Fig. 26. Oxygen supply to the patient through the mask

It must be borne in mind that the oxygen must be moistened (by passing it through water in Bobrov’s apparatus);

1. hyperbaric oxygenation is the therapeutic use of oxygen under increased pressure in special altitude chambers. Altitude chamber is a room that can be closed hermetically, in which increased air (gas) pressure can be created artificially. The size and equipment of the altitude chamber allow several patients to stay in the chamber for a long time. Oxygen pneumatotherapy is used in pulmonology as part of holiatry of purulent obstructive lung diseases.

 

Cough

Cough is a complex reflex act resulting from irritation of receptors of respiratory tracts and pleura, which aims at removing foreign bodies, mucus, sputum, blood from the respiratory tracts in cases of diseases of lungs and upper respiratory tracts. Cough reflex consists of a sudden and quick exhalation while the fissure of glottis is closed and the subsequent energetic throwing out of the air with sputum and other foreign bodies through the mouth when the fissure of glottis suddenly opens.

According to the character cough can be non-productive (without the discharge of sputum) and productive (with the discharge of sputum).

Sputum is a pathologic secretion of lungs and respiratory tracts discharged with cough. Defining the amount and properties of sputum is very important for diagnostics. According to its nature sputum can be mucoid, serous, purulent, hemorrhagic, mixed. The daily amount of sputum is between 10-15 ml in cases of chronic bronchitis and 1 l or more in cases of burst of the lung into the bronchus, of pulmonary gangrene or multiple bronchiectasis.

To prevent others from catching the disease, the nurse must teach the patient to deal with sputum correctly: to try not to cough near healthy people, to cover the mouth with a handkerchief or a hand when coughing; not to spit out the sputum on the floor, since by drying up it can turn into dust and infect others; to collect sputum into a special spittoon with a tight lid and in which there is a small amount of 0,5% solution of chloramine. Spittoons are emptied daily after the amount of sputum a day is marked in the temperature form. The sputum of consumptives is burnt or washed down the drain after having been disinfected by adding dry chlorinated limeto it on the basis of 20 gr for 1 l of sputum for 2 hours.

Attendance of patients with non-productive cough consists of treating the prior disease, use of expectorants; abundant warm alkaline drinking is also recommended. When the cough is productive, the nurse is to see to it that the sputum flask is clean and timely emptied, is daily disinfected with solution of chloramine, clear solution of chlorinated lime. It is necessary to see to it that the patient takes the drainage position (position when sputum is discharged better) for 30 minutes several times a day.

Hemoptysis

Hemoptysis is discharge of sputum with bloody touch which is evenly mixed (for example, sputum in form of “raspberry jelly” in cases of carcinoma of lung) or is separate streaks. In cases of croupous pneumonia sputum can be “prune rusty”.

Hemoptysis is an indication for urgent hospitalization, since when blood appears in sputum, pulmonary bleeding is as like as not.

Discharge of a considerable amount of blood through respiratory tracts (with cough or as continuous stream) is called pulmonary bleeding. It is necessary to differentiate it from gastrorrhagia. In case of pulmonary bleeding the blood is incarnadine, frothy, it does not posset, it has an alkaline reaction and is discharged when coughing, while in case of gastrorrhagia as a rule the blood is crimson, of coffee-ground type as a result of interaction with acid gastric juice and formation of hemin, of acid reaction, it is mixed with food and is discharged when vomiting.

Hemoptysis and pulmonary bleeding are very serious symptoms, which require acute medical intervention (diagnostic fluoroscopy, tomography, bronchoscopy, etc).

Patient care presupposes absolute rest, semi-sitting position with a tilt to the affected side in order to prevent the blood from getting into the healthy lung. An ice bag is put onto the diseased half of the thorax. Ice is also given to the patient to swallow since this leads to reflex vasospasm and reduction of blood filling of lungs. In case of bad cough that increases the bleeding antitussive drugs are prescribed. The patient is fed only on cold semi-fluid food.

Cupping-glasses, mustard plaster, hot-water bottles and compresses on the thorax are contra-indicated!

 

Pains in the thorax

In cases of respiration organs diseases the pain syndrome is mostly related to the involvement of pleura (pleurisy, pleuropneumonia, carcinosis pleurae, etc). Pleural pains are provoked by respiratory movements, that is why the patients’ breathing tends to be shallow.

Attendance of patients with pleural pains consists in helping the patient to find a comfortable position the restricts respiratory excursions (on the diseased side), in applying mustard plaster and iodide grate on the affected area, in using anaesthetics (according to the doctor’s prescription).

In case of temperature rise higher than 38оС any physiotherapeutic procedures are contra indicated.

 

Observing and attending patients with diseases of blood circulation organs

 

Cardiology is a section of internal diseases that studies aetiology, pathogenesis and clinical presentations of diseases of cardiovascular system (diseases of blood circulation organs) and that develops methods of diagnostics, prevention and treatment of the diseases.

At present diseases of cardiovascular system are the most widely-spread pathology of internals and occupies the first place among the causes of mortality. The urgency of this problem requires the search of new measures of prevention, diagnostics and treatment of diseases of blood circulation organs. Recently the arsenal of instrumental methods of examination in the field of cardiology has increased considerably (24 hour electrocardiographic and blood pressure monitoring, echocardiography, stress echocardiography, etc.) but comparatively simple methods of examination, which give valuable information about the patient’s state of circulatory dynamics, are nonetheless important (defining the pulse, measuring blood pressure, etc.).

Arterial pulse, the technique of examination, its main characteristics

Pulse is the periodical vibration of walls of blood vessels caused by the change of their filling with blood during cardiac performance (in systole and diastole). With a diagnostic aim the pulse (arterial) is defined on different arteries:

- carotid (on the front rim of m.sternocleidomastoideus, at about half of its length), the examination should be carried out carefully, since the carotid artery (a.carotis) is a rich reflexogenic zone and there is danger of sudden reflexive deceleration of heart rate;

- temporal;

- femoral;

- subclavian;

- brachial;

- radial (radial artery is to be palpated between the styloid process of radius and chorda of internal radial muscle);

- etc (Fig.27).

Most often pulse is taken on the radial artery (the so-called peripheral pulse), because it is superficial and is well palpated between the styloid process of radius and chorda of internal radial muscle. The pulse on the left and right hand can differ in case of abnormal development, constriction, compression from the outside of the corresponding radial, brachial or subclavian arteries. In this case pulse is taken on the hand, on which it is palpated better.