HUT DICH DA DAY
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Bai 14
1. MUC DICH
Hut dich da day la thu thuat dtfa ong thong vao da day de hut mot it dich
co cl trong do ra de chan doan va dieu tri mot so' benh diidng tieu hoa.
2. CHI DINH
- Cac benh ve da day: viem loet da day ta trang, ung thil da day, hep mon
vi, thung da day.
- Nghi ngd lao phdi cl tre em.
- Cac trtfdng hdp chtfdng bung.
- Ngildi benh md diidng tieu hoa: da day, ruot va cac phlu thuat khac co
gay me.
3. CHONG CHI DINH
- Benh d thtfc quan: co that, chit hep, phinh tinh, dong mach thiic quan.
- Ton thildng thiic quan: u, ro, bong thiic quan, da day do acid, kiem manh.
4. QUY TRiNH KY THUAT
4.1. Chuan bi ngtfdi benh
- Neu la'y dich x6t nghiem can dan ngtfdi benh nhin doi trtfdc 12h.
- Thong bao cho ngtfcJi benh hoac ngtfdi nha biet thu thuat sip lam.
- Dong vien an ui ngtfdi benh yen tam.
- Htfdng d&n ngtfdi benh nhtfng dieu can thiet.
f 'i f i p , i H i . ••>.-1 i, ,
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4.2. Chuan bi ngtfdi dieu dtfdng
- Dieu dtfdng co du ao, mu, khau trang.
- Rua tay thtfdng quy.
4.3. Chuan bi dung cu
- Khay chtf nhat, tru cam kim Kocher, coc dtfng bong tam parafin.
- Coc ntf6c chin, khan lau mieng, nilon, khay qua dau.
- Gia dtfng ong nghiem, ong nghiem neu cln, tui dtfng do ban
- Hop vo khuan dtfng: gang tay, bdm tiem 50 ml, gac, ong Levin tuy theo
tuoi chuan bi cd cho phu hdp.
4.4. Ky thuat tien hanh
Hut dich da day dtfdc tien hanh d buong thu thuat hoac buong benh.
- De ngtfdi benh ngoi hoac nim ttf the thuan ldi, thao rang gia (neu c6),
choang nilon vao cd, ngtfc ngtfdi benh.
- Dat khay qua dau ngang d m (neu ngtfdi benh nim), htfdng din ngtfdi
phu cam khay qua dau (neu ngtfdi benh ngoi).
- Md hdp vo khuan, dieu dtfdng di gang.
- Cam ong thong quan sat so' do hoac vach danh da'u tren dng thong. Neu
dng thong chtfa co vach thi phai do tren ngtfdi benh cach do:
+ Cach 1: do ttf canh mui den dai tai cung ben roi xudng den diem gitfa
ttf mui tfc tdi ron.
+ Cach 2: do ttf cung rang ciia den ron ngtfdi benh.
- Dung bang dinh danh dau, boi trdn dau dng thdng blng dlu nhdn. v»
- Dtfa dng thdng vao Id mui, khi dng vao tdi hong bao ngtfdi benh nuot tiep
tuc dtfa ong tdi vach da danh dau. Sau do dung bang dinh cd dinh dng
thdng lai.
- Kiem tra ong thdng da vao tdi da day blng cach:
+ Cach 1: dung bdm tiem hut neu thay dich chay ra la dng thdng da vao
da day.
+ Cach 2: dung bdm tiem bdm mot ltfdng khdng khi vao dng thdng dong
thdi dat dng nghe len vung thtfdng vi nghe tha'y tieng uc uc la dng
thdng da vao tdi da day.
- Lip bdm tiem vao dau ong thdng de hut dich.
+ Neu hut dich lam xet nghiem thi lay 5 ml - 10 ml cho vao dng nghiem.
+ Neu hut dich de dieu tri thi hut cho dich ra hdt.
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- Kep hoac nut ong thong lai mot thdi gian sau hut tiep.
- Khi dung may hut phai dieu chinh ap ltfc hut trtfdc khi lap may.
+ NgUdi ldn hut vdi ap ltfc 300 mmHg.
+ Tre em hut vdi ap lilc 150 mmHg.
- Khi dich khong chay ra ntfa hoac ngUdi benh dd chtfdng bung thi tat may,
kep ong hoac nut ong lai.
- Khi hut tiep chi can md ong thong lap vao may.
- Hut xong rut ong thong: mot tay cam gac dd ong, mot tay cuon gon ong
lai con khoang 10 - 15 cm thi gap ong lai va rut nhanh dau dng ra.
- Cho ngildi benh xuc mieng, lau mieng va giup ngtfdi benh nSm lai thoai
mai tren gitfdng.
- Gtfi benh pham di xet nghiem (neu cd chi dinh).
4.5. Thu don dung cu - ghi ket qua vao phieu cham soc
- SSp xep dung cu dung ndi quy dinh, thao gang.
- Ghi ho sd:
+ Ngay gid lam thu thuat.
+ S6" ltfdng dich hut ra.
+ Thdi gian hut.
+ So' ltfdng dich chay ra, mau sic, mui.
+ Tinh trang ngtfdi benh trtfdc, trong va sau khi hut.
+ Ten dieu dtfdng thtfc hien.
5. NHU’NG DIEM CAN CHU Y
- Trong khi hut dich phai co dinh ong thong chac chan.
- Khi hut lien tuc bang may dan ngtfdi nha khong dtfdc ttf y dieu chinh ap
ltfc hoac rut crig thong.
- Gitf gin ve sinh mui, rang mieng.
- Thtfdng xuyen bdm riia dng thong bang dung dich natriclorua 9°/00 de
ong thong khong bi tac, sau 12 gid - 48 gid phai thay ong thong (neu hut
lien tuc).
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Bang 14. Bang kiem ky thuat hut djch da day
TT Noi dung Co Khdng
* Chuan bj ngudi benh
1Xem y lenh, doi chieu ngudi benh.
2Giai thich cho ngudi benh biet viec sap iam va dan nhung didu c£n thidt.
* Chuan bj ngudi dieu dudng
3Dieu dudng co du mu, ao, khau trang, rtfa tay thudng quy.
* Chuan bi dung cu.
4Khay ch& nhat, tru cam mot kim Kocher, cdc dung bdng tdm dau nhdn.
5Coc nude chin, khan lau mieng, gang tay, keo, bang dinh, dng nghidm,
gitfy xet nghiem (neu can).
6 Bom tiem 50 ml, dng thdng Levin, hdp dung bdng gac.
7 Nilon, khay qua dau, tui dung do ban.
* Ky thuat tien hanh
8Dat ngudi benh ngoi hoac nam tuthe thuan loi, quang nilon.
9 Hudng dan ngudi phu giup khi ngudi benh non.
10 Dieu dudng mang gang, cam dng Levin do, danh ddu va bdi tron dau dng.
11 Dua dng thdng vao mui hoac mieng ngudi benh ddn vach danh ddu, xac
djnh dau dng thdng da vao den da day.
12 Cd dinh dng thdng, dung bom tiem hut djch da day cho djch vao dng
nghiem (neu can).
13 Rut dng thdng, cho ngudi benh sue mieng, lau midng va n&m lai tuthd
thoai mai.
* Thu dpn dung cu
14 Thu don dung cu, thao gang, ghi phieu cham sdc.
CAU HOI TI/ Ll/ONG GIA
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Hoan thien cac cau sau bang cach chon tti, cum tti thich hdp dien v&o cho
trong.
1. Hut dich da day nhim hai muc dich:
A :................................................
B:................................................
2. Dung may de hut dich da day cho ngUdi benh dieu dudng phai dieu
chinh may hut vdi ap luc ....A
.............
mmHg.
3. TrUdng hdp ngUdi benh dfit sonde hut dich da diy lien tyc thi sau
....A....den ...B
........
phai thay dng sonde.
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4. Khi rut ong thong da day dieu dudng tf6c ltfdng ong thong con trong
ngtfdi benh khoang
.....
A
.........
thi dung kim Kocher kep hoac gap ong lai rut
nhanh ra ngoai.
Chon y dung nhat de tra ldi cho cac cau hoi sau.
5. Khi hut dich da day lam xet nghiem can dan ngtfdi benh nhin an trtfdc:
A: 6 gid.
B: 8 gid.
C: 10 gid.
D: 12 gid.
6. Dung may hut de hut dich da day cho tre em dieu dtfdng phai dieu
chinh ap ltfc may hut.
A: 100 mmHg.
B: 120 mmHg.
C: 150 mmHg.
D: 200 mmHg.
Phan biet dung, sai cac cau sau bang cach dien dau (V) vao cot A cho cau
dung, cot B cho cau sai.
TT Ndi dung AB
7Ngi/di benh sau md da d£y neu thay chi/6ng bung thi ddt Sonde dd
hut djch.
8Tre em ho, sot nghi ngd la viem phdi thi chi dinh hut dich da d£y de xet
nghiem.
9Kh6ng hilt djch da d&y cho ngi/di b§nh bj ton thi/ong thirc quan.
10 Ngi/di benh bj thCing da day Khi chi/a phau thuat thi chi djnh hut djch da
d^y lien tuc.