Nursing: A Comprehensive and Detailed Guide

I. Oxygen Therapy

• Indications: As prescribed by the physician.
• Hygiene and Infection Control:
  • Wash hands before and after the procedure.
  • Clean the oxygen mask before and after use.
  • Replace the oxygen tubing regularly.
• Preventing Respiratory Tract Mucosal Dryness:
  • Use a humidifying device.
  • Apply moisturizing cream to the patient’s nose and lips.
• Fire Prevention:
  • Inspect the oxygen system regularly.
  • Avoid contact of oxygen with fire or heat sources.
• Nelaton Catheter Size:
  • Children: Size 8-10
  • Adults: Size 10-12 or 14
• Replacing the Oxygen Mask:
  • After 1-2 hours, remove the oxygen mask to dry and clean it.
• Note:
  • Always check the oxygen flow rate.
  • Closely monitor the patient’s condition during oxygen therapy.

II. Bandaging

• Bandaging Open Wounds:
  • Need to absorb exudate within 24 hours.
  • Change dressings regularly and monitor the wound’s condition.
• Storage Time of Tubes:
  • Rubber tubes: 3-5 days
  • Plastic tubes: 7-10 days
  • Latex tubes: 2-3 weeks
• Urinary Catheterization:
  • Inject into the auxiliary branch: 10-15 ml.
  • Clean the equipment after use.
• Types of Bandages:
  • T-bandage:
    • 1 strip: Bandage for perineum and female genitalia.
    • 2 strips: Bandage for males.
  • Multi-strip bandage: Abdominal bandage.
  • Adhesive tape: For flat areas, clean wounds that are not bleeding.
  • Circular interlocking bandage:
    • The posterior turn presses tightly on the previous turn.
    • Bandage for the neck and forehead.
  • Spiral bandage:
    • The posterior turn overlaps 1/2 or 2/3 of the previous turn.
    • Apply to fingers, upper half of the body for males (relatively even).
  • Figure-of-eight bandage:
    • Areas that are uneven.
    • Forearm, lower leg.
• Note:
  • Choose the appropriate type of bandage for each specific case.
  • Do not bandage too tightly, avoiding obstruction of blood flow.

III. Urinary System

• Oliguria: <30ml/hour (<500ml/24 hours).
• Anuria: When urine <10ml/hour (<100ml/24h).
• Polyuria: When urine > 2500ml – 3000ml/24h.

IV. Patient Transport

• Hypotension, Spinal Cord Injury: Transport with the head level.
• Significant Blood Loss, Decreased Circulating Volume, Edema: Supine position, legs elevated.
• Leg Fracture, or Pelvic Fracture: Supine position, legs elevated.
• Traumatic Brain Injury, Cerebrovascular Accident, Increased Intracranial Pressure: Transport with head elevated, supine position (30 degrees).
• Altered Consciousness but Not Respiratory Distress: Place the patient on their side.
• Acute Pulmonary Edema, Heart Failure, Dyspnea: Head elevated, semi-Fowler’s position from 45-60 degrees.
• Injury to the Posterior Region: Prone position.
• Note:
  • At least two people are needed to transport the patient.
  • Always monitor the patient’s condition during transportation.

V. Cardiac Arrest

• Definition: A condition where the heart suddenly stops beating, leading to inadequate supply of oxygen and blood to organs.
• Urgent Emergency: Cardiac arrest is the most urgent emergency.
• Causes:
  • Lack of oxygen.
  • Heart shock, myocardial infarction, …
  • Fluid and electrolyte disturbances, acid-base imbalances.
  • Increased intracranial pressure.
  • Drug poisoning.
  • Accidents.
• Consequences: If emergency response is delayed, the patient may die or suffer brain death, prolonged coma.
• Diagnosis: Do not waste time measuring blood pressure or listening to the heart to diagnose cardiac arrest (True).
• External Chest Compressions:
  • Location: Lower 1/3 of the sternum.
  • Compression force: Depress the patient’s chest by 5-6 cm.
  • Compression rate: 100-120 beats/minute.
• Opening the Airway:
  • Clear any foreign objects in the patient’s airway to ensure a clear airway.
• Technique for opening the airway:
  • Place one hand on the forehead, push the forehead back. The other hand pushes the chin up and tilts the neck back to the maximum extent.
  • If suspected spinal cord injury, only lift the lower jaw, do not move the head.
• Breathing rate: 10-12 breaths/minute.
• Note on breathing:
  • If the patient’s chest does not rise, breathing is heavy, check the patient’s head position.
• Optimal oxygen source in breathing: 6-8 l/minute.
• Coordination of chest compressions and breathing:
  • 30 continuous chest compressions, followed by 2 breaths.
  • After about 2 minutes of emergency response, check the carotid pulse for 5 seconds, if no pulse, stop chest compressions, check breathing, if spontaneous breathing then stop breathing.
• Evaluation of successful cardiopulmonary resuscitation:
  • Pupils constrict, react to light.
  • Heart rate and blood pressure return.
  • Spontaneous breathing returns.
• When emergency response is unsuccessful:
  • Emergency response time > 60 minutes, dilated pupils, no eye reflex to light, no heartbeat.

VI. Fractures

• Closed fracture: Fracture where the fracture site is not open to the external environment.
• Open fracture:
  • Fracture where the fracture site is open to the external environment, causing infection.
  • May encounter different types of fractures, depending on the fracture morphology.
• Signs and symptoms of fracture:
  • Shock (if there is blood loss).
  • Pain.
  • Swelling, bruising.
  • Decreased or loss of mobility.
  • Deformity, axial deviation.
  • Sharp pain point.
  • Crepitus.
• Purpose of First Aid for Fractures:
  • Pain relief.
  • Reduce the risk of displacement, damage to blood vessels, nerves.
  • Prevent infection.
• Splinting Fractures:
  • Spinal and lumbar fractures: U splint.
  • Ankle fracture: L splint.

VII. Wounds

• Clean wound:
  • Newly inflicted wound.
  • Wound without swelling, no pus.
  • Wound edges are usually neat.
• Postural hypotension from lying to sitting: Lower systolic blood pressure by 25mmHg and diastolic blood pressure by 10mmHg.
• Size of air bag for blood pressure measurement: 40% of the circumference of the middle section of the limb used for blood pressure measurement.

VIII. Examination and Treatment

• Diagnosing cardiac arrest:
  • Sudden loss of consciousness: No response to loud calling.
  • Gasping.
  • Loss of major pulse: Carotid pulse, femoral pulse.
  • Cyanosis or pallor.
  • Dilated pupils, loss of light reflex.
  • During arterial surgery, arterial blood stops flowing, blood from other locations flows profusely.
• Rules of injection:
  • Five verifications:
    • Bed number, room number.
    • Drug name.
    • Drug quality.
    • Route of administration.
    • Time of administration.
  • Three checks:
    • Correct patient.
    • Correct drug.
    • Correct dosage.
• After enema: Advise the patient to retain the water as long as possible, at least 10-15 minutes.
• After gastric lavage: Record and report any issues:
  • Patient’s response to the procedure.
  • Characteristics of gastric fluid, pH value.
  • Procedure time, type of lavage tube.
  • Tube is clamped or connected to a drainage device.
• Gastric lavage: Patients usually breathe through their mouths, to minimize water loss through the mouth, therefore…
• Purpose of gastric lavage:
  • Remove toxins from the gastrointestinal tract in cases of acute oral poisoning.
  • Obtain gastric fluid for toxin testing to help diagnose the cause.
• Gastric lavage: Endotracheal intubation should be performed if the patient is confused or comatose to reduce aspiration of lavage fluid into the lungs.
• Position during gastric intubation (stage of passing the tube through the esophagus): Head tilted back.
• Patient position during gastric lavage: Head lowered 20 degrees, tilted to the left or sitting if the patient is conscious.
• Fluid for gastric lavage: Normal saline.
• Core body temperature:
  • Direct temperature influences the rate of biochemical reactions in the body.
  • Changes little with the environment.
  • Usually measured in the rectum.
  • Also measured orally.
• Purpose of wound dressing change:
  • Protect the wound, prevent infection.
  • Clean the wound.
  • Control wound bleeding.
  • Limit movement at the site of the wound.
  • Support.
  • Create a moist environment for wound tissue.
• Types of bandages and their uses:
  • Cloth bandage: Compression, fixation, support.
  • Gauze bandage: Bandage for children or for pressure points in adults.
  • Elastic bandage: Compression, sprains, dislocations after reduction (for small joints).
  • Plaster bandage: Immobilization of fractures, sprains, dislocations (apply plaster to cloth bandage or gauze bandage, soak in water when using).
  • Adhesive tape: Bandage for flat areas, no blood.
  • Rubber bandage: Tourniquet for hemostasis.
• Effectiveness of hemostasis: Compression bandage.
• Angle of antibiotic injection: Intravenous injection 15-30 degrees C.
• Patient transport position:
  • Blood loss: Legs elevated, head lowered.
  • Uphill: Head elevated, legs lowered, head in front.
• Feeding through a gastric tube:
  • Applies to patients who cannot eat orally.
  • Comatose patients.
  • Patients with oral injuries unable to chew or swallow (such as jaw fracture, tongue and throat cancer).
  • Patients with severe tetanus.
  • Patients who refuse to eat.
• Skin prick test: Number 24.
• SpO2 in newborns: > 88%.
• Obtaining clean urine for examination: Discard the first urine, collect the middle urine.
• Splinting fractures:
  • … (Need to add information on splint types for each body part).
• Sterile urinary catheterization equipment:
  • 2 deep kidney trays.
  • 2 cups for solutions.
  • 1 perforated glove.
  • 1 glove clamp.
  • 2 non-beaded or beaded Koucher clamps.
  • 2 non-beaded or beaded surgical clamps.
• Common antiseptics:
  • Peracetic acid: 0.23%.
  • Orthophtaleadehyd: 0.55%.
  • Glyceraldehyde: 2.35%.
  • Hydrogen peroxide: 7.35%.
• PaO2 in young children and FiO2 concentration: PaO2: 50-80 mmHg.
• Medication test needle: 24G.
• Solution for anal irrigation: Mild cleansing solution with low detergent concentration, dilute saline.
• Most effective sterilization method: Moist heat.
• Antibiotic injection: Intravenous injection, injection angle 15-30 degrees.

Note:

• The above article provides general information only, not a substitute for professional medical advice.
• Always follow your physician’s instructions and healthcare regulations.
• Monitor the patient’s condition regularly for timely intervention.

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