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Samenvatting VMV6- Verpleegkundige methodiek en vaardigheden 6
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Samenvatting van 39 pagina's voor het vak Verpleegkundige Methodiek En Vaardigheden 6 aan de VIVES (Deel Respiratie)
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Inhoud1 Verpleegkundige zorg aan de patiënt met acuut respiratoir falen......................................................6
1.1 Definitie en classificatie................................................................................................................6
1.2 Pathofysiologie.............................................................................................................................6
1.2.1 Ventilatie-perfusie mismatch.................................................................................................6
1.2.2 Intrapulmonaire shunting......................................................................................................7
1.2.3 Alveolaire hypoventilatie.......................................................................................................7
1.3 Diagnose.......................................................................................................................................7
1.4 Behandeling..................................................................................................................................8
2 verpleegkundige zorg aan de patiënt met acuut respiratoir distress syndroom..................................8
2.1 beschrijving...................................................................................................................................8
2.2 Pathofysiologie.............................................................................................................................9
2.3 Assassment en diagnose...............................................................................................................9
2.4 Behandeling................................................................................................................................10
3 De vrije luchtweg...............................................................................................................................10
3.1 Het plaatsen van een mayocanule..............................................................................................10
3.2 Het endotracheaal intuberen.....................................................................................................10
3.3 Het uitvoeren van een tracheo(s)tomie......................................................................................10
4 Zuurstoftherapie................................................................................................................................10
4.1 Low—flow systemen vs. High-flow systemin..............................................................................10
4.2 Venturi masker...........................................................................................................................11
4.3 High-flow nasale canule therapie...............................................................................................11
4.4 Mechanische ventilatie...............................................................................................................11
4.5 Complicaties van zuurstoftherapie.............................................................................................11
5 Mechanische ventilatie......................................................................................................................11
5.1 Definitie......................................................................................................................................11
5.2 Juridisch aspect...........................................................................................................................12
5.3 Niet-invasieve ventilatie.............................................................................................................12
5.3.1 Beademingsmodi.................................................................................................................12
5.3.2 Indicaties en tegenindicaties...............................................................................................13
5.3.3 Voor-en nadelen..................................................................................................................13
5.3.4 Materialenkennis.................................................................................................................14
5.4 Invasieve ventilatie.....................................................................................................................14
5.4.1 Basisinstellingen..................................................................................................................14
5.4.2 Indeling................................................................................................................................15
Pagina 1 van 39
, 5.4.3 Beademingsmodi.................................................................................................................15
5.4.4 Bewaken van de beademde patiënt....................................................................................19
5.4.5 Farmacologische ondersteuning bij beademing..................................................................21
5.4.6 Pijn en sedatieschalen.........................................................................................................21
5.4.7 Het signaleren en bestrijden van complicaties tgv beademing............................................21
6 Ventilatie geassocieerde pneumonie.................................................................................................23
6.1 Definitie......................................................................................................................................23
6.2 Pathogenese...............................................................................................................................24
6.3 Risicofactoren die bijdragen aan het ontwikkelen vanVAP.........................................................24
6.3.1 Patiëntgebonden risicofactoren..........................................................................................24
6.3.2 Ventilator gebonden risicofactoren.....................................................................................24
6.3.3 Risicofactoren vanuit de zorgverlener.................................................................................24
6.4 Diagnose.....................................................................................................................................24
6.5 Preventie....................................................................................................................................25
6.5.1 Behandeling VAP..................................................................................................................25
7 Van weaning tot extubatie................................................................................................................25
7.1 Weaning......................................................................................................................................25
7.1.1 Definitie...............................................................................................................................25
7.1.2 Weaningscriteria..................................................................................................................26
7.1.3 Weaningsmodaliteiten.........................................................................................................26
7.2 Extubatie.....................................................................................................................................26
7.2.1 Definitie...............................................................................................................................26
7.2.2 Juridisch aspect....................................................................................................................26
7.2.3 Voorwaarden.......................................................................................................................26
7.2.4 Complicaties........................................................................................................................26
8 Verpleegkundige zorg aan de patiënt met een kunstmatige luchtweg in de acute fase....................27
8.1 Verwijderen bronchussecreet.....................................................................................................27
8.1.1 Juridisch aspect....................................................................................................................27
8.1.2 Definitie...............................................................................................................................27
8.1.3 Indicaties..............................................................................................................................27
8.1.4 Tegenindicaties....................................................................................................................27
8.1.5 Complicaties........................................................................................................................27
8.1.6 Aanbevelingen.....................................................................................................................28
8.1.7 Endotracheale aspiratie met het open systeem..................................................................28
8.1.8 Endotracheale aspiratie met het gesloten systeem.............................................................29
8.1.9 Subglottisaspiratie...............................................................................................................30
Pagina 2 van 39
,8.2 Afname van een steriel staal sputum.........................................................................................30
8.2.1 Definitie...............................................................................................................................30
8.2.2 Juridisch aspect....................................................................................................................30
8.2.3 Indicaties..............................................................................................................................30
8.2.4 Complicaties........................................................................................................................30
8.2.5 Materialenkennis.................................................................................................................30
8.2.6 Procedure afname van een steriel staal sputum..................................................................30
8.3 Het fixeren van een ET en tracheacanule...................................................................................30
8.3.1 Definitie...............................................................................................................................30
8.3.2 Juridisch aspect....................................................................................................................30
8.3.3 Doelstellingen......................................................................................................................30
8.3.4 Materialenkennis – methodes.............................................................................................30
8.3.5 Algemene aandachtspunten................................................................................................31
8.4 Het verplaatsen van een orale ET-tube.......................................................................................31
8.4.1 Definitie...............................................................................................................................31
8.4.2 Doelstelling..........................................................................................................................31
8.4.3 Juridisch aspect....................................................................................................................31
8.4.4 Complicaties........................................................................................................................31
8.4.5 Aandachtspunten.................................................................................................................31
8.5 Het monitoren van de cuffdruk..................................................................................................31
8.5.1 Definitie...............................................................................................................................31
8.5.2 Juridisch aspect....................................................................................................................31
8.5.3 Doelstelling..........................................................................................................................31
8.5.4 Frequentie...........................................................................................................................32
8.5.5 Aandachtspunten.................................................................................................................32
8.5.6 Methodes.............................................................................................................................32
8.6 Het bevochtigen van de inspiratoire lucht..................................................................................32
8.6.1 Juridisch aspect....................................................................................................................32
8.6.2 Inleiding...............................................................................................................................32
8.6.3 Actieve bevochtiging............................................................................................................32
8.6.4 Passieve bevochtiging..........................................................................................................32
8.6.5 Passieve en actieve bevochtiging gecombineerd.................................................................33
8.7 Mondhygiëne bij de kunstmatig geventileerde patiënt..............................................................33
8.7.1 Juridisch aspect....................................................................................................................33
8.7.2 Definitie...............................................................................................................................33
8.7.3 Doestelling...........................................................................................................................33
Pagina 3 van 39
, 8.7.4 Relatieve contra-indicaties..................................................................................................33
8.7.5 Invloed van de endotracheale tube op de mondhygiëne....................................................33
8.7.6 Materiaalkennis...................................................................................................................33
8.7.7 Aanbevelingen bij de uitvoering van de mondhygiëne........................................................33
8.7.8 Procedure mondzorg...........................................................................................................34
8.8 Het onderhouden van de communicatie....................................................................................34
8.9 Steriele tracheacanulezorg.........................................................................................................34
8.9.1 Definitie...............................................................................................................................34
8.9.2 Juridisch aspect....................................................................................................................34
8.9.3 EBN-richtlijnen.....................................................................................................................34
8.9.4 Procedure vervangen buitencanule bij de niet-beademde patiënt.....................................34
8.9.5 Procedure reinigen binnencanule bij de niet-beademde patiënt........................................34
8.9.6 Procedure reinigen binnencanule bij de beademde patiënt................................................34
9 Bloedgasanalyse................................................................................................................................34
9.1 Inleiding......................................................................................................................................34
9.2 Juridisch aspect...........................................................................................................................35
9.3 Interpretatie van arteriële bloedgassen in 4 eenvoudige stappen.............................................35
9.4 Bufferstoffen...............................................................................................................................36
9.4.1 Algemeen.............................................................................................................................36
9.4.2 Soorten bufferstoffen..........................................................................................................36
9.5 Arteriële bloedgas interpretatie bij kinderen.............................................................................36
9.6 Aandachtspunten bij de interpretatie van arteriële bloedgasresultaten....................................36
10 Verpleegkundige zorg aan de patiënt met een thoraxdrainage.......................................................37
10.1 Juridisch aspect.........................................................................................................................37
10.2 Definitie....................................................................................................................................37
10.3 Indicaties...................................................................................................................................37
10.4 Complicaties.............................................................................................................................38
10.5 Passieve of actieve drainage.....................................................................................................38
10.6 De thoraxdrain..........................................................................................................................38
10.6.1 Kenmerken.........................................................................................................................38
10.6.2 Lokalisatie..........................................................................................................................38
10.7 Heimlichklep.............................................................................................................................38
10.8 Basisprincipe.............................................................................................................................38
10.8.1 Eenflessensysteem (passief)..............................................................................................38
10.8.2 Tweeflessensysteem (passief)............................................................................................38
10.8.3 Drieflessensysteem............................................................................................................39
Pagina 4 van 39
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