NHNG NGUYEN TAC DUNG THUOC

MUC TIEU: 1. Liet ke c cac phng phap dung thuoc. 2. Trnh bay c nguyen tac c ban trong viec cho thuoc. 3. Phan tch nhng yeu cau can thiet khi dung thuoc cho ngi benh. 4. Phan tch cac tai bien khi dung thuoc va cach x tr. 5. Nhan thc c tam quan trong cua viec dung thuoc an toan.

NHNG YEU CAU CAN THIET KHI DUNG THUOC

1. Co kien thc ve thuoc

- Ten thuoc, biet dc - Tac dung chnh cua thuoc - Tac dung phu cua thuoc

- Lieu lng thuoc

- Thi gian ban huy

- Thi gian tac dung - ng ao thai cua thuoc - Tng tac thuoc - Nam vng qui che ve thuoc

2. Tac phong lam viec * Co tinh than trach nhiem Sang suot khi ra y lenh. Khong ra y lenh qua mieng hoac qua ien thoai. Y lenh ro rang. Khong pha tron cac loai thuoc vi nhau neu khong co ch nh. Thanh that khi co sai pham.

*Co khoa hoc, chnh xac

Sap xep thuoc theo th t Tu thuoc e gan ni lam viec. Thuoc co nhan ro rang, sach se. Phan loi thuc theo ung theo qui che.

Thuoc nc e rieng vi thuoc vien, thuoc uong e rieng vi thuoc boi ngoai da. Kiem tra thuoc moi ngay. anh so th t khi dung cac loai thuoc khang sinh, thuoc gay nghin

3. Biet ro ve ngi benh

Ten ho ngi benh Chan oan benh. Trieu chng hien co tren ngi benh.

Tien can d ng thuoc, thc an.

Tong trang, tuoi, gii tnh. Kien thc va s hieu biet cua ngi benh ve thuoc.

4. Y lenh ve thuoc ro rang

Ten thuoc Ham lng thuoc

Lieu lng thuoc

ng dung thuoc Thi gian dung, so lan trong ngay

5. Ap dung: * 3 kiem tra:

Ten ngi benh Ten thuoc Lieu thuoc

* 5 oi chieu:

So ging, so phong Nhan thuoc Chat lng thuoc

ng tiem thuoc
Thi han dung thuoc

* 6 ung:

ung ngi benh ung thuoc ung lieu ung ng tiem ung thi gian ung ho s

6. Theo doi tac dung cua thuoc

anh gia tien trien cua benh. Giup viec chon thuoc, lieu lng phu hp vi benh trang cua ngi benh. Phat hien sm va phong nga tai bien do dung thuoc.

7. Ghi ho s

Ghi ro ten, ham lng, lieu lng thuoc a dung Ghi nhan lai trng hp ngi benh b d ng vi thuoc Ghi nhan lai nhng tai bien neu co. Ghi ten ngi dung thuoc

CAC YEU TO ANH HNG EN TAC DUNG CUA THUOC

1. 2. 3. 4. 5. 6. 7. 8.

Tuoi Can nang Gii tnh

Yeu to di truyen, van hoa

Yeu to tam ly Benh ly Moi trng Thi gian

CAC PHNG PHAP DUNG THUOC 1. ng tieu hoa:

Tac dung cham, t gay tai bien, tien dung. Khong c uong cac loai thuoc cung mot luc vi nhau

Theo doi dau sinh hieu khi dung cac loai thuoc co tac dung len he tuan hoan, ho hap.
Cho ngi benh ngam nc a, hoac pha thuoc vi mot t ng e de uong.

Thuoc dau nen gi am trc khi uong

Thuoc ang hoac co mui tanh khong nen uong ngay sau khi an. Thuoc li tieu phai uong trc 15 gi .

Thuoc lam ton thng niem mac da day

phai uong sau khi an no. Thuoc co tac dung lam hai men rang, nen cho uong qua ong hut.

Thuoc sunfamide cho uong vi nhieu nc e tranh thuoc lang ong than. Nen uong thuoc vi nhieu nc, tot nhat la nc am. Ngi benh hon me, cho uong thuoc qua sonde da day.

Cho uong thuoc qua sonde

Thuoc uong qua sonde: Can nhuyen va pha loang Kiem tra v tr sonde Bm 15 30 ml nuc (ngi ln), 5 10 ml (tre nho).Trc va sau khi bm thuoc Neu co 2 3 loai thuoc nen bm tng loai, khoang cach gia 2 loai la nc e tranh tng tac Neu ang dung may hut qua sonde: ngat may hut 20 30 phut sau khi bm thuoc Ghi ro so lng nc va thuoc neu co s roi loan nc ien giai

2. Ngam qua niem mac:

Mat, tai, mui, hong, li, hau mon, am ao thng co tac dung nhanh. Thuoc at hau mon phai ngam qua nc

a.

Thuoc at am ao nen nhung qua nc trc khi at va nam yen 30 phut e tranh thuoc rt ra ngoai.

Dung thuoc qua niem mac mat

Dung thuoc qua niem mac mat

Dung thuoc qua niem mac tai

Dung thuoc qua niem mac mui

Dung thuoc qua niem mac hong

Dung thuoc qua niem mac mieng

Dung thuoc qua niem mac am ao

Dung thuoc qua niem mac hau mon

3. Ngoai da:

Ra sach va lau kho vung da trc khi dung thuoc. Nen massage vung da dung thuoc giup thuoc hap thu nhanh hn.

4. ng mau:

Trong cac trng hp cap cu Nhng loai thuoc gay:

Ton

thng niem mac ng tieu hoa. hap thu c qua ng tieu hoa.

Khong B

pha huy bi dch ng tieu hoa.

Ngi benh khong the uong c:

Non

oi nhieu benh chuan b mo

Ngi Tam

than, khong hp tac

Cac loai thuoc tiem

Goc o tiem thuoc

CAC TAI BIEN KHI TIEM THUOC Do vo khuan khong tot

Ap xe nong Viem tnh mach Nhiem trung huyet

Do qua trnh tiem

Nham lan thuoc: khong ap dung 3 tra 5 oi Gay kim: ngi benh giay giua. Cham day than kinh, mach mau do xac nh sai v tr tiem. Ton thng mo hoai t

Shock do bm thuoc qua nhanh Tac mach do: kh, thuoc, vat la (long) Tiem nham vao ong mach. Ap xe lanh do thuoc khong tan

Do tac dung cua thuoc

Shock phan ve: do c the phan ng v thuoc. Viem tnh mach do tnh chat cua thuoc.

TIEM BAP (INTRA MUSCULAR) IM :

C kim : 21 23 G dai 2,5- 4 cm Goc o tiem: 90 o so vi mat da V tr tiem:

Nong:

C delta cach u vai 5 cm

Lng thuoc khong qua 1ml Khong dung tiem thuoc dau Khong dung cho c delta cha phat trien (tre < 2 tuoi, liet)

Sau:

ui: 1/3 gia mat trc ngoai ui Mong: 1/3 tren ngoai ng noi gia gai chau trc tren va xng cung (chia mong lam 4: tren ngoai la v tr tiem c) Khong dung cho c mong cha phat trien (tre<2 tuoi, liet) Lng thuoc tiem khong qua 5ml

DUNG LNG THUOC TNG NG V TR TIEM BAP

V TR DI 18 THANG TRE TREN 6 TUOI NGI LN

C DELTA

0,5 ml 0,5 ml 0,5 ml 0,5 ml 1,5 ml 1,5 ml 1,5 ml 1,5 ml

1 ml 2 ml 5 ml 5ml 5ml

C THANG UI

C RONG NGOAI UI

NAM NGHIENG

NAM SAP

Cach tiem bap

TIEM DI DA (SUBCUTANEOUS) SC

C kim: 25 G

Dai : 1-1,6cm

Goc o tiem: 45 o so vi mat da, >80 kg => 90 o, < 30 kg => 15- 30 o Lng thuoc khong qua 1 ml

V tr tiem:
C delta : au di c delta Hai ben ba vai Hai ben ron cach ron 5cm 1/3 gia mat ngoai, trc cua ui

V tr tim di da

Tim di da

TIEM TNH MACH (INTRAVENOUS) IV

C kim: 19-21 G

dai : 2,5- 4 cm

Goc o tiem: 30 - 40 o so vi mat da tuy theo v tr tnh mach

V tr tiem: Cac tnh mach ngoai bien. u

tien chon cac tnh mach:
To,

ro, t di ong mai, khong gan khp

Mem

Cach tiem tnh mach

TIEM TRONG DA (INTRADERMAL) ID

C kim: 26- 27 G

dai: 0,6-1,3 cm

Goc o tiem: 15 o so vi mat da V tr: Vung da t va cham, trang, khong seo, long 1/3 tren mat trong cang tay (thong dung nhat)

Tim trong da

NHNG IEM CAN LU Y KHI KHI DUNG THUOC

Nhan nh c NB va hieu ro tai sao dung thuoc cho NB Chuan b thuoc dung cho ngi benh:

Kiem tra thuoc: ten thuoc, lieu lng, ham lng, ng dung, chat lng, han s dung, s nguyen ven. Chuan b kim va bm tiem: so lng thuoc, o am ac cua thuoc, ng tiem, kch c NB, loai thuoc
Kiem soat s vo khuan cua ong tiem va kim

NHNG IEM CAN LU Y KHI KHI DUNG THUOC

Tnh lieu lng thuoc chnh xac Thc hien nguyen tac vo khuan khi tiem thuoc.

Thc hien 3 kiem tra, 5 oi chieu, 5 ung

trong suot qua trnh tiem thuoc. Chon c kim va chieu dai kim thch hp Khong pha tron cac loai thuoc vi nhau

trong cung mot ong tiem.

NHNG IEM CAN LU Y KHI KHI DUNG THUOC

Xac nh v tr tiem ung, nen thay oi v tr tiem. Chon vung tiem: c tha long khong gong cng Kim khong dnh thuoc trc khi tiem
Khong c am ngap kim khi tiem. am va rut kim cung 1 goc Khong nen tiem lng thuoc nhieu qua so vi v tr quy nh Tiem thuoc t t, 10 giay/ 1ml

NHNG IEM CAN LU Y KHI KHI DUNG THUOC

Tiem heparine khong nen rut kim th mau Khong nen massage vung tiem khi tiem

heparine hoac insuline v co the gay ton

thng mo va giam s hap thu.

Ap dung cach tiem Z track khi tiem bap loai thuoc co nguy c kch thch mo di da

ng tiem Z track

NHNG IEM CAN LU Y KHI KHI DUNG THUOC Sau tiem dung lc an nhe len vung tiem Theo doi tnh trang NB trong va sau khi tiem. Theo doi va lng gia s ap ng thuoc cua ngi benh Giai thch cho NB hieu ve vai tro va tac dung cua thuoc Ghi ho s: Ch ghi nhng loai thuoc do chnh tay mnh cho: ngay, gi tiem thuoc, ten thuoc, lieu lng, phan ng cua benh nhan va ten ngi dung thuoc Giao duc y te: che o an, sinh hoat tuy loai thuoc

KY THUAT LAM TEST LAY DA

(kem theo thong t so 08/1999-TTBYT, ngay 04 thang 5 nam 1999)

Ky thuat lam test lay da:

- Nho mot giot dung dch khang sinh
(penicillin hoac streptomycin) nong o 100.000 n v/1ml len mat da (1 gam streptomycin tng ng 1 trieu n v).

- Cach o 3 4cm nho mot giot dung dch

NaCl 0,9% (lam chng).

- Dung kim tiem vo khuan (so 24) cham vao 2 giot tren (moi giot dung kim rieng) qua lp thng b, tao vi mat da mot goc 45O roi lay nhe, khong c lam chay mau. - Sau 20 phut oc va anh gia ket qua.

oc ket qua
MC O
Am tnh Nghi ng Dng tnh nhe Dng tnh va Dng tnh manh Dng manh tnh KY HIEU +/ + ++ +++

BIEU HIEN
Giong nh chng am tnh Ban san ng knh < 3mm ng knh ban san 3 5mm, nga, xung huyet ng knh ban san 6 8mm, nga, ban o ng knh ban san 9 12mm, nga, chan gia

rat + + + + ng knh tren 12mm, nga nhieu, nhieu chan gia

8 nhom thuoc de gay d ng can theo doi sat khi tiem thuoc:
1. 2. 3. 4. 5. 6. 7. 8.

Thuoc khang sinh Vitamine: B1, B12, Vietamin C Thuoc khang viem non steroide: Thuoc gay te, gay ngu, dan c Noi tiet to: Insuline, ACTH Dch truyen co protein Vaccin va huyet thanh

Chat can quang co Iode