definition
 Personal hygiene is a treatment that helps clean and protect its integument , it is a factor of physical and moral of the person being cared for well-being , it also allows the observation and relationship.
objectives
• Ensure the hygiene of the person.
• Monitoring of the skin condition.
Complete toilet to bed
equipment
• Linen:
o 2 washcloths 1 for the top, one for the lower body.
o 2 towels : one for the top, one for the lower body.
o clean linen for the rehabilitation of beds: 2 sheets, pillowcase, bed pad and / or coverage if needed.
o clean linen for the patient : pajamas or personal laundry .
o anatomical protection in cases of incontinence .
• Material hygiene :
o Soap .
o Massage Oil kind of sweet almond oil .
o Cologne .
o Brush, comb.
o Razor and shaving foam.
• Miscellaneous equipment:
o 1 cup , 2 cups if possible ( 1 up, 1 down).
o Toilet paper .
o 2 pairs of non-sterile disposable gloves.
o Bag eliminating paper waste and uncontaminated material .
o Laundry bag .
o container contaminated sharps .
o surface disinfectant and cloth.
o Required for hand hygiene.
Implementation of care
installation
The grooming of the face, ears and neck
Toilet chest , abdomen , arms and hands
Toilet legs and feet
Toilet genitals
Toilet back
The toilet seat
Rehabilitation bed
installation
• Warn the patient .
• Always take into account the degree of autonomy of the patient and stimulate the patient during treatment , allowing the patient to do what he can do ( face, torso , arm, hand , genital toilet ) .
• Close windows , lower the blinds to preserve the privacy of the patient if there is visibility.
• Install the hardware :
o bowl filled with warm water at the desired temperature by the person .
o Installation on a clean and disinfected prior surface.
o Install bins at the foot of the patient bed .
o Provide a chair to put the bed cover , disinfect before treatment .
o Respect the health, safety and ergonomics triangle : Clean (hardware) - Patient - Sale ( bins) .
• Depending on the patient :
o If patient probed : empty collection bag urine before treatment ( the necessary materials ) .
o If patient can urinate : offer him empty his bladder before treatment ( flat basin , urinal , bathroom) .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
• Overflow bed from top to bottom without finding the person.
• Remove the bed cover , cover , place the disinfected chair for this purpose .
• Prepare a " small blanket " with the top sheet : Fold the sides toward the center to cover the patient.
• The toilet is done starting with the face and ending with genital toilet and seat, but if the person is contaminated with feces or urine , we begin by genital toilet then the seat for comfort.
• Remove the nightgown , and cover the person with the "little coverage."
The grooming of the face, ears and neck
• Shaving person . Remove the shaver in the container contaminated sharps .
• Do not face soap unless the person wants.
• Start eyes with the corner of the washcloth in from the inside (nose ) outwards ( ears).
• Wash the front, from the middle to the outside, and go behind the ear. Make the second hémiface .
• Wash the neck.
• Wipe dabbing , without rubbing.

Toilet chest , abdomen , arms and hands
• Start with the farthest member :
o Put the towel up under the arm. Cover the nearest hémicorps with little coverage .
o Soap shoulder inside outwards .
o Soap armpit .
o Soap then the arm from the shoulder to the hand and making movements "8" around the arm which allows not board twice in the same place .
o Soap then the hand and fingers .
o Rinse proceeding in the same way.
o Wipe dabbing , without rubbing.
• Proceed in the same way to the nearest arm.
• Wash the chest and abdomen with emphasis in the folds and the umbilicus , rinse and pat dry .
• Cover the chest with the towel or small blanket .
Toilet legs and feet
• Take the glove down.
• Start with the farthest member :
o Put a towel under the leg.
o Support the leg below the ankle to do the washing.
o Start soap from shorts ( mid-thigh ) by performing movements "8" .
o Wash the interdigital spaces with the edge of the washcloth, do not place fingers.
o Rinse the same way .
o Wipe the towel by blotting with toilet reserved for the bottom.
• Proceed in the same way to the nearest leg.
• Perform strokes to support points ( heels) with circular movements without pressing with massage oil : anti- bedsore prevention.
Toilet genitals
• Change the water in the basin.
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
• Develop non-sterile gloves.
• If the person has an anatomical protection , open and fold the opening between the legs , around the anal area.
• Soap starting with the furthest thigh , up towards the abdomen, passing on the pubis and finish down to the nearest thigh.
• Soap then the organs from the outside to inside and top to bottom , without returning to avoid spreading germs anal in the vagina or penis. Stress at the folds .
• Rinse proceeding in the same way.
• Wipe dabbing , without rubbing.
Toilet back
• Discard gloves .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
• Change the water in the basin.
• Remove the pillow , take the dirty pillowcase pillow, open and return to the back of the chair that allows a dirty cloth bag .
• Install comfortably in recovery position , ensuring security, ask for help .
• Resume the washcloth and towel reserved for toilet top .
• Put the towel under the back.
• Soap up and down without going several times in the same place .
• Rinse and dry .
• Suggest friction cologne to refresh .
• Rub the sacrum with massage oil .
• Put the towel riding on the back and chest to preserve modesty and prevent the person from getting cold .
The toilet seat
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
• Place the second pair of non-sterile gloves.
• Resume the washcloth and towel reserved for toilet bottom .
• Discard the anatomical protection bag disposal.
• If the presence of stool, wipe the seat with toilet paper and throw it in the bag disposal.
• Soap starting genitals and back to the anal area.
• Rinse and dry by blotting .
• Put the towel horse on the buttocks and pubic area to meet modesty.
• Discard gloves .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
Rehabilitation bed
• Roll the sheet up half the bed and slide a bit in the person .
• Disinfect the mattress from head to foot with the solution of cleaning and disinfection of surfaces.
•
• Fold a clean sheet in half , put on some clean mattress and stuck the other party in person.
• Install the anatomical protection.
• Turn the person on the back and switch to the other side.
• Pull and remove the dirty cloth and throw it into the pillowcase acting laundry bag .
• Disinfect the rest of the mattress with the disinfectant solution.
• Expand the clean sheet and anatomical protection.
• Reinstall the person on the back.
• Close the anatomical protection.
• Dress the person and style.
• Replace the pillow covered with a clean pillowcase .
• Change the top sheet , if necessary put a blanket, bedspread.
• Place objects of the person at hand , give the bell.
• Put dirty clothes in the laundry bag .
• Ranger, throw and disinfect all equipment used including the chair and other items that have been in contact with the machine .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.

Toilet to the sink
equipment
• Linen:
o 2 washcloths 1 for the top, one for the lower body.
o 2 towels : one for the top, one for the lower body.
o 2 drawsheets fabric .
o clean linen for the patient : pajamas or personal laundry .
o anatomical protection in cases of incontinence .
• Material hygiene :
o Soap .
o Massage Oil kind of sweet almond oil .
o Cologne .
o Brush, comb.
o Razor and shaving foam.
• Miscellaneous equipment:
o kocher clamp (clamp ) .
o Toilet paper .
o Gloves non sterile single use.
o Bag eliminating paper waste and uncontaminated material .
o Laundry bag .
o container contaminated sharps .
o surface disinfectant and cloth.
o Required for hand hygiene.
Implementation of care
• Warn the patient .
• Assist the patient and the things he can not do it alone ( leg, back ), the boost .
• Place a draw sheet on the floor to prevent falls.
• Place a draw sheet in the back and secure it with the clamp at the chest to preserve his privacy.
• Proceed in the same way as toilet in bed by adapting care to the situation and depending on the patient.

The capiluve care or head.
equipment
• Linen:
o Netting rubber .
o Alaise fabric .
o Towel .
o Pillows .
• Material hygiene :
o Shampoo .
o Brush, comb.
• Miscellaneous equipment:
o kocher clamp (clamp ) .
o Broc.
o Laundry bag .
o surface disinfectant and cloth.
o Required for hand hygiene.
Implementation of care
• Warn the patient .
• Remove eyeglasses and hearing equipment if the person is a carrier .
• Fill the jug of warm water at the desired temperature by the person .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
• Install the person so head back in bed , supporting shoulders with pillows ; head forward or backward if the sink is carried capiluve .
• Overlay the pad and the pad rubber fabric . Surround the patient's neck with the protections and keep up with the clamp at the chest.
• Wet hair .
• Apply shampoo, massage the scalp gently .
• Rinse thoroughly to remove all shampoo .
• Squeeze and dry hair with the towel.
• Remove the protection.
• Comb .
• Store and disinfect all equipment used .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.
The foot bath or foot bath .
equipment
• Linen:
o Alaise rubber .
o Alaise fabric .
o 2 towels .
o 1 washcloth.
• Material hygiene :
o Soap .
o Solution on prescription drug .
• Miscellaneous equipment:
o Bowl .
o Broc.
o Laundry bag .
o surface disinfectant and cloth.
o Required for hand hygiene.
Implementation of care
• Warn the patient .
• Install the person sitting on a chair or semi-sitting if treatment is given to bed.
• Overlay the pad and the pad rubber fabric . Protections put under the legs.
• Install the bowl and pour in water to the desired temperature by the person .
• Allow feet to soak for 5-10 minutes depending on the tolerance of the person.
• Soap after soaking.
• Rinse and dry well between the interdigital spaces.
• Store and disinfect all equipment used .
• Perform a simple hand washing or perform hygienic hand by rubbing with an alcohol-based solution : hand hygiene.

Monitoring and evaluations
• Monitor skin condition and mucous membranes.
• Reaction of the patient.
• Participation of patient care

I - DEFINITION AND GENERAL :

 This is a method of exchange between two solutions , blood and a liquid called dialysate through a semipermeable membrane synthetic .
Hemodialysis is performed using a device called a generator that produces the dialysis fluid or dialysate and a filter called a dialyzer or artificial kidney
It aims to prevent and correct the manifestations of uremic syndrome and its complications and to maintain homeostasis ( maintenance of normal value for different physiological constants , eliminate excess water , to overcome kidney failure and purify the blood of toxic waste, some toxic drugs.

II - MATERIAL:
- For the dialysis equipment :
* Capillary dialyzer fibers disposable.
* Bottles of saline .
* CC syringe 20 to increase the level of the expansion rooms.
* Heparin according to medical prescription.
* Extracorporeal circuit : arterial line and venous line .
* Bicarbonate.
Acetic acid * .
* Sterile compresses .
* Antiseptic.
- For connection :
* Needle arteriovenous fistula.
* Four clamp.
* Tray containing sterile hemodialysis : - two masks.
                                                                     - A waterproof field.
                                                                     - Sterile disposable gloves.
                                                                     - Boulle sponge for the patient's hand .
                                                                     - Sterile gauze .
                                                                     - Hypoallergenic tape .
                                                                     - Withers decontaminated and cleaned.
                                                                     - Antiseptic.
                                                                     - Tube for examination.
- To disconnect :
* Disposable gloves sterile and non- sterile.
* Mask .
* Sterile gauze .
* Antiseptic.
* 2 syringes of 5 CC .
* 2 10 CC syringes .
* 0.9% saline .
* 5 CC syringe containing heparin e .

III - PREPARATION OF THE PATIENT :

- Ensure cleanliness arm fistulized or support arm of the shunt.
- Take the weight before to assess weight relative to the weight lost on the checklist .
- BP and pulse after a rest.
- Take the patient's temperature .
- Place the patient supine elevated bars.
IV - TECHNICAL :

- Select the puncture which must be no closer than 6 inches to avoid recirculation.
- Sanitize the area of puncture on the arm and place the sterile field.
- Insert the needle into the blood arterial shunt but in the direction of blood flow and venous needle
  above the venous shunt.
- Fix 2 needles with hypoallergenic tape.
- The needles used must first be rinsed with saline.
- Turn on the blood pump .
- After stabilization , check: * 200A blood flow 300 ml / min
                                                   * Venous pressure
                                                   * Depression, and the conductivity of the dialysate flow
- Turn on the pump heparin.
- Check the TA and FC.
- Stop the heparin pump 1-15 minutes before the end of the dialysis session and measure the remaining content and
   note on the control sheet .
- Stop the blood pump and clamp the tubing and the arterial needle
- To empty the blood circuit by remaining saline.
- Keep the arm elevated patient.
- Ranger, clean and sterilize equipment .

V - SURVEILLANCE:

1 / BEFORE :

- Weigh the patient and check for digestive disorders.
- Take the patient's temperature .
- Examine the fistula pain inflammation or edema.
- Rinse all the dialyzer with saline to avoid serious namely shock accident.
  Anaphylactic , back pain .....
- To monitor the performance of the generator.
- Check pump heparin.
- Check the pressure at the bubble trap .

2 / DURING:

- Monitor BP and HR at least 3 times to detect in time the beginning of voltage drop.
- Monitor the facies of the patient.

3 / AFTER :

- Monitor the appearance of the dialyzer and verify the absence of clotted blood.
- Weigh the patient and take his TA .
- Take his temperature.
- Establish a long-term monitoring for vascular aging was found mainly in
   chronic patients.
- Pre joint pain were noted in the wrist of the vertebrae.

                                  OXYGENOTHERAPY

I - DEFINITION :
This is a technique that consists in supplying the body greater than the area ambiant.Elle is particularly useful in the treatment of hypoxic conditions resulting from a decrease in O2 concentration in the blood . The purpose of the process is xygénothérapie hypoxia while reducing the work of the respiratory system and the myocardial stress .
All transport of oxygen to tissues depends on several factors :
- From cardiac output
- The amount of O2 pressure
- The concentration of hemoglobin
- The need for metabolism

II - INDICATIONS:
   A / Lack of saturation of hemoglobin O2

- Drop the pressure of O2 in ambient air
- Airway obstruction eg oviposition or foreign body
- Impairment of respiratory muscle reached by the nerve centers or paralysis eg tetanus
- Any bronchopulmonary disease resulting in insufficient ventilation eg asthma
- Emphysema
   B / Insufficient hemoglobin necessary for the transport of O2:

- Hypoxemia anemic eg anemia
- In case of massive hemorrhage
- In case of CO2 poisoning
   C / Traffic slowed causing a poor transport of O2 in the blood :

- Heart Failure
- Shock and collapse
III - AGAINST - INDICATIONS:
Are not formal , however the O2 should be used with extreme caution in older chronic respiratory insufficiency , in PA and in NNE

IV - SOURCE O2:
The O2 can be provided by:

A / Obus O2 pressure or O2 cylinder :
Distribution is provided by a suitable pressure regulator on each shell to reduce the pressure
A meter indicating the number of liters / min
Precautions are necessary for the use of the shell :
- Never lubricate the valves and fittings regulators as the combination of a fat + O2 yields a mixture deteriorating
- Remove the shells of excessive heat as the temperature may rise dangerously high pressure shell
- Remove the shells with great caution
- Do not smoke near
B / receivable in wall socket :
  Allows to control the number of liters per min

V - FORMS OF GOVERNMENT :
The O2 is distributed by different devices, all have the same principles:
- The flow rate is 6 to 8 l / min in adults and three to 6L/min except complications in children
- The O2 must be humidified by passing it through a bubbler bottle filled ¾ of the distilled
• The nasopharyngeal probes : Irritating and risk of infection
• The tents O2 generates an atmosphere containing 50-60 % O2 ¼ hours after commissioning
                                   marche.Certaines people feel claustrophobic anxiety tent .
• Incubators : Can be used in children and have the same principles as tents adults
• Eyeglasses O2
• O2 masks : it is necessary to connect and adjust the speed before adjusting the mask on  sick

 VI - PREPARATION OF MATERIALS :
- To administer : glasses, among other probe
- Provide a source of O2
- Check the piping must be properly sealed
- Fill distilled water in the bottle ( bubbler ) to mark water
- Set the number of l / min
- Possibly tape to fixing probe

VII - THE PATIENT MONITORING :
A - Monitoring of the patient :
* Monitoring of respiratory movements and heart rate
* The color of the face, lips and corners
* Presence or absence of sweat
* Head Position
* Fall of the language
* Congestion
* The patient's condition improved
* While natural ventilation continue monitoring
* Spontaneous breathing stops :
 - check the airway
   - Begin artificial ventilation
  - Check the respiratory status and the need to associate with cardiac massage  external ventilation
* Health care and frequent mouth nose because O2 dry mucous
* Frequent blood gas control prescription or as service protocol

B - Monitoring of the O2 system :
- If nasal tube :
 - Check the location and attachment of the probe
                              - Check frequently for proper flow through the probe (nasal secretion)
                              - Change daily e probe and nostril healthy gloves

C- Flow Monitoring :

Prescribed at the start rate may change depending on the monitor and the patient's condition

D - Monitoring source :
- Ensure that no pipe is bent or disconnected
- Check the stability of the flowmeter
- IT must frequently check the pressure in a cylinder O
VIII - PRECAUTIONS :

- An O2 excess can have :
       ex a toxic effect on the lungs and the CNS : O2 intoxication in artificial ventilation
       attenuation of respiratory stimulation with low respiration eg IRC - emphysema
       chronic obstructive bronchitis
should always monitor : the state of consciousness , facial color , change in BP , PULSE and FR
- The O2 is a combustible material there tjs fire risk
- The equipment O2peut be a source of bacterial cross infection
- The breathing circuits are changed daily and sterilized

IX - ACCIDENTS :

• O2 pressure ( dosing error )
• O2 unhumidified
• OAP
• Blindness
• Apnoea in chronic respiratory insufficient
• Bloating of the stomach when introduced probes deeply

The O2 is a very effective treatment side must be used with caution


                                         INTUBATION

I - DEFINITION :
It is the establishment d4une endotracheal tube for mechanical ventilation

II - INDICATIONS:
- Emergency Oxygenation
- General anesthesia
- Artificial respiration

III - CONTRAINDICATIONS :
- Laryngeal lesions
- Tumors of the larynx
- Head Injury

IV - MATERIAL:
- With different laryngoscope blades suitable for illuminating adult and pediatric ( This equipment must be maintained checked after each use
- Sterile Gloves
- Endotracheal Tube with inflatable balloon at different sizes
- Sterile single-use syringe
- Sterile forceps to guide the probe MAGILLE
- Stethoscope
- Fixing
- Source suction and O2
- Cannula GUEDEL of different sizes ( avoid the trauma and fall of language )
- Local anesthesia ( Xylocaine 5% spray )
- A mouthguard
- Gastric tube
- Broncho - dilators ( Ventolin )

V - dificulties AIRWAY AND COMPLICATIONS :
 A - Difficulties in intubation :
They are due either :
- A anatomical problems : * Short neck or cervical spondylosis
                                                         * Small mouth opening
                                                         * Not visibility of the glottis and soft palate
                                                         tumors
- A etiological criteria: * laryngeal edema
                                                         * Laryngeal spasm
                                                         * Poor dental status
                                                         * Obesity
B - Complications:
- Esophageal Intubation
- Cardiac Stimulation with hypertension , heart rhythm disorder , bronchospasm
- Wound lips and tongue
- Inhalation
- Herniated balloon
- Cranking probe
- Trauma to the trachea

                                                                                                                                                                         J - R
LUNG ASPIRATION AND ENDOTRACHEAL

I - VACUUM ORAL ORAL OR NASAL :
It is a technique of removing liquid or solid substances out of the airways in order to: - facilitate breathing
                 - Prevent pneumonia
1 / INDICATIONS:
- People bedridden
- Patients suffering from respiratory problems

2 / MATERIAL:
- Sterile equipment: * sterile gauze
                                * Clamp to serve
- Antiseptic
- Sterile syringe
- Glove non sterile single use
- Bottle of sterile saline to change every day
- Sterile suction probe with a rounded tip straight or curved adaptive caliber sick
- Bag Waste
- Apparatus maintained daily source of suction or suction wall

3 / PREPARATION OF THE PATIENT :

- Information on the purpose and the process explained: introduction of a suction catheter into the cavities
   nose or mouth to suck secretions and make breathing easier
- Place the patient in proper head position hyperextension
- To protect the patient's chest

4 / TECHNICAL :

- Put clean gloves
- Insert the probe and sterile moistened deeply with a swab containing serum
   physiological without aspiration ( clamp the socket area or pinching the probe by hand)
- Vacuum cleaner and the entire region of the nose and / or throat carefully without causing
   vomiting in patients
- Take immediately after the disposables including gloves removed and the probe
- Rinse the suction system saline
- Soak in a disinfectant reusable equipment (pipes, etc ... ). , Clean and sterilize , clean and
   sterilize


II - VACUUM ENDOTRACHEAL :
This is a method often used in intensive care and which is to suck the bronchial secretions by an endotracheal tube ( intubation ) , a tracheostomy tube

1 / INDICATIONS:
- Persons having undergone a tracheotomy
- People intubated

2 / MATERIAL:

- Sterile equipment: sterile gauze
                             clamp used
- Antiseptic
- Sterile disposable gloves
- Syringe with rinsing solution
- Suction probe disposable provided with a rounded tip
- Bottle of sterile solution ( saline ) to change 2 times / day
- Extractor : pipe, container and lid to renew every day
- Source mobile central vacuum or electric pump
- Réanimas
- Sterile syringe eventually inflate the balloon of the endotracheal tube

3 / PREPARATION OF THE PATIENT :

- Inform the patient care
- Instill a washing solution in the trachea and bronchi
- Place the patient in proper position ( hyperextension )

4 / TECHNICAL :

- Let the patient deeply surventiler
- Instill prescription under a special washing solution with vent. providing antibiotic
- Put on sterile gloves
- Take the probe and moisten with sterile saline and enter without aspiration
- If you remove the probe abuts qq centimeters before withdrawing to avoid trauma
   bronchial mucosa
- Carefully aspirate at various heights from the bottom up to the region to be sucked
- Remove the probe slowly under vacuum by turning slightly without moving to avoid injury
- The duration of intake should not exceed 15-20 sec vent again after a pause
- Monitor ECG waveform and saturation on the monitor
- Let the patient surventiler
- Throw away any equipment used
- Clean fittings and hoses with a disinfectant
- Before tracheal aspirate always first carefully mouth and nose with another probe to
   prevent a flow of secretions in the trachea at the suction


III - COMPLICATIONS :

- Injury to the mucosa
- Infection of the patient or staff
- Cardiac arrest from vagal reaction in the region of the trachea and larynx
- Regional perforation by the tip of the probe into the tissue already damaged (ulcers)



                                            GASTRIC ASPIRATION

I - DEFINITION :
This is a technique of aspirating the stomach contents using a gastric probe or dual stream by gravity ( the probe is connected to a collecting bag ) or depression ( the probe is connected to a pressure gauge for a gentle suction and continuous)

II - INDICATIONS:
- Patient postoperative
- Patient intubated ventilated (avoid gastric inhalation)

III - GOAL:
- Ensure the aspiration of gastric contents
- Prevent acute dilatation of the stomach
- Encourage the postoperative digestive tract

IV - MATERIAL:
- Jar suction Disposable collecting the liquid sucked
- Gauge
- Two sterile tubes
- Biconical connection
- Syringe 60 CC big tip
- Stethoscope

V - TECHNICAL :

- Prepare the patient properly
- Ask the gastric tube if necessary
- If sensor already in place, verify its correct position by injecting approximately 10CC area by listening to the abdomen
   stethoscope should hear an air-fluid noise franc
- Aspirate gastric contents then gently with a syringe by gently pulling the piston there must
  have onset of gastric fluid to confirm the correct position of the probe
• Suction Gravity : adapt the hose of the manifold cover to the gastric tube
• Suction vacuum : * mount the gauge on empty wall outlet and check
                                                         operation known suction system
                                                      * Adapt the hose from the gauge on one of the inputs of the jar
                                                            * Fix the gastric tube to a pipe of the jar through
                                                               a connector
                                                            * Adjust the pressure between 10 and 30 CC depending on the desired effect
                                                               and prescription
                                                   * Mount the sensor on the patient's cheek and hose bed sheet to
                                                               avoid traction on the probe or violent displacement
* Collect biological examinations in medical prescription
                                                            * Offset losses as prescribed to avoid alkalosis
- During ablation, close the gauge and let the suction by gravity (if asp depression. )
- Clamp (if asp gravity . ) If patient makes his gasses and / or stool remove the probe clamped to avoid
   fluid leak slowly but with a rapid gesture
- Clean the nostrils and make a careful mouth




VI - DAILY CARE :

- Check maintaining the probe correctly for each
- Perform mouth care at least every 6 h
- Clean and lubricate nostrils mobilizing the probe gently
- Varying the fixing areas of the probe in order to avoid skin irritation
- Record the amount of liquid collected and appearance
- Empty the jar or throw the bag regularly
- Check on the care and monitoring sheet that the result

VII - SURVEILLANCE:

- Drainage system : * position of the probe
                                         Permeability * Probe
                                         * Verification of the absence of the probe fold
                                         * Control adjustment depression
                                         * Daily amount of gastric fluid
                                         * Aspect of the liquid , odor, color , presence of biles , blood or secretions
- Clinical Supervision: * signs of dehydration
                                         * breathing
                                         * Measuring the blood pressure and temperature
                                         * Presence of edema
                                         * Laxation

VIII - INCIDENTS AND ACCIDENTS :

- Occlusion of the probe with secretions or reflux of gastric fluid ( aspiration stop , disconnect the
   probe and inject saline
- Occlusion of the probe by the gastrointestinal mucosa ( check the pressure gauge and move slightly
   probe
- Gastric tube collabée by excessive depression or defective pipe ( check the pressure
   gauge hose and change if necessary
- Dehydration resulting in a sensation of thirst , dry mucous membranes , fall in BP ,
   hyperthermia ( start compensation on prescription )
- Hyperhydratation digestive disorders and elevated BP, PAO (reduce compensation)
- Bleeding due to excessive pressure or suction of the mucosa



                                               SUCTION CHEST

I - DEFINITION :

This is a technique that consists in evacuating liquids and gasses intra thoracic and pleural . The drain connects the pleural cavity to a single jar ( siphonages ) or with a continuous extraction system

II - INDICATIONS:

- Spontaneous Pneumothorax
- Purulent pleurisy
- Hemothorax
- Nécrotomie superinfected

III - GOALS :

The establishment of a chest tube designed to:
- Evacuate gas or Fluid thoracic effusions
- Perform chest washes continuously in case of empyema and pneumonia

IV - MATERIAL:

- Drain implemented by a metal trocar MONALDI which introduces light into the pleural
  drains fine gauge which tend to clog quickly blood clots
- Trocar MONALDI
- Drains JOLLY disposable
- Sterile equipment: * sterile gauze
                             * Clamp to serve
- Antiseptics
- Sterile gloves
- Plaster
- Scissors
- Field pierced
- Local anesthetics ( Xylocaine 2% )
- Sterile syringe needle +
- Box of minor surgery
- Jar sterile graduated 3l containing an antiseptic
- Closing the jar cap crossed by two pipes in a plunging antiseptic , the other in connection with the
   Suction system
- Sterile tubing

V - PREPARATION OF THE PATIENT :

- Explain the patient care
- Put in proper position : supine torso raised , link bars behind the head

VI - NURSING ROLE :

- Make available the intubation equipment and emergency drugs
- Preparation of the suction device : * fill with saline
                                                                    * Connect with the suction source
                                                                    * Verification of operation
                                                                    * Ensure the connection with the drain pipe connected to the
                                                                       Suction system
- Sanitize the puncture
- Put a bandage and secure with tape elbows in the suction pipe
- Changing the drain suction sterile device

VII - SURVEILLANCE:

- Check the suction device
- Findings of the liquid and suction volume
- Take stock of outputs

VIII - COMPLICATIONS :

- Drain Output
- Moving the drain ( emphysema s / c)
- Compressive pneumothorax
- Bleeding intercostal vascular or pulmonary
- Lung Injurysuction
- Lesion of an abdominal organ


                                      TRACHEOTOMY OR tracheostomy

I - DEFINITION :

The tracheostomy is a surgical procedure which involves making a surgical opening on the front side of the trachea to establish an endotracheal tube without modification of the anatomical structures . Tracheostomy may be temporary or permanent . Breathing is through the tracheal opening but also the airway. The orifice without cannula may quit quickly.

II - OBJECTIVES :

- Maintain the freedom of the airways.
- Ensure adequate gas exchange .
- Extract effectively bronchial secretions .
- Assist patients who can not tolerate intubation .
- Allow the patient to gain greater autonomy.

III - INDICATIONS:

- Breach of the respiratory centers without paralysis of swallowing ( mennigé state).
- Paralysis of swallowing (poliomyelitis) .
- In case of temporary or permanent laryngeal disorders ( obstructive tumor benign or malignant ) .
- Trauma of the larynx.
- Diphtheria .
- Brain tumors leading to impairment of the respiratory centers .
- Tetanus .

IV - MATERIAL:

- 10ml syringe .
- Sterile compresses .
- Serving tongs .
- Broad-spectrum antiseptic .
- Gans sterile disposable .
- Gloves non sterile single use.
- Disposable mask .
- Cording .
- Tracheostomy cannula with sterile balloon.
- Tape or tape.
- A pair of sterile scissors .
- Local anesthetics .
- Tracheal suction equipment .
- Bean .
- Bag disposal.

V - TECHNICAL :

The surgeon makes a horizontal incision in the patient's right under the first cartilaginous rings , the tracheal cannula with a curved mandrel or plug is inserted into this opening
After inserting the shutter is immediately removed so that the patient can breathe. The tracheal cannula is inserted and then is internally latched . Tracheal cannula was held in place by a cord gas tied around the neck of the patient.
VI - NURSING ROLE AND MONITORING POST -OPERATIVE :
- Humidification of the air we breathe :
* This is necessary because the natural humidification is removed by tracheotomy , we risk
    thus increasing the concentration of bronchial secretions and therefore result in an obstruction.
      * It can be achieved either by saturating the air with humidity by spraying or serum
          physiological by the tracheostomy tube .
 
- Aspiration of bronchial secretions :
* For this there must be a vacuum in working condition and sterile probes to soft side ports
    béquillées slightly .
      * Depression used for vacuuming should be moderate .
      * Starting after insertion of the probe into the trachea probe should never be pinched
          when suction is on.
      * The frequency of aspirations vary with the condition of the bulk of the disease but it will know that
          it not a trivial gesture.

- Change of dressing and cannula :
* If the patient is conscious, prevention care and explain the course .
* Perform a simple hand washing.
* Gather materials .
* Put on disposable gloves to avoid contact with secretions and put on a mask to avoid
   risk projection secretions.
* Remove the pads and discard.
* Clean the area around the opening of the tracheostomy with sterile gauze soaked in antiseptic
   sliding the pad under the flange of the cannula .
* Clean the flange of the cannula .
* Firmly grasp the cannula and cut the cord and discard soiled .
* Change the cord and insert the precut under the collar compresses to absorb
   flow and prevent infection.
* Remove the sterile gloves.
* Make an antiseptic wash.

- Other treatments:
* A patient can eat tracheotomy if no swallowing disorders if this is the case it is
   pose a gastric tube .
* The caregiver must not forget that the patient is aphonique and thus provide him what to write.
Monitoring will depend in part the cause of tracheotomy :
      * A temperature curve of pulse and respiration TA .
      * Observation facies and the patient's condition , cyanosis , agitation being signs of respiratory problems
      * Radiation monitoring (chest clichet ) , biological ( blood gas ) ( electrolytes ) .

VII - ACCIDENTS AND INCIDENTS :
- Sudden Death in the very rare introduction may occur especially during aspirations in tetanus .
- Trigger cough reflex during the insertion of the cannula : remove the cannula and ask the patient to
   to qq . of inspiratory and expiratory movements.
- Accidental decannulation due to inadequate fixation.
- Stenosis of the trachea and vocal cord paralysis ( nerve damage reccurents ) .
- Bronchial irritation and exacerbation of the hole due to tracheal aspiration of secretions and
   inadequate care .

VIII - Conclusion :
Tracheotomy is almost always benign early intervention that could save bcp . life , it is still necessary that the post-op care and monitoring. is level so as not to lose the patient the benefit of the tracheotomy. J - R
AROUND THE VENOUS

I - GENERAL :

Venous approaches rely on a complex system of channels , arteries, capillaries and heart . Veins drained blood to the heart . There are 2 types of veins
- Receptive veins which plays a passive role in the return circulation .
- Propelling veins which circulates back managed by gravity.

II - GENERAL RECOMMENDATIONS :

 The patient should be informed of the technique he will undergo .
 Ensure comfort to gain his cooperation.
 The operator must comply with hygiene by washing hands , skill and knowledge.

III - ADVANTAGES AND DISADVANTAGES:

- ADVANTAGES: - implemented in a vessel of large caliber and therefore a larger and faster throughput
                                 for a faster effect of drugs .
                              - Allow the measurement of PVC.

- DISADVANTAGES: - risk of injury and bleeding arteries and adjacent veins.
                                       - Risk of perforation.

IV - MONITORING AND TECHNICAL :
( See courses in medicine SI )

V - CONCLUSION :

Take a venous access is an important technique that should be taken into consideration so it will avoid incidents and accidents that may occur to avoid complications .

   


















     

La relation entre le couple , peu importe la façon dont il a parfait . Avant de démonter la relation , attendre quelques minutes et dix Lisez les conseils qui peuvent être activés avec la relation en crise à une relation bien établie , solidaire et heureux.

Être satisfait de vous

Votre partenaire ne peut vous rendre heureux , et vous n'êtes pas capable de fournir le bonheur désiré de l'autre partie , ou du moins , ce n'est pas votre travail . Une bonne relation entre le couple et la stabilité sont celles que chaque partie a ses propres forces et qui maintient la stabilité et d'optimisme , seuls et ensemble . Ce qui est recommandé est possible de faire un travail sur le changement interne .
Dans le cas d'une extrême colère , dit vous-mêmes que vous avez la capacité de voir les choses différemment . Si vous souffrez d'anxiété ou de dépression , n'oubliez pas que vous êtes qui devrait prendre soin de lui-même et que l'assistance du mari / E est juste un bonus de bienvenue . Votre Excellence est juste pour vous . J'ai essayé de trouver le côté positif de chaque situation . Une personne qui est content de lui ont une plus grande capacité à vivre en paix avec ceux qui l'entourent .

Percer la responsabilité de vos actions

La poursuite de la relation entre le couple dépend des choix que nous faisons aujourd'hui. Vous avez la possibilité de choisir votre réaction à des gens autour de vous . Si vous transportez chacun de vous est responsable de ses actes , vous pouvez briser le cycle de la colère , de la culpabilité et de frustration.



Plus d'informations sur ce sujet:
• Êtes-vous romantique ? Testez votre personnage maintenant !
• votre témoignage à la vie conjugale dans la section suivante
• Voulez-vous m'épouser? !
• Comment pouvons-nous éviter les erreurs de la première réunion ?
• suivi plus de médicaments à travers le Web


Travailler pour améliorer la communication

La chose la plus importante doit être fait pour améliorer la communication avec votre conjoint / e est à l'écoute . Tout simplement trop ! Quand vous parlez entre vous , même au cours du débat , pas Tchochoa à l'autre et d'écouter . Dans un grand nombre de fois quand nous écoutons , nous nous apporter et formuler la réponse effectivement .
Ils se sont concentrés sur l'autre côté , et même lui demander de répéter ce qu'il a dit , afin que vous puissiez comprendre ses sentiments plus profond. Bien que cela semble un peu d'arrogance , essayé et montré à l'autre partie que vous vous souciez de lui et de ses sentiments qui vous intéressent .



Mettre des limites claires

Dans toute relation , y compris la relation entre le couple , l'une des choses les plus importantes est de mettre la frontière . Vous devez savoir où mettre fin à la relation conjugale et commencer espace personnel pour chaque partie . Identifié entre vous comment il veut l'autre côté à traiter , et vice versa . Qu'est-ce qui est permis et ce qui est interdit . Vous devez toujours vous rappeler que vous êtes  , chacun de vous est une entité distincte d'être respecté comme une personne .



Calmez-vous

Quand un mari ou une épouse soulève votre colère , il ne le fait pas exprès nécessairement . Parfois, les gens acte est ennuyeux . Donc , c'est la vie . Ne le prenez pas personnellement et essayé d'absorber et de comprendre que ce n'est pas dirigée contre vous, et il ya généralement un besoin de base pour gagner l'affection et découvrir l'étendue de votre amour pour lui .





Courtoisie !

Essayé de maintenir à un minimum de trois compliments par jour à votre partenaire de vie . Cela améliore la relation surprenante . Courtoisies mutuelles donnent beaucoup d'énergie positive pour les deux parties et à retenir ce qui a commencé l' histoire d'amour entre vous au début. Plaisanteries sur le meilleur dans la relation conjugale , et de faire chacun d'entre vous se sentent importants et en sécurité dans cette relation .





Il n'y a vraiment pas d'école pour enseigner la parentalité

La parentalité est une question complexe et n'est pas en vain qu'il a dit qu'il n'y a pas une telle chose comme une mère parfaite ou le père . Vous devez comprendre que votre partenaire de vie de son mieux en tant que parent à vos enfants et à vous tous là-bas, et les erreurs se produira dans tous les aspects de l'éducation des enfants . Il est important de comprendre que chacun de vous a eu une enfance différente, avec des expériences de l'enfance , positive ou négative , et chacun de vous traiter avec le motif de la paternité et de la maternité différente dans la maison  . Cela permet non seulement votre partenaire de vie ou un mauvais stupide . Il est tout simplement un autre et chacun d'entre vous peut faire de son mieux avec ce qu'il a appris tout .



Le différend peut être résolu

Dans chaque mariage il y'a des conflits peuvent être traités d'une manière positive . Le visage du conflit peut vous rapprocher de l'autre ou de faire la différence entre vous pour toujours. La majorité des conflits de malentendus ou des besoins non satisfaits . Tout d'abord, il est important de comprendre quels sont vos besoins et les besoins de l'autre partie concernant la relation entre le couple . Ensuite , l'examen ensemble comment chaque partie peut répondre aux besoins de l'autre avec une compréhension profonde de ses sentiments et les raisons de ces besoins . Pas avec vous-mêmes , Silence races confusion, la peur et le manque de compréhension de l'autre partie .



Travailler pour améliorer l'intimité

L'intimité n'est pas seulement une bonne relation sexuelle . Intimité qui est bon , que l'expression des sentiments de chaque partie , les rêves , les illusions , les peurs, l'anxiété et tout ce qui nous distingue en tant qu'êtres humains . Ouverture émotionnelle vous rappeler que vous faites-vous confiance assez pour que l'autre partie que vous êtes , vous pouvez exposer vos documents et vous montrer vos points partenaires  , sans crainte . L'intimité physique n'est pas seulement une relation sexuelle , vous A l'autre au cours de la journée , échangé des baisers , et  autant que possible sans relation au sexe ou à la stimulation sexuelle . Un autre genre d'intimité est l'intimité spirituelle , qui peut être atteint par la recherche d'un noble objectif commun . Vous pouvez échanger des idées  , des visions et des idées philosophiques . Parlé des leçons que je leur ai appris la vie jusqu'ici , et rechercher commun entre vous.

égoïsme

Apportez votre relation conjugale égoïsme est préférable d'avoir
 . Peu importe ce qui se passe et ce que vous ressentez de la relation , vous voudrez peut-être contrôler vos émotions , et vous êtes capable d'être calme et vous n'avez pas contrarié
 . Votre engagement que vous serez heureux , pour la sécurité de la famille que vous avez construit
. Offrez à votre partenaire de vie sans limites et toujours penser à comment vous faites sa vie de plus en plus excitant . Le but du mariage est la tranquillité et le bonheur . Lorsque vous commencez à agir de cette manière , les choses étonnantes qui se passera dans votre vie de couple .

Madonna is following a very strict macrobiotic diet , which excludes from the diet of wheat , eggs, meat and dairy products. You may ask: " What did she eat ? ". Answer - vegetables. Personal chef singer even wrote a book called " Mayumi ", which includes dishes macrobiotic diet . If you want to test yourself and check if you can hold out , arranging themselves 10 days detox , then read on our stuff . We describe in detail what you need to have these "heavy" in all senses of days.
day 1
Start your morning with a miso soup and brown rice for breakfast. Sounds scary , but trust me , it's not so scary. Especially because you quickly naedites . This dish is so satisfying that we assure you, you skip lunch . When the time comes to dinner , cook a dish of algae and barley stew .
day 2
To give your body to come to his senses after eating algae and barley stew , the second day of the diet Madonna advises eating vegetables and apples varieties Fuji. Try something to do : stroll around the town , watch a movie , meet with friends.
day 3
This day is best to devote to sports. Jogging in the park or exercise in the fitness club should be fine . We have to make yourself work hard to bring out all the toxins from the body. For breakfast you can eat again miso soup to recharge and wait for dinner . In the evening it is best to eat tofu or soy meat .
day 4
More plums. These fruits contain a lot of sugar , which we just need . Especially after long days without sweet . Do not worry, it does not mean that you have broken , and the whole diet went down the drain .
See also:
How Katy Perry , Elizabeth Hurley and other stars lose weight for Vogue
We know the secret harmony Irina Shayk
Day 5 and 6
Oh, yes ! Here they are happy days . When Madonna followed this diet , it certainly took two days off yourself when you could have everything they want. So that we can follow her example . Just be careful . Better to eat small portions of food . Otherwise unaccustomed to our stomach may suffer. These two days of freedom undoubtedly needed . We generally hard to imagine how Madonna could just eat . But Madonna - especially women.
day 7
Go back to the diet. Making blank tofu 3 days ahead. You have to eat them within three days . Do not be afraid , not in pure form . It can be added to the leaves of lettuce or miso soup.
day 8
In order not to go into a depression , arrange macrobiotic party. It sounds sad, but it really helps you unwind. Prepare a variety of meals that you eat , following your diet. Show your friends what you eat . They just appreciate your efforts . Incidentally, sauerkraut can be a very delicious dish .
Day 9 and 10
The last two days diet. Hooray ! Again we return to the sport. Do push-ups. There are various options : if you can , squeeze off the floor, if difficult , then knees. The most advanced can be wrung leaning feet on a chair. Yes, it's very difficult. Especially when we simply have no strength. Eat vegetables and seaweed - no easy task. And as Madonna still manages to jump on stage and sing in parallel ?

Chaque personne, en fonction de sa taille, de son ossature, de sa musculature, de son âge, etc., rentre dans une fourchette de poids physiologique correspondant à son poids normal. Si vous avez ce poids, ne cherchez pas, par coquetterie déplacée, à en changer. Ce poids correspond à vos normes et vouloir y toucher débouche presque toujours, à coup de régimes anarchiques, sur de véritables obésités secondaires assorties de nombreux troubles de santé.

Si votre poids actuel est inférieur, égal ou supérieur de 5% au chiffre que vous trouvez, je vous conseille vivement de ne rien chercher à modifier. Si vous dépassez ce chiffre de plus de 5%, alors vous avez effectivement quelques kilos à perdre pour bien et mieux vous portez.

Pour vous fixer les idées, voici un exemple chiffré. Vous êtes une femme mesurant 1,65 m, de constitution normale (ossature et musculature moyennes), l'équation va s'écrire ainsi:

165 - 100 = 65 - (165 - 150 = 6) = 59 kg + 5% = 62 kg
................................2,5

Si vous ne dépassez pas 62 kg, ne faites rien car il n'y a aucun excédent de poids.

Si vous avez des kilos à perdre, voici les règles fondamentales à suivre pour bien maigrir et conserver ensuite votre "bon" poids:

D'abord, choisissez toujours de préférence un régime qui vous fera maigrir petit à petit, en "douceur". En cas "d'urgence", un régime aux résultats plus rapides peut être adopté à condition qu'il soit bref et suivi systématiquement d'un nouvel équilibre alimentaire adapté à vos besoins.

Ensuite, adoptez de nouvelles règles diététiques faciles à suivre et qui s'intégreront assez facilement dans votre régime alimentaire habituel. Un régime trop différent de vos habitudes, ou trop draconien, ne dure jamais longtemps et vous reprendrez - après l'avoir abandonné - non seulement les kilos si chèrement perdus mais 2 ou 3 de mieux !…

Enfin, suivez les recommandations que voici quel que soit le régime alimentaire adopté:

1 - Buvez de l'eau, encore de l'eau, toujours de l'eau, au moins deux litres par jour, mais uniquement entre les repas (la meilleure façon de ne plus boire en mangeant consiste à ne plus mettre votre verre à table). L'eau est un excellent diurétique naturel qui permet de drainer votre organisme et de bien éliminer les déchets métaboliques dont l'accumulation joue un rôle déterminant dans les prises de poids intempestives. En revanche, ne buvez plus une goutte d'alcool sous aucune forme (un demi-verre de bon vin de temps à autre pour le plaisir d'accompagnement gustatif ou de convivialité étant tout de même permis sans poser de problème quant au résultat final). Ces deux simples mesures vous feront déjà perdre 1 ou 2 kilos (parfois plus) en trois ou quatre semaines sans restriction alimentaire particulière.

2 - Prenez au minimum trois repas par jour, sans jamais en sauter un, en mastiquant longuement tous vos aliments. Il est impératif de prendre son temps pour manger. Les repas doivent être des "plages" privilégiées débouchant sur une bonne détente physique et psychique, indispensable à une bonne digestion et à une parfaite assimilation des aliments, sans lesquelles l'organisme réagira souvent par des troubles fonctionnels qui favorisent ou aggravent les problèmes de surcharge pondérale.

3 - Diminuez légèrement le sel, le pain, les aliments gras, les farineux, les féculents, le sucre ainsi que les produits - ou préparations culinaires - qui contiennent ce dernier en quantité (supprimez, par contre, complètement les glaces qui, pour le même goût sucré, vous apportent deux fois plus de sucre et par là-même deux fois plus de calories). Dans la mesure où vous ne pouvez guère vous passer du goût sucré, vous pouvez remplacer le sucre par un édulcorant de synthèse qui n'apporte pratiquement aucune calorie et facile à trouver dans le circuit commercial traditionnel. Attention, pour tous les aliments mentionnés plus haut, je dis bien diminuez et non supprimez - sauf pour les glaces.

4 - Mangez, à chaque repas, des salades vertes (chicorée, cresson, laitue, mâche, scarole, etc.): elles vous donneront l'impression d'avoir l'estomac plein sans vous apporter beaucoup de calories, ainsi que des légumes et fruits frais - de préférence biologiques - tels que: céleri, chou, concombre, poireau, endive, épinard, fenouil, haricot vert, melon, navet, poivron, radis, tomate, pamplemousse (sans sucre évidemment) et pastèque qui, eux non plus, ne vous feront pas grossir. Ces fruits et légumes viennent, bien sûr, en remplacement d'autres et non en supplément.

5 - Ne "grignotez" jamais entre les repas et évitez systématiquement les "amuse-gueules" dont la mode généralisée constitue actuellement une source calorique non négligeable dans les prises de poids de nombreuses personnes, et cela d'autant plus qu'ils sont habituellement proposés avant les repas avec la prise d'alcools. Gardez toujours à l'esprit que ce sont toutes ces "petites calories" - non indispensables - additionnées journellement en dehors des repas (petits gâteaux secs, bonbons, chocolat, crakers, etc.) qui font petit à petit, sans que vous en ayez conscience, les "gros kilos" que vous avez en trop.

6 - Veillez à ne pas être constipé(e). Si c'est le cas, mettez en œuvre de petits moyens naturels en évitant toujours les laxatifs irritants pour la muqueuse intestinale.

7 - Enfin, un dernier point important qui demande à être bien précisé car il prête souvent à de nombreux malentendus et de graves déconvenues. Sachez que la gymnastique forcenée ou la pratique d'un quelconque sport à outrance, n'a jamais fait maigrir personne. Inutile, donc, de suer sang et eau dans cet espoir. Toutefois, une activité sportive légère et régulière est vivement conseillée pendant toute la durée d'une cure d'amaigrissement, car elle s'avère très utile pour pallier le relâchement musculaire et cutané consécutif à la perte de poids. Choisissez donc une activité physique douce et peu fatigante - en fonction de vos goûts et de vos possibilités: gymnastique adaptée, vélo, natation, golf et surtout la marche journalière - à même de prévenir ce problème pour que votre amincissement ne se solde pas finalement par des "plis maigres" qui, sur un plan purement esthétique, ne valent guère mieux que des "bourrelets arrondis" !… Un bon amaigrissement doit éviter à tout prix le piège de remplacer une disgrâce par une autre. Le nombre de kilos perdus sur la balance ne suffit pas, encore faut-il que la silhouette s'en trouve aussi améliorée.