Glossary assessment of the patient's functional state. Methodology for assessing the patient's functional state. According to the MDK “technology for the provision of medical services”

PM. 04 Performing work in the position of “Junior nurse for patient care”

MDK 04.02. Safe environment for patient and staff

Speciality: 02/34/01 “Nursing”

Well: 2 Semester: 4

Subject: Assessment of the patient's functional state (lesson 2).

Teacher ____________________________________Duration: 270 minutes

Objectives of the training session:

Educational: learn to determine the pulse of patients, its characteristics, learn to measure the body temperature of patients, record data in a temperature sheet, provide assistance in each period of fever.

Developmental: promote the development of students' thinking and cognitive independence.

Educational: foster responsibility for the results of services provided medical services.

Requirements for knowledge, skills, practical experience:

Know: principles of effective communication with the patient and his environment in the process professional activity; technologies for performing medical services

Be able to: collect information about the patient’s health status; identify the patient’s problems related to his health condition; assist the nurse in preparing the patient for diagnostic and treatment measures

Have practical experience: provision of medical services within the limits of their powers;

maintaining medical records

Educational technology: technology of modular learning, problem-based learning, technology of practice-oriented learning.

Teaching methods and techniques: independent work, explanation, practical work, conversation, comparison, demonstration (slides, tables, posters, models and layouts).

Means of education:

1. Educational visual and natural aids, handouts: tables, posters, guidelines.

2. Technical teaching aids: devices for listening and visualizing educational material. Electronic educational module on the topic: “Fever”, stopwatch, thermometers, “Medical record of an inpatient”, temperature sheets, disinfectants.

Literature:

Main sources:

Obukhovets T.P. Nursing and nursing care: textbook/T.P. Obukhovets.-M.; KNORUS, 2017.-680p.

Obukhovets T.P. Fundamentals of nursing: workshop: textbook / T.P. Obukhovets - Rostov-on-Don.: Phoenix, 2016.-685 p.

Additional sources:

Manipulations in nursing: a textbook / Under the general editorship. A.G. Chizha. – Ed. 5th – Rostov n/a. “Phoenix”, 2013. – 318 p.

Morozova G.I. Fundamentals of nursing: Situational tasks: textbook / G.I. Morozova. - M.: GEOTAR-Media. 2013. - 240 p.

Mukhina S.A., Tarnovskaya I.I. Practical guide to the subject “Fundamentals of Nursing”: textbook / Mukhina S.A., Tarnovskaya I.I. – 2nd ed. corr. and additional - M.:GEOTAR-Media.2013.- 512 p.

Fundamentals of nursing: Algorithms of manipulation: textbook / N.V. Shirokova et al - M.: GEOTAR-Media.2012.-160p.

Yaromich I.V. Nursing and manipulation techniques: educational and practical manual / I.V. Yaromich. Rostov n/a. "Phoenix"; Minsk: Higher School, 2012.- 568 p.

Interdisciplinary and intra-subject connections: basics of the Latin language with medical terminology, human hygiene and ecology, a healthy person and his environment, human anatomy and physiology.

Chronological map of the lesson

	Stages of a training session	Time (minutes)
	Organizing time.
	Goal setting, initial motivation and actualization.
	Determination of the initial level of knowledge.
	Induction training.
	Independent work.
	Final briefing.
	Filling out diaries, etc.
	Summarizing.
	Tasks for independent work students.
	Cleaning the workplace.

Determination of the initial level of knowledge:

Rules for conducting a general inspection?

Which changes skin and mucous membranes can patients have?

What changes in consciousness may patients experience?

What is edema? Their types? Ways to determine hidden edema?

What types of constitution are there?

What is anthropometry? The purpose of it?

Measuring the patient's height. Indications, contraindications, equipment?

Measuring the patient's weight. Indications, contraindications, equipment?

Measuring the patient's blood pressure. Equipment, normal performance, deviations from norms?

Breathing characteristics?

Independent work in class:

Determining the pulse and its characteristics to each other and to oneself.

Measuring body temperature and recording data in the “Inpatient Medical Record”, graphical representation of the temperature curve in the temperature sheet.

Carrying out disinfection of used equipment.

Solving situational problems.

Test manipulation:

Determination of pulse and its characteristics.

Measuring body temperature and recording data on a temperature sheet.

Filling out diaries:

Drawing up manipulation algorithms: “Determination of pulse”, “Measurement of body temperature”.

Drawing up a diagram: “Nursing care during each period of fever.”

Homework: Topic: “Organization of nutrition in a hospital. Feeding seriously ill patients."

Compiling a terminological crossword puzzle on the topic: “Assessment of the patient’s functional state.”

Topic: “Nursing care in every period of fever”

1. Duration of measuring body temperature in the axilla Oarea:

a) 2 minutes

b) 10 minutes

c) 5 minutes

d) 20 minutes

2. Body temperature measurement results are recorded in

temperature sheet:

a) morning and evening

b) every three hours

c) only in the morning

d) morning, afternoon, evening

3. To disinfect thermometers, you must use the following solution:

a) 1% chloramine

b) 3% hydrogen peroxide

c) furacilin

d) manganese

4. The normal pulse rate per minute for an adult is:

a) 100-120 strokes

b) 90-100 beats

c) 60-80 beats

d) 40-60 beats

5. Bed linen seriously ill patient change:

a) once every 3 days

b) once a week

c) as it gets dirty

d) once every 2 weeks

6. Water temperature used for heating pad:

a) 36-37 degrees.

b) 20-30 degrees.

c) 60-70 degrees.

d) 40-45 degrees.

7. Water temperature used for ice pack:

a) 36-37 degrees.

b) 14 - 16 degrees.

c) 60 degrees.

d) 40-45 degrees.

8. An ice pack is placed on the forehead:

a) 5 – 10 minutes

b) 20 – 30 minutes

c) 2 – 3 minutes

d) 15 – 20 minutes

9. The heating pad is placed on:

a) 20 minutes

b) 10 minutes

c) 2 – 3 minutes

d) 30 minutes

10. Water temperature for cold compress:

a) 36-37 degrees.

b) 14 - 16 degrees.

c) 60 degrees.

d) 40-45 degrees.

11. Time to apply a cold compress:

a) 5 – 10 minutes

b) 20 – 30 minutes

c) 2 – 3 minutes

d) 15 – 20 minutes

Task No. 1

	Tasks: 1. Name the period of fever. 2. State the patient's problems.
Task No. 2
	Tasks: 1. Name the period of fever. 2. State the patient's problems. 3. Provide assistance during this period of fever.
Task No. 3
	Tasks: 1. Name the period of fever. 2. State the patient's problems. 3. Provide assistance during this period of fever.

Memo to the nurse.

Assessment of the patient's functional state

· Calculation of the arterial pulse on the radial artery and determination of its properties

·Measurement blood pressure

· Respiratory rate counting

Calculation of the arterial pulse on the radial artery and determination of its properties

1. Give the patient a comfortable position;

2. Ask him to relax his hand (the hand should not be suspended);

3. Simultaneously press the patient’s hands with your fingers above wrist joint(2nd, 3rd and 4th fingers should be above the radial artery);

4. Compare the frequency of oscillations of the walls of the arteries on the right and left arms, determining the pulse rhythm;

5. Assess the intervals between pulse waves;

6. Take a stopwatch and count pulse waves;

7. Assess pulse filling;

8. Assess tension (compress the radial artery until the pulse disappears);

9. Register the properties of the pulse (temperature sheet);

10. Tell the patient the result.

Blood pressure measurement

1. Warn the patient about the upcoming procedure 15 minutes before it begins;

3. Place the patient’s arm in an extended position with the palm up (put a cushion under the elbow, or ask the patient to place the clenched fist of the free hand under the elbow);

4. Choose the correct cuff size;

5. Apply a tonometer cuff (the tubes should be at the bottom, the cuff should be at a distance of 2-3 cm above the elbow);

6. Connect the pressure gauge to the cuff;

7. Check the position of the pressure gauge needle;

8. Determine the pulsation in the ulnar fossa with your fingers, apply the phonendoscope membrane to this place;

9. Close the bulb valve, force air into the cuff until the pulsation in the ulnar artery disappears;

10. Open the valve, slowly releasing air, listening to the tones, and monitor the reading of the monometer;

11. Note the number of appearance of the first beat of the pulse wave (corresponds to systolic blood pressure);

12. Note the disappearance of sounds (corresponds to diastolic blood pressure);

13. Release all the air from the cuff;

14. Assess the result of blood pressure height and pulse pressure;

15. Report the result to the patient;

16. Register the result (temperature sheet).

Respiratory rate counting

1. Warn the patient about the procedure;

2. Give the patient a comfortable position;

3. Take the patient’s hand as for examining the pulse;

4. Place your hand and the patient’s hand on the patient’s chest (for thoracic breathing) or epigastric region (for abdominal breathing), simulating a pulse examination;

6. Assess the frequency of respiratory movements.

7. Explain to the patient that his respiratory rate has been counted;

8. Record the data in the temperature sheet.

Body temperature measurement

Body temperature is an important indicator of our health. As soon as the thermometer crosses the 37 degree mark, it’s time to think about whether there are any problems. From time to time, the body temperature may rise slightly, but if the values are clearly above 37.2, and the temperature does not want to “fall”, and other symptoms and complaints appear, then it is time to consult a doctor. Measuring body temperature is a fairly simple process and we have all been familiar with it since childhood. Many people have a medical thermometer or a simple glass thermometer at home. It is inexpensive and quite accurate, but differs from new thermometers in the time it takes to measure temperature. New digital thermometers are already appreciated by many, especially parents with young children. This thermometer allows you to accurately and, most importantly, quickly find out the temperature. Unfortunately, if the batteries from which this miracle works medical equipment, “shattered” and require replacement, this is not always reflected in a timely manner on the thermometer itself. For this reason, thermometer readings can sometimes be incorrect, which means do not forget to compare them with the readings of a regular thermometer at least once a month. Thermometers that can measure body temperature on the forehead or ear have similar characteristics.

Most often, body temperature is measured in armpit. To do this, you need to hold the thermometer about 7 minutes. However, many doctors believe this method is not accurate enough. Another option would be to measure the temperature in oral cavity, but even here the indicators may be inaccurate and depend on breathing, eating time, or even smoking. Also, putting an old glass thermometer in your mouth can be downright dangerous, and of course this option is not suitable for children and for people with an unbalanced psyche. The most accurate option is to measure the temperature in the rectum and ear canal using a special thermometer. It should be noted that the temperature in the rectum differs from the temperature in the armpit by approximately 0,3-0,6 degrees. The temperature sheet is used in hospitals, where the patient's condition is constantly monitored. Body temperature is measured at least 2 times per day (morning and evening), and sometimes more often. The data is entered into a sheet and sometimes a graph is drawn point by point for clarity. Each such document is created for an individual patient. Additionally, data is indicated when measuring blood pressure, pulse, respiratory rate, and weight. In some cases, data is entered on the daily amount of urine and fluid consumed, etc. The temperature sheet must include the patient’s full name and card number.

62. Measuring body temperature in the armpit
(thermometry)

Target: diagnostic: determine the body temperature of an adult patient.
Indications: monitoring the functional state of the body, prevention nosocomial infection.
Contraindications: diaper rash, inflammatory processes in the axillary region, hyperemia in the axillary region.
Locations for measuring body temperature: armpits, oral cavity, inguinal folds (in children), rectum.
Prepare: medical thermometer, tray, napkins,
temperature sheet, pen with black tip, clock, temperature log, container with disinfectant solution, container for storing clean thermometers.
Action algorithm:
1. Explain to the patient the purpose and course of the procedure, obtain his consent.
2. Decontaminate your hands at a hygienic level.
3. Have the patient sit or lie down.
4. Take a thermometer, check it for integrity, look and shake it so that the mercury column drops below 35°C in the reservoir.
5. Examine the armpit: in the presence of local inflammatory processes, temperature cannot be measured (the thermometer readings will be higher than body temperature).
6. Dry the skin in the patient’s armpit with an individual napkin (wet skin distorts the thermometer readings).
7. Place the thermometer with the mercury reservoir in the armpit so that it is in full contact with the body (ask the patient to press the shoulder against the chest cage).
8. Record the time of body temperature measurement.
9. After 10 minutes, remove the thermometer and determine its readings by the height of the mercury column.
10. Record the thermometer readings in the temperature log as a digital entry and on the temperature sheet as a graphical curve (in black).
11. Communicate the measurement results to the patient.
12. Shake the used thermometer and make sure that the mercury has dropped into the reservoir.
13. Disinfect the used thermometer.
14. Rinse the thermometer under running water until the smell of the disinfectant disappears, wipe dry with a napkin, place it in a tray or container on a napkin and store dry.
15. Wash and dry your hands.
63. Determination of pulse on the radial artery

Target: determine the basic properties of the pulse, assess the state of the cardiovascular system.
Indication:
Places for pulse examination: radial artery, ulnar, carotid, temporal, popliteal, femoral, dorsum of the foot.
Heart rate parameters: rhythm, frequency, filling, tension, magnitude .
Prepare: watch (stopwatch), paper, red pen, temperature sheet.
Action algorithm:
1. Explain the procedure to the patient, obtain his consent, and find the place where the pulse is taken.
2. Give the patient a comfortable position - sitting or lying in a relaxed, comfortable position, in a calm state.

3. Decontaminate hands at a hygienic level.
4. At the same time, wrap your fingers around the patient’s wrist (in the area of the wrist joint) so that the pads of the 2nd, 3rd, and 4th fingers are on the palmar (inner) surface of the forearm in the projection of the radial artery (at the base thumb), place 1 finger on back side forearm, the radial artery is palpated between the styloid process of the radius and the tendon of the radial muscle.
5. Cover the area of the radial artery, pressing it lightly against the radius bone , determine the location of the pulsation; Feel the elastic pulsating waves associated with the movement of blood through the vessel.
6. Compare the frequency of oscillations of the artery walls on the patient’s right and left arms. Determine the symmetry of the pulse. Symmetry is the coincidence of pulse beats on both hands in terms of filling (if the pulse is symmetrical, further characteristics are given on one hand).
7. Determine the pulse rhythm.
8. Determine your heart rate.
9. Assess the filling of the pulse.
10. Determine the pulse voltage.
11. Enter the pulse study data into the temperature sheet - graphically (in red), and into the observation sheet - digitally.
12. Tell the patient the results of the study.
13. Wash and dry your hands.
Note:
- normally the pulse is rhythmic, palpable equally on both hands, its frequency in an adult at rest is 60-80 beats per minute;
- pulse rhythm is determined by the intervals between pulse waves. If pulse oscillations of the artery wall occur at regular intervals, then the pulse is rhythmic. In case of rhythm disturbances, an incorrect alternation of pulse waves is observed - an irregular pulse.
- determining the pulse rate (if the pulse is rhythmic) count the number of pulse waves (beats) for 1 minute, keeping track of the time on a watch with a stopwatch.
- PS is normal - 60 - 80 beats per minute.
PS > 80 beats per minute - rapid - tachycardia.
PS< 60 ударов в одну минуту - уреженный - брадикардия.

Assess the filling of the pulse by the degree of filling of the arteries with blood, depending on the systolic volume of the heart. They are distinguished: the pulse is full, empty, thread-like.
- pulse tension - determined by the force with which it is necessary to press the radial artery to the radial bone until the pulse disappears.
There are: pulse of satisfactory tension, tense (hard), relaxed (soft).
64. Blood pressure measurement

Target: determination of blood pressure indicators and assessment of study results, determination of functional features of cardio-vascular system.
Indications: monitoring the patient's condition.
Possible complications: painful sensations in the limb due to prolonged compression of the artery.
Prepare: tonometer, phonendoscope, paper, pen, temperature sheet .
Action algorithm:
1. Explain to the patient the purpose of the procedure, find out whether such a procedure has been performed before, what the results were, whether the patient knows how to behave, what sensations may be.
2. Place the patient in a comfortable position, sitting or lying in a calm, relaxed position, with the patient’s arm in an extended position (palm up) at the same level as the device.
Blood pressure is usually measured 1-2 times at intervals of 2-4 minutes.
3. Place the tonometer cuff on the patient’s bare shoulder 2-3 cm above the elbow at the level of his heart so that one finger fits between them; firmly secure the cuff on the shoulder without squeezing the soft tissues using a fastener (hook, adhesive tape).
4. Connect the pressure gauge to the cuff, securing it to the cuff, check the position of the arrow (mercury column) relative to the zero mark of the scale.
5. Determine the pulse in the ulnar artery in the area of the ulnar fossa by placing a phonendoscope in this place (the pressure of the phonendoscope head must be moderate, otherwise the data will be distorted).
6. Close the valve on the bulb and pump air into the cuff with a balloon until the pulsation in the ulnar artery disappears and until the pressure gauge readings are 20 - 30 mmHg above normal (or for the given patient).

7. Open the valve and slowly release air from the cuff, watch the speed at which the column lowers or the arrow moves
- indicators can change at a rate of 2 mmHg/s: at the same time, carefully listen to the sounds in the artery and monitor the readings of the pressure gauge.
8. Note the pressure gauge readings at the moment the first sounds (tones) appear (the blood pressure value at the moment heart rate- systolic blood pressure) and at the moment of disappearance of sounds (blood pressure at the moment of heart relaxation - diastolic blood pressure); release the air from the cuff completely.
9. Remove the tonometer cuff from the patient’s arm and place it in the case.
10. Record the data in the form of a digital record on an observation sheet in the form of a fraction (systolic pressure in the numerator, diastolic pressure in the denominator) and a temperature sheet.
11. Repeat the procedure, compare the data obtained.
12. Disinfect the phonendoscope head by wiping it twice with 70% alcohol.
13. Tell the patient the result of the blood pressure measurement.
Note:
- blood pressure is measured on both arms, and the resulting numbers are compared.
- blood pressure can be measured by the patient himself; teach him the rules for measuring blood pressure and interpreting the data obtained.
- normal blood pressure 120/80 mm Hg, 130/85 mm Hg.
- arterial hypotension 90/60 mmHg
- arterial hypertension 140/90 mmHg
65. Counting the frequency of respiratory movements

Target: assessment of the patient's condition.
Indication: assessment of the functional state of the respiratory organs.
Prepare: clock with second hand, temperature sheet, pen with
blue rod.
Action algorithm:
1. Explain the procedure to the patient and obtain his consent.
2. Decontaminate hands at a hygienic level.
3. Place the patient in a comfortable position (lying down). You need to see top part his chest cage and belly.
4. With one hand, grasp the patient's arm as for examining the radial pulse to distract his attention.
5. Place your and the patient’s hand on the chest (for thoracic breathing) or on the epigastric region (for abdominal breathing) of the patient.
6. Count the number of breathing movements in one minute, using a stopwatch (inhalation and exhalation is one breathing movement).

7. Assess the respiratory rate.
8. Explain to the patient that his respiratory rate has been calculated and report the results.
9. Wash and dry your hands.
10. Record the data on the temperature sheet.
Note:
- counting the frequency of respiratory movements is carried out unnoticed by the patient;
- the number of respiratory movements in 1 minute is called the respiratory frequency (RR),
- in a healthy adult, the normal respiratory rate at rest is 16-20 per minute;
- NPV relates to heart rate on average as 1:4;
- with an increase in body temperature by 1°C, respiratory rate increases by 4 respiratory movements;
- bradypnea - rare breathing with a frequency of less than 16 per minute;
- tachypnea - rapid breathing with a frequency of more than 20 per minute.
66. Determination and accounting of water balance

Target: determination of hidden edema, monitoring of their dynamics and the effectiveness of diuretics.
Prepare: measuring glass graduated container for liquid and for collecting the night with a volume of 3 l., 0.5 l., water balance sheet, pen, temperature sheet.
Action algorithm:
1. Provide the patient with measuring containers for drinking and for overnight collection.
2. Explain to the patient the purpose and technique of the procedure. The patient must collect urine in a 3-liter container during the day and at the same time keep a record of the amount of fluid drunk and administered.
3. Explain to the patient about the need to adhere to the usual water, food and physical regime.
4. Give detailed information to the patient about the order of entries in the water balance sheet. Make sure you know how to fill out the sheet.
5. Explain to the patient that at 6 o'clock in the morning it is necessary to release urine into the toilet.
6. Collect subsequent portions of urine during the day in 3 liters. graduated capacity up to 600 am next day inclusive.
7. Determine the total amount of night in a measuring container. It will be
daily diuresis.
8. Record the amount of liquid released on the record sheet.

Excreted liquid

9. Record the amount of fluid you drink and inject into your body on a record sheet.

Injected liquid

10. At 6:00 am the next day, the patient hands over the record sheet to the nurse.

The difference between the amount of fluid you drink and the daily amount at night is the amount of water balance in the body.
The nurse should:
- Ensure that the patient can perform a fluid count.
- Ensure that the patient has not taken diuretics within 3 days before the study.
- Tell the patient how much fluid should be excreted in the urine normally.
- Explain to the patient the approximate percentage of water in food to facilitate accounting for the administered fluid (not only the water content in the food is taken into account, but also the administered parenteral solutions).
- Solid foods can contain between 60 and 80% water.
- Not only urine, but also vomit and feces of the patient are taken into account.
- The nurse calculates the amount of input and output per night.
The percentage of fluid excreted is determined (80% of the normal amount of fluid excreted).
amount of urine excreted x 100

Excretion percentage =
amount of fluid administered

Calculate water balance using the following formula:
multiply the total amount of urine excreted per day by 0.8 (80%) = the amount of night that should be excreted normally.

Compare the amount of fluid released with the amount of normal fluid calculated.
- Water balance is considered negative if less fluid is released than calculated.
- The water balance is considered positive if more fluid is released than calculated.
- Make entries on the water balance sheet and evaluate it.
Result evaluation:

80% - 5-10% - excretion rate (-10-15% - in the hot season; +10-15%
- in cold weather;
- positive water balance (>90%) indicates the effectiveness of treatment and resolution of edema (reaction to diuretics or fasting diets);
- negative water balance (10%) indicates an increase in edema or ineffectiveness of the dose of diuretics.
Feeding the patient.

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Slide captions:

Assessment of functional state Teacher Levkovskaya E.N. Federal State Kazan Military Educational Institution of Higher Education vocational education“Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation

Concepts and terms Blood pressure is the pressure that the blood in the artery exerts on its wall. Bradycardia - heart rate less than 60 per minute. Hyperemia - redness. Fever is a protective-adaptive reaction of the body to the effects of pyrogenic substances, expressed by a temporary restructuring of heat exchange to maintain a higher level than normal. Heat content and body temperature.

Thermometry

Pulse - periodic jerky oscillations of the walls blood vessels associated with changes in their blood supply and pressure dynamics in them during one cardiac cycle. Tachycardia – heart rate more than 100 per minute. Thermometry - measuring body temperature. Ovulation is the rupture of the ovarian follicle and the release of a mature egg into the abdominal cavity.

Body temperature Thermoregulation – totality physiological processes, ensuring the maintenance optimal temperature bodies. Vascular thermoregulation - carried out due to the narrowing or expansion of the lumen of blood vessels. Physical thermoregulation is carried out by changing the heat transfer of the body. Chemical thermoregulation is carried out by changing heat production in the tissues of the body.

Body temperature healthy person during the day it is subject to fluctuations, but does not exceed 37˚С. In the armpit the temperature is 36.4 -36.8 ˚С. A temperature of 43 ˚C is the maximum (lethal), at which irreversible changes occur at the cellular level, metabolism is disrupted and death occurs. The minimum body temperature at which irreversible processes are also observed is 23-15 ˚С. Physiological fluctuations in body temperature during the day for the same person are 0.3-0.5 ˚С

In the elderly and old age the temperature is often lowered (subnormal). The mechanisms of thermoregulation in children are imperfect, and metabolic processes proceed more intensely, due to this there is instability in body temperature with large fluctuations during the day. In newborn children, the temperature in the armpit is 37.2 °C. In the rectum, vagina, and oral cavity it is 0.2-0.4 °C higher than in the armpit. In women, body temperature depends on the phase menstrual cycle: during the period of ovulation it increases by 0.6-0.8 ˚С. Body temperature rises with intense physical and emotional stress and food intake. With depression, the temperature drops.

Measuring body temperature Thermometry is a set of methods and methods for measuring temperature. Using thermometry, febrile and hypothermic conditions are recognized. Basal temperature(normal state) - body temperature measured in the morning after sleep before eating; used in studying the dynamics of body temperature. Temperature is measured: - in the armpit. -in the groin fold. - oral cavity. - rectum. -vagina.

Contact measurement methods: -mercury thermometer, -electronic digital thermometers. -infrared thermometer (for the ear). - liquid crystal thermometer. Non-contact - transfer of heat to a device by radiation through an intermediate medium, usually air.

Medical thermometers

Infrared thermometer "Kelvin-Compact 201 (M1)" A non-contact infrared thermometer allows you to measure temperature without touching the human body. You just need to point it at the object and hold it in front of the patient’s forehead for 1 second, after which the thermometer will report the temperature. When identifying elevated temperature the device emits a beep.

When measuring body temperature in the armpit or groin fold, the skin should first be wiped dry. Before insertion into the rectum, the thermometer is lubricated with Vaseline. The duration of temperature measurement in the armpit is approximately 10 minutes. In the rectum for 1-2 minutes, insert the thermometer to a depth of 2 cm. Measure twice a day (7-8 a.m. and 5-7 p.m.). If necessary, temperature measurements are carried out every 2 or 4 hours. The thermometer readings are noted on a temperature sheet (at home on a regular sheet).

Temperature sheet

The highest temperature during the day is observed between 17-21 hours, and the lowest - between 3-6 hours in the morning. The temperature difference in healthy people does not exceed 0.6 ˚С. The normal temperature in the oral cavity is 36.0-37.3 ˚С (average 36.8 ˚С). The thermometer is placed under the tongue to the right or left of the frenulum and the mouth is kept closed. Measurement duration 3 min. This method is not used in children under 4 years of age or in excitable children.

Types of fevers According to the degree of increase in t˚: - subfebrile (from 37-38˚С); - febrile (moderate) from 38 to 39 ˚С; -high from 39 to 41 ˚С; - hyperpiritic (excessive) over 41 ˚С According to the duration of the course: - acute (up to 2 weeks); - subacute (up to six weeks). By types of curves: - constant; - laxative (remitting); - intermittent (intermittent); perverted; g ectic (depleting); incorrect; -wavy.

Fever has three stages in its development. Stage I - a gradual rise, accompanied by sharp chills, blue lips, limbs, headache, feeling unwell. Stage II is characterized by a maximum increase in temperature, accompanied by headache, dry mouth, flushing of the face and skin, delirium, and hallucinations. Stage III occurs in different ways: in some diseases, a critical (sharp) or lytic (gradual) drop in temperature is observed.

Figure 1-9. Different types of temperature curves. Fig. 1-7 Fever: Fig. 1 - constant; rice. 2 - laxative; rice. 3- intermittent; rice. 4. - hectic; rice. 5 - return; Fig 6 - wavy; rice. 7 is incorrect. Rice. 8. Crisis. Rice. 9. Lysis.

Character of temperature curves Persistent fever characterized by high temperature; fluctuations between morning and evening temperatures do not exceed 1° C (occurs when lobar inflammation lungs, typhoid fever). With a laxative, remitting fever, the difference between morning and evening temperatures is within 2-3 ° C, and the morning temperature does not reach the norm (in case of purulent diseases, focal pneumonia). In the case of intermittent, intermittent fever, the difference between morning and evening temperatures lies within 2-2.5 ° C, morning temperatures are below 37 ° C (this happens, for example, with malaria). If debilitating, or hectic, fever develops, temperature fluctuations reach 2-4 ° C during the day (with sepsis, severe pulmonary tuberculosis, etc.). A rise in temperature is accompanied by chills, and a fall is accompanied by profuse sweating. This temperature is very debilitating for the patient. Undulating fever is characterized by a gradual rise in temperature, and then the same gradual descent, after which a few days later it begins to rise again (occurs in brucellosis, lymphogranulomatosis). With relapsing fever, periods of increased temperature are replaced by its normalization, after which a new rise is noted (characteristic of relapsing fever). In perverted fever, the evening temperature is lower than the morning temperature.

Rice. 19. Temperature curves during fever: a - constant; b - laxative; c - intermittent; g - depleting; d - wavy; e - returnable.

Pulse study

Examination of the venous arterial pulse - rhythmic oscillations of the artery wall. Caused by the release of blood into the arterial system during one cardiac cycle. They are distinguished: - central (on the aorta, carotid and femoral arteries); -peripheral (on the radial artery, dorsal artery of the foot, etc.) capillary Determination of the capillary pulse in the nail bed area

Determination of pulse for diagnostic purposes: - sleepy; -temporal; -femoral; -brachial; - popliteal; -posterior tibial artery.

The nature of the pulse depends on the size and speed of blood ejection from the heart. So it depends on the condition of the artery wall, primarily on its elasticity. More often the pulse is examined on the radial artery.

Pulse rate per minute Newborns 140- 160 1 year 120 5 years 100 10 years 90 12- 13 years 80- 70

Properties of the pulse Frequency Pulse frequency is a value that reflects the number of oscillations of the artery walls per unit of time. Depending on the frequency, the pulse is distinguished: moderate frequency - 60-90 beats/min; rare (pulsus frequens) - less than 60 beats/min; frequent (pulsus rarus) - more than 90 beats/min. Rhythmicity Pulse rhythmicity is a value that characterizes the intervals between successive pulse waves. Based on this indicator, they distinguish: rhythmic pulse (pulsus regularis) - if the intervals between pulse waves are the same; arrhythmic pulse (pulsus irregularis) - if they are different.

Filling Pulse filling is the volume of blood in the artery at the height of the pulse wave. There are: moderate filling pulse; full pulse (pulsus plenus) - filling the pulse above normal; empty pulse (pulsus vacuus) - poorly palpable; thread-like pulse (pulsus filliformis) - barely noticeable. Tension Pulse tension is characterized by the force that must be applied to completely compress the artery. There are: pulse of moderate tension; hard pulse (pulsus durus); soft pulse (pulsus mollis).

Height (magnitude) The height of the pulse is the amplitude of oscillations of the arterial wall, determined on the basis of a total assessment of the tension and filling of the pulse. There are: a pulse of moderate height; high pulse(pulsus magnus) - high amplitude; small pulse (pulsus parvus) - low amplitude. The shape of the pulse depends on the rate of change in pressure in the arterial system during systole and diastole. When the increase in the pulse wave accelerates, the pulse acquires a jumping character and is called fast (p. seler); when the increase in the pulse wave slows down, the pulse is called slow (p. tardus).

Types of pulse. D - diastole; C - systole.

Arterial pressure

Blood pressure Blood pressure - which is formed in the arterial system of the body during heart contractions. Its level is influenced by the magnitude and speed of cardiac output, frequency and rhythm of heart contractions, peripheral resistance artery walls. The blood pressure that occurs in the arteries at the moment of maximum rise of the pulse wave after ventricular systole is called systolic. The pressure maintained in the arterial vessels in diastole due to their tone is called diastolic. The difference between systolic and diastolic pressure is called pulse pressure.

CLASSIFICATION OF BP LEVELS BP GARDEN (mm Hg. Art.) DBP (mm Hg. Art.) Optimal 120 80 Normal 130 85 High normal 130-139 85-89 1st degree of increase 140-159 90-99 2nd degree of increase 160-179 100 -109 3rd degree increase >180 >110

Tonometers

Blood pressure measurement 1-tonometer cuff 2-stethoscope

Sphygmomanometer (tonometer) is a device for measuring blood pressure. It consists of a cuff that is placed on the patient's arm, a device for inflating air into the cuff, and a pressure gauge that measures the air pressure in the cuff. Also, the sphygmomanometer is equipped with either a stethoscope or electronic device, registering air pulsations in the cuff. The method of recording blood pressure, which underlies the operation of the tonometer, was invented in 1881 by the German physicist Siegfried Karl Ritter von Basch (in German), improved to a safe one for the patient by Scipione Riva-Rocci (in Italian) in 1896. Both inventions used measurement using a mercury manometer, in 1905 the Russian surgeon N.S. Korotkov improved the measurement to modern look, with pressure assessment using the sound method.

The cuff of the device must correspond to the length and circumference of the shoulder. The width of the shoulder cuff for newborns should be 2.5-4 cm, length 5-10 cm, for infants 6-8 and 12-13 cm, for preschoolers 9-10 and 17-22 cm, respectively. For schoolchildren, a standard cuff with a width of 12-13 cm and a length of 22-23 cm can be used. It should be remembered that using a disproportionately large cuff gives values lower than the true ones, and a small one will overestimate the measurement results. The patient should not drink coffee at least 1 hour before the blood pressure measurement procedure and refrain from smoking for at least 15 minutes before the test. Also, ensure that the patient does not take adrenergic stimulating drugs on the day of the study.

Blood pressure is measured 2-3 times at intervals of 1-2 minutes, the air from the cuff is completely released each time. Digital recording of blood pressure in the form of a fraction, recorded in the temperature sheet in the form of a column, upper limit means systolic pressure, lower - diastolic pressure (for example: 120/80).

Rules for measuring blood pressure

Method of measuring blood pressure (BP) The blood pressure on the brachial artery is determined with the patient lying on his back or sitting in a comfortable position. The cuff is placed on the shoulder at the level of the heart, its lower edge 2 cm above the elbow. The cuff should be sized to cover 2/3 of the biceps. The cuff bladder is considered long enough if it surrounds more than 80% of the arm and the width of the bladder is at least 40% of the arm circumference. Therefore, if blood pressure measurement is carried out in an obese patient, then it is necessary to use a cuff bigger size. After putting on the cuff, it is pressurized to values higher than expected systolic pressure. Then the pressure is gradually reduced (at a rate of 2 mmHg/sec), and using a phonendoscope, heart sounds are heard over the brachial artery of the same arm. Do not apply too much pressure to the artery with the membrane of the phonendoscope. The pressure at which the first heart sound will be heard is systolic blood pressure. The pressure at which heart sounds can no longer be heard is called diastolic blood pressure. The same principles are used when measuring blood pressure in the forearm (tones are heard on the radial artery) and thigh (tones are heard on the popliteal artery). Blood pressure is measured three times, with an interval of 1–3 minutes, on both arms. If the first two blood pressure measurements differ from each other by no more than 5 mmHg. Art., measurements should be stopped and the average value of these values is taken as the blood pressure level.

If there is a difference of more than 5 mm Hg. Art., a third measurement is carried out, which is compared with the second, and then (if necessary) a fourth measurement is performed. If the tones are very weak, you should raise your hand and perform several squeezing movements with the hand, then the measurement is repeated. In patients over 65 years of age, with diabetes mellitus, and in those receiving antihypertensive therapy, blood pressure should also be measured after 2 minutes of standing. Patients with vascular pathology (for example, with atherosclerosis of the arteries of the lower extremities) are advised to determine blood pressure in both upper and lower extremities. For this purpose, blood pressure is measured not only on the brachial, but also on the femoral arteries with the patient in the prone position (the artery is heard in the popliteal fossa).

RESPIRATORY RATE

NPV is a dynamic indicator of pulmonary ventilation. This indicator is expressed as the number of cycles of respiratory movements per unit of time. Watching your breath Special attention attention should be paid to changing the color of the skin, determining the frequency, rhythm, depth of respiratory movements and assessing the type of breathing. The respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths in 1 minute is called the respiratory rate (RR). In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute; in women it is 2-4 breaths more than in men. NPV depends not only on gender, but also on body position, state of the nervous system, age, body temperature, etc. Observation of breathing should be carried out unnoticed by the patient, since he can arbitrarily change the frequency, rhythm, and depth of breathing. NPV is related to heart rate on average as 1:4. When body temperature increases by 1°C, breathing becomes more frequent by an average of 4 respiratory movements. .

There is a distinction between shallow and deep breathing. Shallow breathing may be inaudible at a distance or slightly audible. It is often combined with a pathological increase in breathing. Deep breathing, audible from a distance, is most often associated with a pathological decrease in breathing. Physiological types of breathing include thoracic, abdominal and mixed type. In women, thoracic breathing is more common; in men, abdominal breathing is more common. At mixed type breathing occurs uniform expansion of the chest of all parts of the lung in all directions. Types of breathing are developed depending on the influence of both external and internal environment body. When the rhythm and depth of breathing is disturbed, shortness of breath occurs. There is inspiratory dyspnea - this is breathing with difficulty inhaling; expiratory - breathing with difficulty exhaling; and mixed - breathing with difficulty inhaling and exhaling. Rapidly developing severe shortness of breath is called suffocation.

Pathological types of breathing ■ large Kussmaul breathing - rare, deep, noisy, observed in deep coma (prolonged loss of consciousness); ■ Biotta breathing - periodic breathing, in which there is a correct alternation of periods of superficial respiratory movements and pauses of equal duration (from several minutes to a minute); ■ Cheyne-Stokes breathing - characterized by a period of increasing frequency and depth of breathing, which reaches a maximum on the 5-7th breath, followed by a period of decreasing frequency and depth of breathing and another long pause of equal duration (from several seconds to 1 minute). During a pause, patients are poorly oriented environment or lose consciousness, which is restored when breathing movements resume. Asphyxia is the cessation of breathing due to the cessation of oxygen supply. Asthma is an attack of suffocation or shortness of breath of pulmonary or cardiac origin.

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Federal State Kazan Military Educational Institution of Higher Professional Education “Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation Teacher:. Levkovskaya E.N. Fundamentals of movement ergonomics.

Fundamentals of movement ergonomics. The concept of the medical and protective regime of health care facilities. Elements of the medical and protective regime. The importance of the therapeutic and protective regime. Types of physical activity of the patient. Safety nurse. The concept of ergonomics. Basic rules for moving a patient, means of small-scale mechanization.

The therapeutic and protective regime in medical institutions provides for the creation of optimal conditions for the patient’s recovery. The medical and protective regime includes a certain organization of the patient’s day - a schedule for performing therapeutic and diagnostic measures, diet, sleep, communication with visitors, etc. In addition, the medical and protective regime includes creating in the patient a certain psychological mood for recovery, improvement of the condition, overcoming health problems. Therefore, staff are advised to show kindness to patients, speak in a calm, quiet voice, and observe, if possible, the daily routine established for them. Patients suffering from serious illnesses or on strict bed rest or bed rest are recommended to be placed in separate rooms or fenced off with a screen while hygiene measures and physiological functions are carried out. This is necessary for the comfortable well-being of the patient and the people around him.

Depending on the patient’s condition, he may be prescribed different kinds regime - general, semi-bed, bed, strict bed. Ward (semi-bed) rest is recommended if it is necessary to gradually increase physical activity. A patient on a ward basis is allowed to sit for half of the day, and can walk around the ward several times a day.

Strict bed rest recommended to provide the patient with maximum peace. With it, the patient is constantly either in a horizontal position on his back or in a semi-sitting position with the head of the bed raised. A patient who has been assigned to strict bed rest is not allowed to independently change body position or make movements. large joints. This patient needs complete care(All hygiene procedures, feeding, assistance with physiological functions is provided by a nurse).

Bed rest is indicated when the patient's health allows him to slightly intensify his movements. Such a patient spends most of his time in a horizontal or sitting position with the head of the bed raised. At the same time, he is allowed to move his limbs, turn in bed, and also wash and eat independently. However, the patient needs to be helped while eating, feeding a bedpan, changing bed and underwear, and much more.

Free (general) mode is indicated if it is necessary to increase physical activity. With this regimen, the patient spends most of his time out of bed, goes outside the ward, and is allowed to walk fresh air. However, the patient spends his quiet time lying in bed. In sanatorium-type medical institutions there are three types of general regime: Gentle regime in terms of level physical activity corresponds to the general regime in a hospital. Patients are allowed to walk on the territory of the sanatorium, but a certain part of the daytime must be spent in a sitting position and relative peace. The gentle training regime involves the patient’s participation in excursions and mass cultural events, and he is allowed longer walks in the vicinity of the sanatorium. The training mode allows for significantly longer walks and active participation in any activities.

The medical and protective regime includes the following elements: transformation of the external hospital environment; prolongation of physiological sleep; protecting the patient from negative emotions and pain; combination of rest mode with physical activity(hygienic and therapeutic exercises) and raising the general neuropsychic tone.

Transforming the external hospital environment begins with creating a cozy environment: snow-white bed sheets, walls painted in light soft colors, paintings with life-affirming content. All visual irritants that can produce a depressing impression on patients (frightening posters, anatomical preparations in jars, temperature sheets, etc.) must be eliminated. It is necessary to combat unpleasant hospital odors with the help of increased ventilation, by using deodorizing agents, using vessels with lids for purulent waste dressings, feces, urine, etc. For the same purpose, garden flowers should be placed in the wards and corridors. Noise control is extremely important in transforming the hospital environment. All staff must speak quietly, telephones are installed away from the wards, sound alarms are replaced with light ones, rubber hoses are put on water taps, staff walk only in slippers, and paths are laid out in the corridors and wards. Furniture legs are equipped with rubber caps and ball bearings, door hinges are thoroughly lubricated, and contacting surfaces are covered with rubber.

Nurse's work safety: General safety requirements 1.1. Persons who have passed a medical commission and instructions on labor protection in the workplace are allowed to work as a nurse. 1.2. The nurse must be provided with special clothing and personal protective equipment in accordance with the standard standards for the free issuance of special clothing and safety footwear. 1.3. The nurse must comply with: internal regulations; fire safety rules; work and rest schedule. 1.4. When working for a nurse, exposure to the following dangerous factors is possible: - thermal burns due to careless use of an alcohol lamp; - chemical burns when solutions of acids and alkalis come into contact with the skin or eyes; - cuts on hands. 1.5. Observe the rules of personal hygiene. 1.4. Use as intended and treat the issued PPE with care.

Safety requirements before starting work 2.1. Properly wear the required clean, serviceable overalls and safety shoes. Overalls should not have developing ends; sleeves and collars should be tied. 2.2. Prepare working tools, 2.3. Check the sufficiency of lighting of passages and corridors. Safety requirements during operation 3.1. Be attentive, do not be distracted by extraneous matters or conversations. 3.2. The endoscopy room must be kept spotlessly clean. 3.3. Monitor the integrity of glassware and glassware; do not wash them if their integrity is damaged. 3.4. When operating instruments and apparatus, it is necessary to strictly follow the rules (instructions) set out in the technical data sheet attached to the instruments and equipment. 3.5. The metal casings of all electrical appliances must be grounded.

3.6. If there is a power outage, all appliances must be turned off. 3.7. When working with a solution of chloramine, bleach, use rubber gloves. 3.8. When washing dishes from acids and alkalis, use protective rubber gloves. 3.9. When working with electrical appliances: do not work with faulty electrical appliances; do not repair faulty devices; do not turn electrical appliances on or off with wet hands; When working with a drying cabinet, do not load or unload dishes without first turning off the drying cabinet. 3.10. Follow the rules for using gas appliances. 3.11. It is allowed to carry a load of no more than 10 kg. 3.12. Bottles with acids and alkalis should be carried by two people in special boxes or baskets, after first checking the serviceability of the container. 3.13. Place contaminated rags and rags in a specially designated place or take them outside into a special container.

Safety requirements in emergency situations At chemical burn it is necessary to rinse the affected area with plenty of running water cold water from under a tap or bucket for 15-20 minutes. In case of a chemical burn, it is not possible to completely wash away the chemicals with water. Therefore, after washing, the affected area must be treated with a solution baking soda(a teaspoon of baking soda per glass of water). If splashes of alkali or vapors get into the eyes or mouth, rinse the affected areas with plenty of water and then with a solution boric acid(half a teaspoon of acid per glass of water). After treatment, call an ambulance. 5. Safety requirements upon completion of work 5.1. Walk around your area, check the cleanliness and order. 5.2. Hang overalls in a separate locker. 5.3. Wash your face and hands with warm water and soap.

Ergonomics (from the Greek ergon - “work”, nomos - “law”) is a group of sciences that study human behavior in a production environment and optimize working conditions. You should never lift a person who cannot make the task much easier for you, unless he is light enough and someone else can help you. When lifting a patient or performing other care work, keep your back as straight as possible. Never attempt to lift or move a patient with outstretched arms. Know your limits and never try to exceed them. If the situation worsens, let your doctor know.

Assessment of the patient’s general condition includes such concepts as the state of consciousness, the patient’s position in bed, the condition of the skin and mucous membranes, the concept of pulse, blood pressure and respiration.

Assessment of the state of consciousness, types of consciousness.

There are several states of consciousness: clear, stupor, stupor, coma.

Stupor (numbness) is a state of stunning. The patient is poorly oriented in the surrounding environment, answers questions sluggishly, late, and the answers are meaningless.

Stupor (subcoma) - a state of hibernation. If the patient is brought out of this state by a loud response or inhibition, he may answer the question and then fall back into deep sleep.

Coma (complete loss of consciousness) is associated with damage to the center of the brain. In coma, muscle relaxation, loss of sensitivity and reflexes are observed, and there are no reactions to any stimuli (light, pain, sound). Coma may occur with diabetes mellitus, cerebral hemorrhage, poisoning, severe liver damage, renal failure.

In some diseases, disorders of consciousness are observed, which are based on excitation of the central nervous system. These include delusions and hallucinations (auditory and visual).

Assessment of the patient's activity regime, types of position.

Types of position of the patient in bed.

1. active position - they call this position when the patient is able to independently turn around, sit down, stand up, and serve himself.
2. passive position - the position is called when the patient is very weak, exhausted, in unconscious, is usually in bed and cannot change his position without assistance.
3. forced position - a position in bed that the patient himself takes to alleviate his suffering, reduce painful symptoms (cough, pain, shortness of breath). In patients suffering from pericardial effusion, the patient's pain and breathing are relieved in the knee-elbow position. With heart disease, the patient, due to shortness of breath, tends to take a sitting position with his legs dangling.

Assessment of the condition of the skin and mucous membranes.

Examination of the skin allows you to: identify changes in color, pigmentation, peeling, rash, scars, hemorrhage, bedsores, etc.

Changes in skin color depend on the thickness of the skin and the lumen of skin blood vessels. The color of the skin may change due to the deposition of pigments in its thickness.

1. pallor of the skin and mucous membranes can be permanent or temporary. Paleness may be associated with chronic and acute blood loss (uterine bleeding, peptic ulcer), may be due to anemia, fainting. Temporary pallor can occur due to spasm of skin vessels during fright, cold, or chills.
2. abnormal redness of the skin depends on the expansion and overflow of small vessels of the skin with blood (observed during mental excitement). The red color of the skin in some patients depends on a large number of red blood cells and hemoglobin in the blood (polycythemia).
3. cyanosis - bluish-violet coloring of the skin and mucous membranes is associated with an excessive increase in carbon dioxide in the blood and a lack of oxygen saturation. There are general and local. The general one develops with cardiac and pulmonary insufficiency; some congenital defects hearts when part venous blood, bypasses the lungs, mixes with the arterial; in case of poisoning with poisons (Berthollet salt, aniline, nitrobenzlol), which convert hemoglobin into methemoglobin; in many lung diseases due to the death of their capillaries (pneumosclerosis, pulmonary emphysema). Local - developing in individual areas, may depend on blockage or compression of the veins, often due to thrombophlebitis.
4. jaundice - coloring of the skin and mucous membranes due to the deposition of bile pigments in them. With jaundice, there is always a yellow discoloration of the sclera and hard palate, which distinguishes it from yellowing of other origins (tanning, use of quinine). Jaundice discoloration of the skin is observed when there is an excess content of bile pigments in the blood. There are the following forms of jaundice:
- a) subhepatic (mechanical) - in case of disruption of the normal outflow of bile from the liver into the intestine along the bile duct when it is blocked gallstone or a tumor, with adhesions and inflammatory changes in the bile ducts;
- b) hepatic - if the bile formed in the cell enters not only the bile ducts, but also the blood vessels;
- c) suprahepatic (hemolytic) - as a result of excessive formation of bile pigments in the body due to significant breakdown of red blood cells (hemolysis), when a lot of hemoglobin is released, due to which bilirubin is formed.
5. bronze - or dark brown, characteristic of Addison's disease (with a lack of adrenal cortex function).

Increased pigmentation can cause changes in skin color. Pigmentation can be local or general. Sometimes the skin has limited areas of pigmentation - freckles, birthmarks. Albinism is called partial or complete absence pigmentation, the lack of pigmentation in certain areas of the skin is called vitiligo.

Skin rashes - the most characteristic rashes occur with skin and acute infectious diseases.

Skin moisture depends on sweating. Increased humidity is observed in rheumatism, tuberculosis, and diffuse toxic goiter. Dryness - with myxedema, diabetes mellitus and diabetes insipidus, diarrhea, general exhaustion.

Skin turgor - its tension, elasticity. Depends on the content of intracellular fluid, blood, lymph and the degree of development of subcutaneous fat.

Pulse and its characteristics.

Arterial pulse is a rhythmic oscillation of the arterial wall caused by the release of blood into the arterial system during one heartbeat. There are central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

Most often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radius and the tendon of the internal radial muscle.

When examining the arterial pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse depends on the elasticity of the artery wall.

Frequency is the number of pulse waves per minute. Normally, an adult's heart rate is 60-80 beats per minute. An increased heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asisitole. With increased body temperature at HS, the pulse increases in adults by 8-10 beats per minute.

The pulse rhythm is determined by the interval between pulse waves. If they are the same, the pulse is rhythmic (correct); if they are different, the pulse is arrhythmic (incorrect). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals. If there is a difference between the number of heart contractions and pulse waves, then this condition is called pulse deficiency (with atrial fibrillation). The counting is carried out by two people: one counts the pulse, the other listens to heart sounds.

Pulse filling is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then a normal pulse is felt (full); if not, then the pulse is empty.

Pulse voltage depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. At high blood pressure, the artery is compressed by strong pressure; such a pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

At low pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).

An empty, relaxed pulse is called a small filamentous pulse.

Pulse study data is recorded in two ways: digitally - in medical documentation, journals, and graphically - in the temperature sheet with a red pencil in the column “P” (pulse). It is important to determine the division value on the temperature sheet.

Calculation of the arterial pulse on the radial artery and determination of its properties. arterial comatose patient pulse

The places where the pulse can be felt are the temporal, carotid, radial, femoral, and popliteal arteries.

Prepare: stopwatch.

Algorithm of actions:

1. Place the patient in a comfortable position
2. Grasp the patient's hand right hand in the area of the wrist joint
3. Feel the pulsating radial artery on the palmar surface of the forearm, at the base of 1 finger.
4. Press the artery (not too much) with 2,3,4 fingers
5. Count the number of pulse beats in 1 minute - this is the pulse rate
6. Determine the pulse voltage - the force required to stop pulsation by pressing on the artery wall.
7. Determine the filling of the pulse - if the filling is good, a clear pulse wave can be felt under the finger; if the filling is poor, the pulse wave is not clear, poorly distinguishable.

Poor filling of the pulse (“thread-like pulse”) indicates a weakening of the heart muscle. Tell your doctor immediately!

Determination of blood pressure.

Blood pressure is the pressure that blood exerts on the wall of the arteries. It depends on the strength of heart contraction and the tone of the arterial wall. There are systolic, diastolic and pulse pressure.

Systolic is the pressure during systole of the heart, diastolic pressure at the end of diastole of the heart.

The difference between systolic and diastolic pressure is called pulse pressure.

The normal pressure level depends on age and ranges from 140/90 to 110/70 mmHg for an adult.

An increase in blood pressure is called hypertension (hypertension); a decrease in blood pressure is called hypotension (hypotension).

Blood pressure is usually measured once a day (more often if necessary) and noted digitally or graphically on the temperature sheet.

The measurement is carried out with a tonometer, which consists of a pressure gauge with a rubber bulb and a cuff.

Indications:

1. Assessment of general condition;
2. Diagnosis of cardiovascular and other diseases;

Prepare: phonendoscope, tonometer.

Technique:

1. Make the patient sit or lie down and reassure him.
2. expose the upper limb.
3. Apply the cuff 3-5cm. above the elbow.
4. Place the phonendoscope on the elbow bend and feel the pulsation.
5. Pump air using a bulb until the pulsation disappears (20-30 mmHg above the patient’s normal blood pressure).
6. Gradually reduce the pressure in the cuff by slightly opening the bulb valve.
7. When the first sound appears, remember the number on the pressure gauge scale - systolic pressure.
8. Continue to release air from the balloon evenly.
9. Note the number on the pressure gauge scale at the last perceptible sound - diastolic pressure.
10. Repeat the blood pressure measurement 2-3 times on one limb and take the arithmetic average.
11. A digital recording of blood pressure is made in the medical history, and a graphic recording is made in the temperature sheet.

Observation of breathing.

When observing breathing, special attention should be paid to changes in skin color, determining the frequency, rhythm, depth of respiratory movements and assessing the types of breathing.

Breathing movements are carried out by alternating inhalation and exhalation. The amount of breathing in 1 minute is called the respiratory rate (RR).

In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute; in women it is 2-4 breaths more than in men. NPV depends not only on gender, but also on body position, state of the nervous system, age, body temperature, etc.

Observation of breathing should be carried out unnoticed by the patient, since he can arbitrarily change the frequency, rhythm, and depth of breathing. NPV is related to heart rate on average as 1:4. When body temperature rises at HS, breathing becomes more frequent by an average of 4 respiratory movements.

Possible changes in breathing patterns.

Type 1 - breast in women;
Type 2 - abdominal in men;
Type 3 - mixed.

When the rhythm and depth of breathing is disturbed, shortness of breath occurs. There is inspiratory dyspnea - this is breathing with difficulty inhaling; expiratory - breathing with difficulty exhaling; and mixed - breathing with difficulty inhaling and exhaling. Rapidly developing severe shortness of breath is called suffocation.

Normal respiratory movements range from 16 to 20 per minute.

Prepare: stopwatch.

Algorithm of actions:

1. lay the patient down.
2. With your right hand, take the patient’s hand as if to determine the pulse.
3. left hand place on the chest (for women), or on the stomach (for men).
4. count the number of breathing movements in one minute (1 - one breathing movement = 1 inhalation + 1 exhalation).