The methodical instruction
for practical lesson for 2nd year medical students
Lesson 5 (practical 7 h)
Theme: General rules for care of patient in critical conditions and terminally ill. (7 h)
Aim:
To be able to care of elderly patient, to determine the main symptoms of agony and death; to master the CPR technique, to be able the procedures, influencing on circulatory system.
The professional orientation
The patients with serious disease require help in activity of daily living. They need also special skin care for bedsore prevention. The appropriate practical skills will be useful for students for providing home care in their families.
The CPR skills will be necessary for all doctors in their future work.
The simple techniques of physical therapy is very helpful for patient and can be used at home.
Self-preparation program
1. Making of occupied bed.
2. Making of unoccupied bed.
3. Skin care and prevention of bed sores.
4. Hair and nail care.
5. Oral, eye, ear and nose care.
6. The peculiarities of care for elderly patients.
7. Using of bedpan.
8. Feeding of seriously ill patients.
9. Main symptoms of agony.
10. The sequence of performing of reanimation.
11. Methods and techniques of pulmonary ventilation and heart massage.
12. Signs of clinical death.
The examples of test questions and case studies.
1. The patient S. has decreased mobility and is lying in the bed in the supine position during long time. What sites of his body are in risk of pressure ulcer formation?
2. The doctor is doing the heart massage in patient F. How long is it necessary to do this, if positive changes are absent?
3. What is ratio between chest compressions and breathings during CPR?
4. The patient R. need applying the compress on the infiltration after injection. What solutions can be used?
5. The patient with myositis is administered with mustard-poultice. During this procedure the pain became more severe. What should the nurse do?
6. During taking bath the patient feels dizzy. What should the nurse do?
Answers.
1. Iliac crest, scapula, hills.
2. 30 min.
3. 15 compressions : 1 breathing.
4. Hypertonic NaCl solution, 40º alcohol, 25 % dimexid.
5. Stop the procedure.
6. Help patient go out bath and lye on the couch.
4. LITERATURE
1. Wilson S., Giddens J. Health assessment for nursing practice. Second edition. Mosby.–2001.–P.857.
5. Practical work – 900-1200 (4 hours)
Visual Aids and Material Tools: Tables, slides, compact-disk
Task 1. Assisting with a Bedpan or Urinal
Voiding and bowel elimination for the client confined to bed require a bedpan and/or a urinal. The bedridden client may have altered elimination patterns. Reduced mobility, pain, privacy issues, the need for assistance, delays in getting assistance wheeeded, and the fear of interruption can all alter normal elimination patterns. Fear of creating embarrassing noises, sights, or odors may compel the client to reduce fluid intake or avoid the urge to eliminate while in the hospital. Constipation, embarrassment, incontinence, and discomfort can result. Sensitivity, proper technique, and client education by the nurse support the client on bedrest.
EQUIPMENT NEEDED :
• Bedpan (regular or fracture) or urinal
• Disposable gloves
• Bedpan cover
• Toilet paper
• Washcloth and towel
ACTION
Positioning a Bedpan
1. Close curtain or door.
2. Wash hands; apply gloves.
3. Lower head of bed so client is in supine position.
4. Elevate bed.
5. Assist client to side-lying position using side rail for support.
6. Warm bedpan under warm water if needed; powder if necessary .
7. Place bedpan under buttocks. Place a fracture pan with the lower end near the client’s lower back region. Place large bedpans with the opening near the client’s thighs.
8. While holding the bedpan with one hand, help the client roll onto the back, while pushing against the bedpan (toward the center of the bed) to hold it in place.
9. Alternate: Help the client raise the hips using the overbed trapeze, and slide the pan in place.
Alternate: If the client is unable to turn or raise hips, use a fracture pan instead of a bedpan. With a fracture pan, the flat side is placed toward the client’s head .
10. Check placement of bedpan by looking between client’s legs.
11. If indicated, elevate head of bed to 45° angle or higher for comfort.
12. Place call light within reach of client; place side rails in upright position, lower bed, and provide privacy.
13. Remove gloves; wash hands.
Positioning a Urinal
14. Repeat Actions 1 and 2.
15. Lift the covers and place the urinal so the client may grasp the handle and position it. If the client cannot do this, you must position the urinal and place the penis into the opening.
16. Remove gloves; wash hands.
Removing a Bedpan
17. Wash hands; apply gloves.
18. Gather toilet paper and washing supplies.
19. Lower head of bed to supine position.
20. While holding bedpan with one hand, roll client to side and remove the pan, being careful not to pull or shear skin sticking to the pan and being careful not to spill contents
21. Assist with cleaning or wiping; always wipe with a front to back motion.
22. Empty bedpan (measure urine output if ordered), clean bedpan, and store it in proper place; if bedpan is to be emptied outside client’s room, cover it during transport.
23. Remove soiled gloves.Wash hands.
24. Allow client to wash hands.
25. Place call light within reach; recheck that side rails are in the upright position.
26. Wash hands.
Removing a Urinal
27. Wash hands and apply gloves.
28. Empty the urinal, measuring urine output if ordered, rinse the urinal and replace it within the client’s reach.
29. Remove soiled gloves.Wash hands.
30. Allow client to wash hands.
31. Place call light within reach; recheck that side rails are in the upright position.
32. Wash hands.
Task 2. Moving a Client in Bed
Prolonged immobility is uncomfortable. It can cause muscle wasting, promotes clot formation, and encourages skin breakdown. Clients who are unable to move themselves in bed or are only able to assist with moving in bed are at risk for discomfort and skin breakdown. Often clients’ restlessness in bed will cause them to slide down toward the foot of the bed. This is especially true in beds where the head raises up to a Fowler’s or semi-Fowler’s position. If the client slides down
toward the foot of the bed while the head is elevated, it can lead to reduced respiratory effort and reduced lung capacity.
This can impair the client’s recovery.
The nurse is often called upon to move a client to a more comfortable position. Repositioning a client can sometimes be done by a single staff member, but
often it requires two or more people to do this procedure safely Assess the client’s ability to assist with repositioning. Determine if the client can move with the aid
of an overhead trapeze or the side rail. Judge how much assistance will be needed.
Determines safety for the client and the nurse and good body mechanics for the nurse.
1. Assess the client’s ability to assist with repositioning. Determine if the client can move with the aid of an overhead trapeze or the side rail. Judge how much assistance will be needed.
2. Assess the client’s ability to understand and follow directions and assist and cooperate with the move. Affects how the procedure will be carried out. Affects client teaching.
2. Assess the client’s environment. Check the bed for cleanliness. Has the client been restless, sweaty, or incontinent? Check to see if the sheets have been turned or twisted. Tubes, lines, wires, traction, casts, or splints must be moved carefully Affects how the procedure will be carried out. Affects what additional procedures will
Moving a Client Up in Bed with One Nurse
1. Wash hands.
2. Inform client of reason for the move and how to assist (if able).
3. Elevate bed to just below waist height. Lower head of bed if tolerated by client. Lower side rails on the side where you are standing. Remove the pillow and place it against the headboard.
4. Have the client fold arms across the chest.
5. Have client hold on to the overhead trapeze, if available Have the client bend the knees and place the feet flat on the bed if able (see Figure 4-4-6).
6. Stand at an angle to the head of the bed, feet apart, knees bent, feet toward the head of the bed.
7. Slide one hand and arm under the client’s shoulder, the other under the client’s thigh.
8. Rock forward toward the head of the bed, lifting the client with you. Simultaneously have the client push with the legs.
9. If the client has a trapeze, have the client pull up holding onto the trapeze as you move the client upward in bed.
10. Repeat these steps until the client is high enough in bed.
11. Return the client’s pillow under the head.
12. Elevate head of bed, if tolerated by client.
13. Adjust the client’s bedclothes as needed for comfort.
14. Lower bed and elevate side rails.
15. Wash hands.
Moving a Client Up in Bed with Two or More Nurses
1. Wash hands and apply gloves if needed Inform client of reason for the move and how to assist (if able).
2. Elevate bed to just below waist height. Lower head of bed if tolerated by client. Lower side rails.
3. With two nurses, place turn/draw sheet under client’s back and head.
4. Roll up the draw sheet on each side until it is next to the client
5. The nurses stand on either side of the bed, at an angle to the head of the bed.They stand with knees flexed, feet apart in a wide stance.
6. The nurses hold their elbows as close as possible to their bodies.
7. The nurses will lift up (off the bed) on the turn/draw sheet and forward (toward the head of the bed) in one smooth motion.The move is coordinated to transfer the client toward the head of the bed. Simultaneously, have the client push with the legs or pull using the trapeze.
8. Repeat until the client is high enough in bed to be comfortable.
9. Return the client’s pillow under the head.
10. Elevate head of bed, if tolerated by client. Assess client for comfort.
11. Adjust the client’s bedclothes for comfort.
12. Lower bed and elevate side rails.
Task 3. Changing Linens in an Occupied Bed
After a bath, clean linens are placed on the bed to promote comfort. If the client is able to get out of the bed, assist the client to a chair and proceed to make the bed. If the client is unable to get out of bed, the linens must be changed around the client. Assistance will be needed if the client is in traction or cannot be turned. Care must be taken to avoid disturbing the traction weights. If the client cannot be turned, change the linens from head to toe. Place a waterproof draw sheet on the beds of clients who are incontinent or have profuse drainage. The type and amount of linens placed on the bed will vary based on the type of bed the client is using. Air beds and Clinitron beds for example, use only minimal linens under the client.
Equipment Needed:
Linen hamper
Top sheet, draw sheet, bottom sheet
Pillowcase
Blanket
Top and bottom sheets, draw sheet, and pillowcase are used to make the occupied bed. Gloves reduce the transmission of microorganisms.
ACTION
1. Explain
2. Bring equipment to the bedside procedure to client.
3. Remove top sheet and blanket. Loosen bottom sheet at foot and sides of bed. Lower side rail nearest the nurse, if necessary for access. Client may be covered with a bath blanket
4. Position client on side, facing away from you. Reposition pillow under head.
5. Fan-fold or roll bottom linens close to client toward the center of the bed.
6. Smooth wrinkles out of mattress. Place clean bottom linens with the center fold nearest the client. Fan-fold or roll clean bottom linens nearest client and tuck under soiled linen.Maintain an adequate amount of sheet at head and foot of bed for tucking.
7. Miter bottom sheet at head of bed, then at foot of bed.To miter, lift the mattress and tuck the sheet over the edge of the mattress, lift edge of sheet that is hanging to form a triangle, and lay upper part of sheet back onto bed; tuck the lower hanging section under the mattress. Repeat for each corner.Tuck the sides of the sheet under the mattress.
8. Fold the draw sheet in half. Identify the center of the draw sheet and place it close to the client. Fan-fold or roll draw sheet closest to client and tuck under soiled linen. Smooth linen. Add protective padding if needed.Tuck draw sheet under mattress,working from the center to the edges (see Figure 4-2-6). Draw sheet should be positioned under the lower back and buttocks.
9. Log roll client over onto side facing you. Raise side rail.
10. Move to other side of bed. Remove soiled linens by rolling into a bundle and place in linen hamper without touching uniform.
11. Unfold/unroll bottom sheet; then draw sheet. Look for objects left in the bed. Grasp each sheet with knuckles up and over the sheet and pull tightly while leaning back with your body weight. Client may be positioned supine.
12. Place top sheet over client with center of sheet in middle of bed. Unfold top of sheet over client. Remove bath blankets left on client to prevent exposure during bed making. Place top blanket over client, same as the top sheet
13. Raise foot of mattress and tuck the corner of the top sheet and blanket under.Miter the corner. Repeat with other side of mattress
14. Grasp top sheet and blanket over client’s toes and pull upward, then make a small fan-fold in the sheet.
15. Remove soiled pillowcase.Grasp center of clean pillowcase and invert pillowcase over hand/ arm.Maintain grasp of pillowcase while grasping center of pillow.Use other hand to pull pillowcase down over pillow. Place pillow under client’s head.While changing pillowcase, client can be instructed to rest head on bed, or place a blanket under client’s head
16. Document procedure used to change linens and client’s condition during the procedure.
17. Wash hands.
Task 4. Methods of prevention and treatment of pressure ulcers (bedsores).
Pressure ulcer (bedsores, in Latin: decubitus) is a condition of tissues, caused by long lasting local pressure that leads to diminished perfusion in tissues with progress of dystrophic processes and formation of tissues damage.
Classification:
Stage I – A reddened area on the skin that, when pressed, is “non-bleachable” (does not turn white). This indicates that a pressure ulcer is starting to develop.
Stage II – The skin blisters or forms an open sore. The area around the sore may be red and irritated.
Stage III – The skin breakdowow looks like a crater where there is damage to the tissue below the skin.
Stage IV – The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.
Typical localizations of pressure ulcers:
Occipital prominence, shoulder blades (scapulas), sacrum, elbows, heels.
Assessment:
Braden Scale is used to assess the risk of pressure ulcers development. According to this scale you must check for next characteristics and give certain points to each of them
· Sensory Perception
· Activity
· Mobility
· Skin Moisture
· Friction and Shear
· Nutrition
Then evaluate a total score:
· 1-4 points – with the exception of friction & shear subscale 1-3
· Range 4-23
· The lower the score the higher the risk
· 18 or less: high risk adult
To avoid bedsores:
1. Change child’s position as frequently as possible (advicable 1 time per 3 hours).
2. Protect pressure points, for example, trochanter, sacrum, ankle, heels, shoulder blades, elbows, occiput, by placing them on sheepskin, Egg-crate pad, lightly inflamed air rings.
3. Keep clothing and linen clean and dry, smooth out bottom sheet regularly.
4. Inspect skin surface regularly for signs of irritation, paleness or redness, evidences of pressure.
5. Maintain meticulous skin cleanliness:
§ Cleanse thoroughly the skin with soap and cold water, dry carefully, rub with cotton ball soaked in camphor spirit or 6 % solution of table vinegar not less than twice daily.
6. Stimulate circulation by gentle rubbing with lotion, camphor spirit or other lubricating substances 3-5 times daily.
7. Administer UVR on problematic areas of skin (5-10 min 1 time per day).
Treatment of bedsores:
1. In case of skin paleness:
§ Maintain meticulous skin cleanliness.
§ Provide gentle massage with soft cloth for stimulating circulation 3-5 times per day.
§ Administer ultraviolet radiation (UVR) on problematic areas of skin.
2. In case of hyperemia and edema of skin:
§
§ Administer UVR on problematic areas of skin.
3. In case of blister or/and skin maceration:
§ Wash affected parts with soap and cold water, dry carefully, then rub gently with spirit solution and cover with solution of brilliant green or “Levomycol” ointment (on water-soluble base) and put on dry dressing (2-3 times per day).
§ Provide gentle massage of round-lying tissues with soft cloth for stimulating circulation 3-5 times per day.
4. In case of ulcers and skiecrosis:
§ Surgical “cleaning” of affected places is needed: necrotic tissues must be taken off.
§ The wound should be covered with steril dressing soaked with 10 % saline solution or 1 % solution of Kalium permanganatis; change the dressing 2-3 times per day.
§ After cleansing of the wound from pus and necrotic tissues apply ointments with antibiotics and regenerating substabces (Levomycol, Soframycin, etc.).
Task 5. CARDIOPULMONARY RESUSCITATION
Cardiopulmonary resuscitation (CPR) is an emergency first aid procedure for a victim of cardiac arrest. It is part of the chain of survival, which includes early access (to emergency medical services), early CPR, early defibrillation, and early advanced care. It is also performed as part of the choking protocol if all else has failed. It can be performed by trained laypersons or by health care or emergency response professionals. It is normally begun on an unbreathing unconscious person and continued until the underlying cause can be identified and a pulse is restored. CPR consists of chest compressions and rescue breaths (i.e. artificial blood circulation and lung ventilation) and is intended to maintain a flow of oxygenated blood to the brain and the heart, thereby extending the brief window of opportunity for a successful resuscitation without permanent brain damage.
Many countries have official guidelines on how CPR should be provided, and these naturally override the general description of CPR in this article.
In 2005, new CPR guidelines were published with input from International Resuscitation Councils, and was agreed at the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. The primary goal was to simplify CPR for lay rescuers and healthcare providers alike to maximise the potential for early resuscitation. The important changes for 2005 are as follow.
- A universal compression-ventilation ratio (30:2) is recommended for all single rescuers of infant (less than one year old), child (1 year old to puberty), and adult (puberty and above) victims (excluding newborns). The only difference between the age groups is that with adults the rescuer uses two hands for the chest compressions, while with children it is only one, and with infants only two fingers (pointer and middle fingers). It is worth noting that paediatric guidelines for healthcare professionals differ from the 30:2 compression-ventilation ratio stated here.
- Lay rescuers do not need to assess for pulse or signs of circulation for an unresponsive adult victim.
- Lay rescuers do not need to provide rescue breathing without chest compressions for an adult victim.
As research has shown that lay personnel cannot accurately detect a pulse in about 40% of cases and cannot accurately discern the absence of pulse in about 10%, the pulse check step has been removed from the CPR procedure completely for lay persons and de-emphasized for healthcare professionals.
Cardiac arrest and the place of CPR
The medical term for the condition in which a person’s heart has stopped is cardiac arrest (also referred to as cardiorespiratory arrest). CPR appropriate for cardiac arrest. If the patient still has a pulse, but is not breathing, this is called respiratory arrest and rescue breathing is more appropriate.
However, since people often can’t tell the difference (can’t accurately feel a pulse to determine whether the heart is still beating), CPR is often recommended for both.
The most common cause of cardiac arrest outside of a hospital is ventricular fibrillation (VF), a potentially fatal arrhythmia that is usually (but not always) caused by a heart attack. Other causes of cardiac arrest include drowning, drug overdose, poisoning, electrocution.
Sudden cardiac arrest is a leading cause of death, approximately 250,000 per annum outside a hospital setting in the
Blood circulation and lung ventilation are absolute requirements in transporting oxygen to the tissues. The brain may sustain damage after four minutes and irreversible damage after about seven minutes The heart also rapidly loses the ability to maintain a normal rhythm. Low body temperatures as seen in drownings prolong the time the brain survives. Following cardiac arrest, effective CPR enables enough oxygen to reach the brain to delay brain death, and allows the heart to remain responsive to defibrillation attempts.
CPR is taught to the general public because they are the only ones present in the crucial few minutes before emergency personnel are available. Simple training is the goal of the 2005 guidelines to maximise the prospect that CPR will be performed successfully.
EFFECTIVENESS
CPR is almost never effective if started more than 15 minutes after collapse because permanent brain damage has probably already occurred, especially if the person has stopped breathing, since the brain can only survive for 4-6 minutes without oxygen. A notable exception is cardiac arrest occurring in conjunction with exposure to very cold temperatures. Hypothermia seems to protect the victim by slowing down metabolic and physiologic processes, greatly decreasing the tissues’ need for oxygen. There are cases where CPR, defibrillation, and advanced warming techniques have revived victims after substantial periods of hypothermia.
Used alone, few patients will make a complete recovery, and those that do survive often develop serious complications. Estimates vary, but many organizations stress that CPR does not “bring anyone back,” it simply preserves the body for defibrillation and advanced life support. However, in the case of “non-shockable” rhythms such as Pulseless Electrical Activity (PEA), defibrillation is not indicated, and the importance of CPR rises. On average, only 5%-10% of people who receive CPR survive. The purpose of CPR is not to “start” the heart, but rather to circulate oxygenated blood, and keep the brain alive until advanced care (especially defibrillation) can be initiated. As many of these patients may have a pulse that is unpalpable by the layperson rescuer, the current consensus is to perform CPR on a patient that is not breathing. A pulse check is not required in basic CPR since it is so often missed when present, or even felt when absent, even by health care professionals
Studies have shown the importance of immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest improve survival. In cities such as
CPR is often severely misportrayed in movies and television as being highly effective in resuscitating a person who is not breathing and has no circulation. A 1996 study published in the New England Journal of Medicine showed that CPR success rates in television shows was 75%.
It is considered by a number of international bodies that in order for CPR to be effective, the guidelines must be simple and easy to remember.
CPR TRAINING
CPR is a practical skill and needs professional instruction followed up by regular practice on a resuscitation mannequin to gain and maintain full competency. Training is available through many commercial, volunteer and government organizations worldwide.
CPR training is not confined to the medical professionals. To be effective, CPR must be applied almost immediately after a patient’s heart has stopped. Early CPR on the scene of an incident is essential to the prevention of brain damage during a cardiac arrest. Blood flow and air supply to the brain and other major organs is maintained until a defibrillator and professional medical help arrives. Almost anyone is able to perform CPR with training, and health organizations advocate the development of CPR skills throughout the general public.
It is best to obtain training in CPR before a medical emergency occurs. One needs hands-on training by experts to perform CPR safely, and guidelines change, so that training should be repeated every one or two years. Training in first aid is often available through community organizations such as the Red Cross and St. John Ambulance. In many countries in the Commonwealth of Nations, St. John Ambulance and the Medic First Aid Organization provide CPR training. In
In most CPR Classes a simple shortform is used for people to remember everything they need to do. The most common one used worldwide is DRABCD which stands for Danger, Response, Airway, Breathing, Compressions and Defibrillation.
HISTORY
CPR has been known in theory, if not practice, for many hundreds or even thousands of years; some claim it is described in the Bible, discerning a superficial similarity to CPR in a passage from the Books of Kings (II 4:34), wherein the Hebrew prophet Elisha warms a dead boy’s body and “places his mouth over his”. In the 19th century, doctor H. R. Silvester described a method (The Silvester Method) of artificial respiration in which the patient is laid on their back, and their arms are raised above their head to aid inhalation and then pressed against their chest to aid exhalation. The procedure is repeated sixteen times per minute. This type of artificial respiration is occasionally seen in movies made in the early part of the 20th century.
A second technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, described a form of artificial respiration where the person was laid on their front, with their head to the side, and a process of lifting their arms and pressing on their back was utilized, essentially the Silvester Method with the patient flipped over. This form is seen well into the 1950s (it is used in an episode of Lassie during the Jeff Miller era), and was often used, sometimes for comedic effect, in theatrical cartoons of the time. This method would continue to be shown, for historical purposes, side-by-side with modern CPR in the Boy Scout Handbook until its ninth edition in 1979.
However it wasn’t until the middle of the 20th century that the wider medical community started to recognise and promote it as a key part of resuscitation following cardiac arrest. Peter Safar wrote the book ABC of resuscitation in
SELF-CPR
A form of “self-CPR” termed “Cough CPR” may help a person maintain blood flow to the brain during a heart attack while waiting for medical help to arrive and has been used in a hospital emergency room in cases where “standard CPR” was contraindicated. While this technique is not in widespread use, one researcher has recommended that it be taught broadly to the public However, the American Heart Association (AHA), does not endorse “Cough CPR”, which it terms a misnomer as it is not a recognized form of resuscitation. The AHA does recognize a limited legitimate use of the coughing technique:
This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. In such cases the patient’s ECG is monitored continuously, and a physician is present.
“Cough CPR” was the subject of a hoax chain e-mail entitled “How to Survive a Heart Attack When Alone” which wrongly cited “ViaHealth Rochester General Hospital” as the source of the technique.
1. To check an unconscious victim, place two fingers under his chin and a hand on his forehead. Tilt his head back to open his airway. Remove any obstructions from his mouth.
2. Listen and feel for victim’s breathing. If he is breathing, place him in the recovery position. If he is not breathing, begin rescue breathing.
3. Check the victim’s circulation by feeling for a pulse at the side of his windpipe (carotid artery). If there is no pulse, begin CPR immediately.
1. If a victim is unconscious but breathing, bend his near arm up at a right angle to his body. Hold the back of his far hand to his near cheek. With the near leg straight, pull the far knee toward you.
2. With the victim on his side, place his uppermost leg at a right angles to his body. His head will be supported by the hand of the uppermost arm. Tilt his head back so that he will not choke if he vomits.
1. To ensure an open airway, first clear the victim’s mouth of obstructions, then place one hand under his chin and one on his forehead, and tilt his head back.
2. Pinching the victim’s nose shut, clamp your mouth over his mouth, and blow steadily for about two seconds until his chest rises. Remove your mouth and let his chest fall, then repeat.
3. Listen for the victim’s breathing and check his pulse. If he still has a pulse, give 10 breaths per minute until help arrives or the victim is breathing by himself. If the pulse has stopped, combine rescue breathing with chest compressions.
Cardiopulmonary Resuscitation (CPR)
If a person’s heart has stopped, give cardiopulmonary resuscitation (CPR). This consists of chest compressions to maintain the blood flow to the brain, combined with rescue breathing to oxygenate the blood. Give chest compressions at a rate of 80 per minute, counting “one-and-two-and…”
1. Place the heel of your hand two finger-widths up from the end of the sternum and your other hand on top of the first. Press down firmly, then release.
2. Check for a pulse. After 15 chest compressions, give the victim two breaths of rescue breathing. Repeat until the pulse restarts, professional help arrives, or you are too exhausted to continue.
Control of the airway is the single most important task for emergency resuscitation. If the patient has inadequate oxygenation or ventilation, inability to protect the airway due to altered sensorium from illness or drugs, or external forces compromising the airway (i.e., trauma), he or she may need advanced airway techniques as described in this chapter.
6. Seminar Discussion of pracrical work – 1230-1445 (2 hours)
7. Test control of students’ knowledges – 1415-1500 (1 hour).
Basic level:
Student must know:
– Patients sanitation: methodology, types, contraindications.
– Patients transportation, equipment.
– Main symptoms of agony.
– The sequence of performing of reanimation.
– Signs of clinical death.
Student must have the skills:
– Demonstrate the operation of functional bed
– Change the patients clothes.
– Bedsore prophylactics.
– Methods and techniques of pulmonary ventilation and heart massage.
Prepared by Rega N.S.
Adopted at the Chair Sitting N .2008
