhe nh&ng.
5. CAC PHLTdNG PHAP T H d OXY
- Thd oxy bing ong thong mui hau.
- Sti dung mat na.
- Leu oxy.
- Long ap.
6. QUY TRINH KY THUAT THCJ OXY QUA ONG THONG MUI HAU
6.1. Chuan bi ngtfdi benh
Giai thich va dong vien de ngtfdi
benh yen tam.
- Dat ngtfdi benh d ttf the ntia nim
ntia ngoi hoac ttf the nim ngtia
thing ke goi dtfdi vai.
6.2. Chuan bi ngtfdi dieu dtfdng
Dieu dtfdng cd day du mu ao, khau Hlnh 12.1. Thd oxy b&ng dog thdng
trang, rtia tay thtfdng quy. mQi h£u
■ • - f :V£. t i .t .
98
6.3. Chuan bi phtfdng tien va dung cu
• Dung cu sach:
- Binh dtfng oxy: ap ltfc ke, ltfu liidng ke
(co the dung bao long oxy), day dan oxy.
- Binh (lo) lam am oxy: dung nUdc cat
hoac nUdc chin (ltfdng nUdc trong binh
chiem 1/2 the tich binh).
- Khay chii nhat.
- Bang dinh, keo cit bang dinh.
- Tui dtfng do ban.
- Hop dtfng dng thong Nelaton vo khuan
cd so" thich hdp:
+ Tre em cd so 8 hoac 10.
+ Ngiidi ldn cd so 10 - 12 - 14.
A/
- Ong ngtii oxy hoac mast.
- Hop dtfng bong, gac, tam bong.
- Gang tay. Hlnh 12.3. Binh dimg oxy
6.4. Ky thuat tien hanh
- De ngtfdi benh nim ttf the thich hdp.
- Co' dinh lo dtfng ntfdc lam am oxy. Lip he thong thd oxy va kiem tra stf
hoat dong cua toan bo he thong, md van dieu chinh ltfu ltfdng oxy theo
chi dinh, sau khi thti xong dong van lai.
- Dieu dtfdng mang gang.
- Dung tam bong ve sinh mui cho ngtfdi benh.
- Lam thong thoang dtfdng ho hap tren bing cach hut ddm rai cho ngtfdi
benh neu co tang tiet.
- Do va danh dau dau ong thong: do ttf canh mui den dai tai cung ben cua
ngtfdi benh.
- Cam ong thdng nhtf kieu cam but nhe nhang dtfa ong thong v&o mui ng
tfdi benh cho tdi vach danh dau:
- Neu sii dung mast thi chup mast kin mui mieng ngtfdi benh.
- Neu sti dung he thong ngtii thi dat ong ngtii vao mui va cd dinh lai.
- Ndi h$ thong oxy vdi dng thdng (mast hoac ong ngtii) va md khda cho
ngtfdi benh thd.
- Dung bang dinh cd' djnh dng thdng, day din.
99
- Danh hieu qua viec cho ngudi benh thd oxy bing cach danh gia lai ngtfdi
benh ve mau sic da, niem mac, nhip thd, dau hieu rut lom long ngtfc,
mach, huyet ap...
6.5. Thu don dung cu
• • o «
- Sip xep va xtf ly dung cu theo quy dinh, thao g&ng.
- Ghi phieu cham soc:
+ Tinh trang ngUdi benh trtfdc khi thd oxy.
+ Thdi gian bit dau thtfc hien thu thuat.
+ Ltfu ltfdng oxy.
+ Tinh trang ngtfdi benh trong va sau khi thd oxy.
+ Dieu dtfdng ky ten.
Bang 12.1. Bang kiem ky thuat thd oxy qua dng thong mui h3u
TT Npi dung Co Khong
* Chuan bj ngudi benh
1Xem y lenh, doi chieu ngudi benh.
2Giai thich cho ngudi benh, ngudi nha y€n tam, dat ngudi bdnh d tu thd
thuan ldi.
* Chuan bj ngudi Dieu dudng
3Dieu dudng co day du mu, ao, khau trang, rda tay thudng quy.
* Chuan bj dung cu
4Khay chu nhat, tui dung oxy, to dung nude Idm dm va he thdng day dlin oxy.
5Hop dung dng thdng vd khuan hoac mast hoac dng ngOri oxy, bdng gac,
tam bdng.
6Gang tay, keo, bang dinh, tui dung d6 bln.
* Ky thuat tien hanh
7Dat ngudi benh nam tu thd thich hdp.
8Cd djnh Ip dung nude Idm am oxy vao thanh giudng, l£p tui dung oxy vao
he thdng lam am
9Dieu chinh luu li/dng oxy, khoa lai.
10 Dieu dudng mang gang, ve sinh mui, hut ddm rai cho ngudi bdnh (ndu cdn).
11 Do chidu dai dng thdng (tCr canh mui ddn ddi tai cung ben cua ngudi bdnh).
danh ddu bang bang dinh.
12 Dua dng thdng vao mui ngudi benh den vach danh ddu, c6 djnh lai (sCr
dung mast thi chup mast kin mui mieng ngudi bdnh, sir dung hd thdng ngfr
thi ddt dng ngCri vao mui va cd dinh lai)
13 Lap day d in oxy vdi dng thdng (hoac mast, hd thdng ngtt), md khod day
din oxy vao ngudi bdnh.
14 Cd dinh dng thdng, ddy dan oxy chdc chan.
15 Danh gia hieu qua vide cho ngudi bdnh thd o xy.
* Thu dpn dung cu
16 Thu don dung cu, thao gang, ghi phidu chSm s6c.
100