calendrier de vaccination au Maroc

gestes de base a savoir avant d'effectuer un stage au bloc opératoire

prévention des escarres de décubitus pdf

1 Introduction . Nurse has frequent opportunities to put ice packs to patients for therapeutic purposes , a simple gesture & current but which should not be neglected and that it must monitor the application.
Definition 2 . It is a rubber bag filled shape variable ice that employment on medical opinion, we must renew the ice while the n2 n3 hours.
3 Actions . :
• Decongestive
• révulsive
• antithermic
• Anti- Algonkian
• Anti -infective
4 Notice . :
a) Medical
• Cerebral hemorrhage
• Typhoid
• Cholecystitis
• Myocarditis
• Meningitis
b) Surgical
• Appendicitis
• Peritonitis
• acute salpingitis
• abscess
c) Obstetric
• Infection
• Breast abscess
5. Contre indication
• Constipation
• Pregnant Woman
6 Materials. :
• Pocket rubber
• linen
• Ice broken into small pieces
• Strip
Technique 7 .
• Check if the bladder is not perforated ice
• Fill / bladder 2 by 3 pieces of ice only driven air
• Wipe and closed
• Wrap in a cloth
• Ask the bladder location indicated on the prescription
• Note the time on the monitoring sheet

DEFINITION
Collecting a blood sample in a superficial vein of one or more tubes for review (s ) in the laboratory.

INDICATIONS
- Cytological analysis: blood count , platelets, ...
- Chemical analysis : electrolytes , coagulation study , ...
- Serological Analysis: hepatitis B or C , HIV, ...
- Bacteriological Analysis: blood culture , ...
- Immunoassay ...

MATERIAL
 Plateau decontaminated bean disposable,
 sterile compresses ,
 70 ° alcohol or alcoholic Betadine antiseptic nonalcoholic if BAC to be assayed,
 non-sterile gloves , bed protection ,
 sample tubes suitable for prescription,
 body .
 fixed needle or butterfly needle adapted to the diameter of the vein ,
 withers decontaminated and appropriate size, plaster ,
 hydro- alcoholic solution for rapid hand antisepsis ,
 good laboratory according to the prescription
 container for sharps .

CONDUCT OF CARE
 Warn the patient the day before or as soon as possible and explain the purpose of the review and the deadline for return of results.
 Check if the examination requires that the patient is fasting and / or time of sampling.
 Perform antiseptic hand washing.
 Prepare the necessary equipment on board care.
 Position the patient comfortably with arms flat bearing down. Removing or attaching the handle and check the skin clean.
 If the patient is infused , underwent axillary lymph node dissection , is paralyzed or holder of an arteriovenous fistula for dialysis : Perform blood sampling to the opposite arm.
 Arrange bed protection under the arm.
 Conduct a rapid hand antisepsis .
 Open the bag of sterile compresses.
 Adapting the sampling system and the puncture system then put the pair of non- sterile gloves. Choose a vein by sight and touch.
 Identify the puncture , position and tighten the tourniquet , about 10 cm above. Practise the patient a few contractions of the hand, tapping the vein or massaging the arm in the direction of the venous circulation (wrist, elbow crease ) .
 Perform patient skin preparation with alcohol -soaked and always starting from the puncture site to the outside ( diameter 5 cm) compresses : make a first pass and throw the pad in the beans, then return to the same area with a second compress soaked in alcohol.
 Secure the vein puncture needle bevel facing upward at about 45 ° in the direction of venous return. Puncture the vein.
 Change tubes progressively . Invert the tube several times , with the exception of dry tubes.
 Release the tourniquet .
 mismatching the last tube.
 Remove the needle and dispose of it in a separate container . The rest of the material being thrown into the bean .
 compress the puncture site with a dry gauze about a minute , do not bend the arm .
 Place a compress on the puncture and secure with tape .
 Remove the protective bed .
 Remove and discard non-sterile gloves.
 comfortably Reinstall the patient and, if necessary , serve him a snack.
 Identify the tubes in the patient's room with its labels and transported to the laboratory in bags provided for this effect accompanied requests examinations filled and labeled
 Respect traceability of the examination.

datasheet
Purpose: With strict asepsis , taking a sample of blood.
When? On prescription.
Who? IDE and specialties Midwife .
material:
- Sample tubes suitable for prescription.
- Complete removal device : puncture system and pump body.
- Clean withers (cleaned and disinfected ) .
- Sterile gauze .
- 1 pair of non- sterile gloves.
- Antiseptic solution of alcohol 70 °.
- Protection from bed.
- Hydro- alcoholic solution for rapid hand antisepsis .
- Plaster fixation .
- Sharps container and sharps .
technique:
- After an antiseptic handwashing prepare the necessary materials on a cart or tray own care (cleaned and disinfected ) .
- Place the patient and have the bed protection .
- Conduct a rapid hand antisepsis .
- Open the sterile packaging for easy gripping flawless aseptic .
- Adapting the sampling system and the puncture system .
- Place non-sterile gloves.
- Locate the puncture site positioning and tightening the tourniquet .
- Perform patient skin preparation with alcohol swab , discard the pad , then with a second alcohol-soaked a second pass over the same area compress.
- Puncture the vein for blood sampling .
- Change tubes As .
- Loosen the tourniquet and remove the used needle into the container with the pump for single use ( Vacutainer ® Inventory 36 48 87) , or mismatching if pump body with multiple uses.
- After compression of the puncture site with dry gauze , put in place a bandage.
- Remove the protection from bed and discard gloves .
- Identify the samples and completely fill the right before sending to the laboratory , observing the precautions
Standard .
- Carry out cleaning and disinfection and storage or disposal of the material used .
- Conduct an antiseptic handwash .
- Make written on the back of nursing patient transmissions.

TEMPERATURE
1. DEFINITION
This is the measure of the body temperature with a thermometer powered . It expresses the degree of body heat in degrees Celsius centigrade said .
Physiological values:
- Body temperature is between 36 ° and 37 ° 5 5

Physiological variations :
- It increases slightly with physical activity , brain work and digestion.
- It varies according to:
•   the menstrual cycle,
•   climate, ambient temperature,
The external body temperature of 0,5 ° to lower the internal temperature .

2 Different methods of measuring body temperature. :
• With a tympanic thermometer :
•   atrial temperature (used for all ages ) is shown against after ENT surgery .
• With a skin thermometer :
•   rectal temperature ( most reliable ) can be used at all ages ; it is against diarrheal indicated for people in carriers of hemorrhoids people, postoperative rectal surgery and preterm infants ,
•   axillary and inguinal temperatures ( used when the rectal temperature is impossible) are indicated against in people too thin ,
•   oral temperature is entered against for babies, children, people with breathing through the mouth ( as takes mouth closed) , unconscious patients , confused or agitated and postoperative maxillofacial surgery.
• With a heat sensor skin :
•   the forehead temperature , using an easy to use , unbreakable and non- toxic material, is less accurate ; it is mainly used in infants and children and against specified in facial burns on the forehead .

Temperature taking is a treatment that includes the taking of vital signs of a patient, as well as taking pulse, blood pressure, respiratory rate, and visual analog scale .

3 . INDICATIONS
- Systematic monitoring during hospitalization :
•   any patient entering
•   pre , per and postoperative
•   when prescribing or monitoring schedule every 2 hours , every 4 hours , morning and evening (always at the same time) .
- Monitoring of an infectious syndrome :
•   hyperthermia > or = 38 ° 5
•   hypothermia <or = 36 ° 5
•   when chills, sweats , malaise, signs of septic reaction may correspond to the passage of germs in the blood,
•   during convulsions.

- Monitoring of a neuroleptic malignant syndrome due to .

4. OBJECTIVES
- Knowledge of thermoregulation.
- Knowledge of specific monitoring the temperature indications.

HARDWARE 5.
- For hygiene :
•   own compresses and disinfectant ,
•   skin thermometer must be clean and disinfected between each patient and disposable tips are used for tympanic thermometer.
- For the care :
•   cutaneous thermometer, tympanic ,
•   plateau
•   bean
•   lubricant if necessary kind Vaseline + PEN


6 . CONDUCT OF CARE

skin temperature
- The patient is quiet , preferably lying down.
- Check that the column Gallium is lowered into the bulb of the thermometer tip ( for taking oral temperature , the tip is wide and flat ) .
- Leave the thermometer in the patient with a compress on his place if necessary .
- Ask them to keep up a minute.
- After taking the temperature , wipe the thermometer with a compress.
- Read temperature.
- Remove the pad and thermometer in a bean .
- Record the result on the temperature .
- Clean the thermometer after each use in the treatment room, " tank side" :
•   Never use hot water,
•   soaking in antiseptic solution for 10 minutes at least ,
•   brushing ( brush reserved for this purpose ) with non-sterile gloves ,
•   rinsing
•   drying before immersing into the vial of alcohol or store it in an individual case .

For taking rectal temperature where the risk of injury to the anal mucosa is present, the thermometer is individual and remains in the patient's room .
For axillary or inguinal taken temperature, the thermometer must be held for 5 minutes armpit or groin .
For taking oral temperature , the thermometer is placed under the tongue , slightly to one side .

With the exception of making the rectal temperature , all other methods require that the skin is added to the 0.5 ° temperature displayed .


ear temperature
- The ear thermometer captures infrared rays that our body emits .
- Insert the sensor with a disposable cap in the patient's ear .
- Rotate the device 30 ° back to be in front of the eardrum.
- Read the measurement display between 1 and 3 seconds.
- Record the result on the temperature .
- Discard the used tip in the beans.

EVALUATION 7 .
- Respect the procedure carefully.
- Accuracy of the results obtained to allow the adaptation of treatment or monitoring.
- Analysis of care depending on the person being cared for .
- Awareness of appearance "Responsibility" of this care.






























RESPIRATORY FREQUENCY

DEFINITION
All respiratory movements ; respiratory movement is constituted by inspiration and expiration . The assessment focuses on breathing rate, respiratory frequency and amplitude.

Physiological values:
- Newborn : 40 movements / minute
- Child: 30 to 36 movements / minute
- Adult : 16 to 20 strokes / minute
Respiratory rate accelerates during muscular exertion , stress , emotions , exposure to heat, ... Respiratory rate decreases during sleep or rest ,

INDICATIONS
- Monitoring of a hospital in order to detect respiratory abnormalities patient
- Respiratory distress syndrome , cardiac or respiratory failure ,
- Monitoring post -operative ...

MATERIAL
- A second hand watch.
CONDUCT OF CARE
- Take the respiratory frequency remote physiological variations.
- To the person cared to stand for ¼ hour . Wash hands .
- Counting the view for a minute breathing movements .
- Adults: watch the movements of the thorax or ask the palm of the hand on the thorax.
- In children : undress and starting looking slightly abdominal breathing .
- Record the results .

















PULSE
DEFINITION
Distension of the arteries in the blood caused by the thrust of the left ventricle contraction . It allows the determination of the heart rate and the evaluation of the rhythm and the amplitude of the pulsations.

Physiological values: heart rate decreases with age .
- Newborn : 130-140 beats / minute.
- Child: 80 to 110 beats / minute.
- Adult: 70 to 80 beats / minute.
- People aged 55 to 60 beats / minute.
Heart rate accelerates during muscular exertion , digestion , stress, emotions, exposure to heat , pregnancy, and increased body temperature.

MATERIAL
- A second hand watch.

CONDUCT OF CARE
- Taking the Pulse remote physiological variations.
- To the person cared to stand for ¼ hour .
- Wash hands.
- Select the place of taking pulse ( carotid artery , brachial artery , radial artery : the most common , femoral artery, popliteal , tibial artery , dorsalis pedis artery and temporal artery ) .
- Place the index and middle fingers on the patient's artery by exerting a slight pressure.
- Count every sensation lifting the artery on a minute.
- Record the results .



















BLOOD PRESSURE

DEFINITION
Pressure under which the blood circulates in the vessels ; it is due to the force of contraction of the heart, the force of resistance vessels and blood volume .

Tenson blood is expressed by:
- MT or systolic maxima in relation to ventricular contraction ,
- Minimum or diastolic BP in relation to the resistance of vessels during ventricular diastole .
The difference between the voltage maxima and minima voltage is called the differential voltage ; it can be pinched or expanded.

Physiological values:
- Maximum systolic or <140 mmHg.
- TA diatolique or minima <90 mmHg.

BP rises with age:
- Child: 70 mm Hg / 40mmHg .
- 20 years : 110mmHg / 70 mm Hg .
- 50 years : 120- 150mmHg / 70 - 80mmHg .

Physiological variations :
- BP rises with exercise, digestion , stress , emotions , cold ...
- The TA decreases with rest, sleep , heat, pregnancy, ...

INDICATIONS
- Monitoring or screening for hypo-or hypertension ,
- Hemodynamic a patient in a hospital (if risk of heart failure, postoperative , screening of a shock ... )
- Pathology heart ...

MATERIAL
- Voltage apparatus , stethoscope
- Product antiseptic for cleaning and disinfecting the cuff and stethoscope.

CONDUCT OF CARE
- Take blood pressure remote physiological variations.
- To the person cared to stand for ¼ hour .
- Wash hands and then verify that the meter is zero mmHg and close the nut decompression.
- Locate the brachial artery ; place the stethoscope and keep a hand without support .
- Inflate the cuff to 30 mmHg above the systolic usual patient .
- Deflate slowly and smoothly : the appearance of the first sound is the TA maxima and the last sound heard is the minimum TA .
- Record results and cleaning equipment .

جهاز تنظيم ضربات القلب أو جهاز تنظيم ضربات القلب هو نظام الكتروني يهدف إلى تكملة أو استبدال وظيفة التوصيل الكهربائي الأذيني البطيني عندما فشل هذا الأخير.

 
definition
indications
Cons -indications
risks
nursing
interventional suites


definition

    The pacemaker or pacemaker is an electronic system that is intended to supplement or replace the function of atrioventricular electrical conduction when the latter fails.

    It consists of a housing and two probes which feed cavities concerned .


indications

Disorders of atrioventricular conduction.
Complete asystole ; myocardial infarction, drug intoxication .
Bradycardia , atrial fibrillation , ventricular tachycardia .

Cons -indications

Disorder of hemostasis.
Hyperthermia.

risks

early risk

Poor positioning of the probe.
Rejection of the foreign body .
Bleeding and / or hematoma.
Pneumothorax , air embolism .
Pain.
late risk

Infection .
Thromboembolic risk embolitique .
Housing displacement .
Breakdown, failure or anomaly detection or simulation.

nursing

Nursing preoperative period

Patient Preparation :
Psychological: allay fears and explain . Awareness resumption of normal life.
Blood tests : coagulation test , blood heparin , electrolytes , glucose .
Physics : fasting , skin preparation : shaving , antiseptic, blouse block , not dentures.
Nursing intraoperative

The patient is supine on a table. Pose drape . Local anesthesia. 's ECG and blood pressure taken continuously.
Venipuncture and introduction of the probe. 7 cm incision to place the box. Function test.
Nursing postoperative

Stretched position for 24 hours .
Chest X-ray .
Monitoring of non appearance of pectoral contractions or hiccups.
Handling with care: do not pull the left arm.
Monitoring signs of thrombosis , edema , redness, heat , pain, bleeding , bruising, dyspnea, cyanosis , chest pain , malaise, facies.
Dressing change every 48 hours.
Electrocardiogram (ECG) .

interventional suites

Hygiene of life

Do not carry heavy objects .
Battery protection in the face of objects of daily life : radio, microwave , electric appliance , hearing aid, avoid touching the hood of a car.
Prohibit the MRI scanner, TV relay , cell phone on the left , anti-theft system , magnet.
Progressive physical activity recovery.
Always have the card holder pacemaker itself.
Patient monitoring

Appointment with a cardiologist after a month, then every six months .
Teach him to take his pulse .
Monitoring the location area .
Hospitalization to change the housing ( after 10 years).
Inform port of the stack to doctors and dentists

Angina : Angina pectoris

definition
pathophysiology
clinical signs
additional examinations
complications
treatments


definition

    Angina is chest pain syndrome in relation hypoxia infarction related to an imbalance between inputs and oxygen requirements . Risk of myocardial infarction.


pathophysiology

    Imbalance between needs and intake oxygen infarction. This imbalance is responsible for suffering an ischemic infarction may be due to:

Coronary obstruction .
Atherosclerosis: dead pile fibers of which that block the artery , causing hypoxia.
Coronary spasm : constriction of the coronary artery.
The decrease in coronary flow :
Rhythm disorder .
Valvulopathy .

clinical signs

Stable angina : angina of effort

Stable angina occurs during exertion .
Retrosternal pain : behind the breastbone.
Pain is constrictive , it lasts 1-3 minutes.
Response to nitroglycerin : pain disappear taking nitroglycerin : coronary vasodilator .
spontaneous angina

The spontaneous angina occurs during rest, it is spontaneous .
Retrosternal pain .
Constrictive pain , it lasts 10 to 15 minutes.
Response to nitroglycerin : pain disappear taking nitroglycerin : coronary vasodilator .
Unstable angina : the syndrome of threat

The unstable angina is the most serious stage of coronary artery disease , there is a threat of myocardial infarction.
Chest pain which become more frequent , intense, long : 30 minutes.
Resistance to nitroglycerin : the pain does not disappear taking nitroglycerin : there is no coronary vasodilation .

additional examinations

ECG during the crisis as more likely to see defects.
Stress Test 's ECG with
Holter : small ECG carried by the patient for 24 or 48 hours.
Unsystematic coronary angiography.

complications

Threat syndrome : unstable angina.
Myocardial infarction.
heart failure
Sudden death .

treatments

pharmaceuticals

Nitrates ( nitroglycerin ) : increases oxygen intake opening in the arteries.
The β -blockers : causes a decrease in heart rate, thus a decrease in oxygen requirements .
Calcium channel blockers : dilates coronary arteries and therefore increases the oxygen supply .
therapeutic indications

Angina of effort and spontaneous angina

If more than 5 crises hospitalization.
Therapy.
Treat high cholesterol .
Smoking cessation.
Weight loss if obesity.
A sporting activity .
unstable angina

Hospitalization.
Incision venous glucose .
Surgery : Coronary artery bypass .
Coronary dilation .

pour telecharger le fichier cliquerRAPPORT DE STAGE

LE BOUCHE A BOUCHE
Le volume de chaque insufflation doit être suffisant pour que le sauveteur voit la poitrine de la victime se soulever ou s'abaisser après l'insufflation.


 LE BOUCHE A BOUCHE ET NEZ :            
Cette technique est celle qu'il faut réaliser quand la victime est un nourrisson.  Elle se distingue de celle du bouche-à-bouche car :

• Les chutes accidentelles à l'eau (piscines privées, etc.), la surestimation de ses capacités (en mer souvent), la sous-estimation des risques sur le lieu de baignade,
• Quinte de toux
• Vomissement (mal de mer)
• Panique
• Fatigue
• Essoufflement
• Manque d'entraînement à la nage
• Défaillance du matériel (panne de détendeur)
• Rupture d'apnée (chasseur sous marin) 

• D'un choc thermique (trop longue exposition au soleil)
• D'une congestion (chute de tension artérielle due à des troubles digestifs)
• D'un choc à l'eau froide
• D'une anoxie (rendez vous syncopal pour les chasseurs)

Technique du bouche-à-bouche
Maintenez d'une main le menton de la victime vers le haut et ouvrez sa bouche en utilisant le pouce.  Avec l'autre main sur le front, maintenez la tête en arrière et pincez le nez pour empêcher toute fuite d'air.  Appliquez votre bouche largement ouverte sur celle de la victime.  Soufflez de façon progressive jusqu'à ce que la poitrine de la victime commence à se soulever  Redresse- vous et reprenez votre souffle tout en regardant la poitrine de la victime s'affaisser.  Réalisez une nouvelle insufflation, et ainsi de suite.