CẤP CỨU SẢN KHOA.pdf

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QuQuQuQu ddddnnnn ssssLiLiLiLinnnn hihihihipppp ququququcccc

DDDD NNNN VNMVNMVNMVNM 7PG00107PG00107PG00107PG0010

CCCCpppp ccccuuuu ssssnnnn khoakhoakhoakhoa

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BanBanBanBan sosososonnnn ththththoooo::::1. - TS. Nguyn Vit Tin2. - PGS.TS. Nguyn c Hinh3. - TS. L Anh Tun4. - TS. Phm Th Hoa Hng5. - ThS. Lu Th Hng6. - PGS.TS. Vng Tin Ha7. - TS. L Thanh Vn8. - TS. Phm Huy Hin Ho9. - TS. Nguyn Quc Tun10.- TS. L Hong11.- ThS. Phm B Nha12.- ThS. Phm Th Thanh Hin13.- BS. Nguyn Hu Cc14.- ThS. H S Hng

BanBanBanBan thththth kkkk::::1. ThS. Nghim Xun Hnh2. ThS. H S Hng3. ThS. Phm Phng Lan

2MMMMcccc llllcccc1. Vn y c trong cp cu sn khoa

2. V khun trong cp cu sn khoa

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trong CCSK

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1. K c mi lin quan gia y c v quyn con ngi trong CSSKSS.2.2.2.2. Nu c nhng nguyn tc c bn v y c trong cp cu sn khoa.

PhPhPhPhngngngng titititinnnn hhhhcccc ttttpppp- Bng, my chiu, bt d, giy kh to, projector.

LLLLngngngng gigigigi trtrtrtrc/sauc/sauc/sauc/sau hhhhccccHi hc vin : 5 pht

- Nu c im khc bit cp cu sn khoa khc vi cc chuyn ngnh khc.- Nu nhng l do cn tr lm gim 5 tai bin sn khoa.

KKKK hohohohochchchch bbbbiiii gigigiging:ng:ng:ng: Thi gian 2 tit

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PhPhPhPhngngngng phphphphp,p,p,p,phphphphngngngng titititinnnn ddddy/y/y/y/

hhhhcccc

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1. c im cachuyn ngnh Snkhoa v SKSS.Vn tai bin vt vong m.

10

ng no.Hi, tr li.

Tham giapht biu.

Ging vinnhn xt, sosnh.

MMMMcccc titititiuuuu 1:1:1:1: K c mi lin quan gia y c v quyn con ngi trongCSSKSS.2. Mi lin quangia y c vquyn con ngitrong CSSKSS.

30

Chia nhm.Vit giy to.

Bnh lun.B sung.

Ging vinnhn xt, sosnh.

MMMMcccc titititiuuuu 2:2:2:2: Nu c nhng nguyn tc c bn v y c trong CSSKSS.3. Y c th hinc th trong cpcu sn khoa (10iu).

30

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Bnh lun.B sung.So snh giacc nhm.

Bnh lun.Ging vinnhn xt, sosnh, ktlun.

4.Tm tt bihc.

20

Hc vin pht biuhc c g. Hc vin pht

biu.

Ging vinnhn mnh10 vn v CCSK

4NNNNiiii dungdungdungdung bbbbiiii hhhhcccc

1. Nhng c im ca chuyn ngnh sn khoa v SKSS.c im ring bit ca chuyn ngnh Sn khoa khc vi cc chuyn

ngnh khc l nhng yu t bnh l xy ra s nh hng cng mt lc cho 2 tnhmng con ngi l ngi m v thai nhi (hoc tr s sinh). Mt khc, nhngbin c trong sn khoa xy ra c khi t ngt v din bin rt nhanh. Mang thaiv sinh vn l sinh l bnh thng, nhng trong nhiu trng hp, t sinh lbnh thng din bin chuyn sang bnh l nhanh chng nu khng c x lng v kp thi, c th dn n t vong cho c ngi m v thai nhi.

Hin nay vn cn nhiu bin chng dn n t vong v bnh l khng chring cho ngi m m c cho thai nhi hoc tr s sinh. Nhng bin chng xyra cho b m ngay t khi c thai, trong khi sinh v cho n ht thi k hu sn.Nhng tai bin trong sn khoa lin quan n nhng quan nim ca x hi cngnh ca cng ng v vai tr ca ngi ph n. Hin ti x hi cha nh ging mc v vai tr ca ngi ph n trong vic bo tn ni ging ng thicha quan tm y v chm sc tch cc cho ngi ph n trong sut kmang thai cho n ht thi k hu sn.

2. Mi lin quan gia y c v quyn con ngi trongchm sc sc kho sinh sn ni chung.

Y c th hin c th thng qua cch thc thc hin nng lc, kh nngchuyn mn mt cch c hiu qu v nh th no trong nhng trng hp chmsc sn khoa. Nh vy trc ht, nhn vin y t phi c nhng kin thc chuynkhoa m bo vic chm sc sn khoa. Nu c tinh thn phc v tt mkhng c chuyn mn vng vng lun c cp nht v ngc li nu ch cchuyn mn thun tu m khng c y c th khng th phc v bnh nhn ttc. Y c c th hin mt cch c th l lm th no cho bnh nhnchng c hi phc v sc kho, ng thi thoi mi v tinh thn, hn ch nmc ti a nhng nh hng xu ca bnh tt, tit kim nht nhng chi ph vkinh t m vn t c hiu qu cao nht v iu tr.... KhKhKhKhngngngng thththth ttttchchchch rrrriiii yyyy ccccv

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nhau.

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nhau.

2.1.2.1.2.1.2.1. NhNhNhNhnnnn vivivivinnnn yyyy tttt phphphphiiii cccc yyyy nnnnngngngng llllcccc mmmm bbbboooo ththththcccc hihihihinnnn cccc ccccngngngngttttcccc chuychuychuychuynnnn mmmmn.n.n.n.

- Phi c c mt trnh chuyn mn v chun mc cao nht ngthi phi lun c o to v t o to duy tr cng nh lun cp nht vnng cao v k nng chuyn mn, tip cn v s dng nhng phng php iutr mi nht c chng minh bng nhng chng c khoa hc phc vngi bnh (y hc da trn bng chng).

- Nng lc chuyn mn phi lun c cng c bao gm c vic o to,o to li. Ngnh y t phi cp nht nhng kin thc hoc k thut mi chonhn vin y t t c trnh v kh nng tay ngh ph hp cho cng tcchuyn mn.

+ Tn trng v bo m an ton cho mi ph n khi khm v iu tr bnh.

5Khng qun nhim v gio dc, truyn thng, t vn v phi c lng ghp mtcch hi ho trong cng tc khm cha bnh.

+ Trnh nhng quan h khng ng mc vi bnh nhn cng nh gia nhbnh nhn m nhng quan h c th dn n vic li dng tnh cm, tnh dc,ti chnh hoc nghin cu.

+ Khng p t cho bnh nhn mt cch x tr ch v ph hp vi tn giohay quan im o c ca ring c nhn nhn vin y t. Trong trng hp mcch gii quyt c th a n cc mu thun trn, ngi nhn vin y t phichuyn bnh nhn n mt nhn vin y t khc c cch gii quyt thch hphn. Tuy nhin,,,, nnnnuuuu ttttnhnhnhnh trtrtrtrngngngng ccccpppp ccccu,u,u,u, phphphphiiii ththththcccc hihihihinnnn ngayngayngayngay nhnhnhnhngngngng bibibibinnnnph

ph

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+ Khng c thc hin hoc phphphphiiii t chi h tr ngi khc thc hin nhnghnh vi, vic lm c th vi phm nhn quyn hay nhng nguyn tc y c hocbt k mt hnh ng no m s tc ng xu n sc kho ca ngi bnh.

+ Duy tr , khuyn khch tn trng nhng chun mc cao nht vvvv ttttnhnhnhnhtrung

trung

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+ Biu hin c th nhng hnh vi ng x chun mc trong quan h vi bnhnhn v gia nh nh l mt tm gng cc thnh vin khc noi theo.

+ Lun quan tm ng h cho cc nhn vin y t c hc sut i v quynv sc kho sinh sn, sc kho tnh dc, v y c.

2.2.2.2.2.2.2.2. PhPhPhPhiiii ttttnnnn trtrtrtrngngngng quyquyquyquynnnn tttt quyquyquyquytttt nhnhnhnh vvvv ssss riririringngngng tttt ccccaaaa phphphph nnnn....- Sau khi cung cp y nhng thng tin v cc cch x tr c th p

dng c th cho trng hp ca h, v hu qu v nhng thun li cng nh btli c th xy ra nu p dng cc cch x tr ny s gip cho ngi ph n cmt s chn la, quyt nh v sc kho sinh sn v tnh dc thch hp v ngn, khng lch lc v khng b p t. Nh vy, ngi ph n c th cn nhcv chn c cch iu tr thch hp nht vi hon cnh v vn ho ca h.

- m bo nhng thng tin ring t ca bnh nhn khng b tit l bngvn bn hay qua li ni cho bt c ai, tr trng hp do php lut hay do chnhbnh nhn yu cu.

- Gi vng nguyn tc khng phn bit i x. Tt c ph n phi ciu tr nh nhau, bt lun tui tc, hon cnh gia nh, dn tc, thng tt, honcnh kinh t, tn gio hay cc iu kin khc. Mi ph n u c iu tr theonguyn vng ca h ch khng phi do yu cu ca bn tnh hay gia nh h .

- Khng phn bit i x v tui tc, c bit l cn quan tm n v thnhnin n, phi coi trng tui sinh hc v s pht trin ca h ch khng phi ltui thi gian, gip cho h c c s chn la, quyt nh mt cch t do viy thng tin v sc kho tnh dc v sc kho sinh sn ca h.

2.3.2.3.2.3.2.3. TrTrTrTrchchchch nhinhinhinhimmmm iiii vvvviiii ccccngngngng ngngngng- Bo m quyn ca ph n c thng tin v gio dc sc kho sinh sn

6 gip cho h ch ng quyt nh c thi im sinh con v s con theonguyn vng mt cch c lp v chnh ng nhng phi ph hp vi lut phpv qui nh ca nh nc.

- Bo m quyn ca ph n trong cc mi quan h tnh dc nh l mtphn ca cuc sng t nhin ca h, gip h c c cuc sng tnh dc mtcch thoi mi v an ton.

- Bo m chm sc cho ph n c sc kho sinh sn v sc kho tnh dctt nht theo nhng tin b khoa hc hin i.

- Thng bo cho cng ng v nhng vn v quyn ca ph n tronglnh vc sc kho sinh sn v sc kho tnh dc khuyn khch i x tntrng ph n v a cc quan im ny vo lnh vc hnh ngh y t.

3. Nhng nguyn tc c bn v y c trong cp cu snkhoa3.1.3.1.3.1.3.1. Phi hhhhnhnhnhnh ngngngng ththththtttt khkhkhkhnnnn trtrtrtrng,ng,ng,ng, ttttchchchch cccccccc vvvv khikhikhikhi ccccnnnn thithithithitttt phphphphiiii mmmmiiii ththththmmmmng

ng

ng

ng

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ph

ph

ph

gi

gi

gi

gi

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p

p

p. Khng c tr hon cp cu v nhng l do ring.

3.2.3.2.3.2.3.2. Trn c s nnnnmmmm ththththtttt nhanhnhanhnhanhnhanh vvvv yyyy chichichichi tititititttt v tnh trng sc kho cabnh nhn, nhnhnhnh gigigigi nhanhnhanhnhanhnhanh mmmmcccc nnnnng,ng,ng,ng, nhnhnhnh,,,, nguynguynguynguy hihihihimmmm eeee dodododo nnnn ttttnhnhnhnhm

m

m

m

ng

ng

ng

ng ca bnh, chchchchnnnn cccccccc ccccchchchch iiiiuuuu trtrtrtr ththththchchchch hhhhpppp i vi bnh nhn da trnnhng tin b mi nht ca khoa hc trong v ngoi nc m mnh bit ccng nh cc phng tin hin c ti c s.

3.3.3.3.3.3.3.3. Cp cu sn khoa lin quan n tnh mng ca c m ln con, nhng thngl u tin n tnh mng ca ngi m nhiu hn, tuy nhin tu tng trng hpm ch u tin cho con hay ngi m. Trong nhng trng hp cn phitrao i vi bnh nhn hoc gia nh h hp tc cng gii quyt tt nht chobnh nhn.

3.4.3.4.3.4.3.4. Hi bbbbnhnhnhnh nhnhnhnhnnnn cccc mumumumunnnn mmmmiiii ngngngngiiii nnnnoooo trong gia nh hoc bn b cngchia s nhng thng tin cn thit v tnh trng sc kho ca h. Mi ng ngibnh nhn yu cu vo bn cnh bnh nhn. Tu tnh trng bnh nhn, c thtrao i thng tin vi bnh nhn v ngi nh. Nu bnh nhn nng, cn cngh ngi th ch trao i vi ngi nh.

3.5.3.5.3.5.3.5. Nu bnh nhn v gia nh yu cu mi mt cn b y t c kinh nghim caohn n hi chn th phi chp nhn v to iu kin thc hin nguynvng ca h.

3.6.3.6.3.6.3.6. CungCungCungCung ccccpppp ththththngngngng tintintintin mmmmtttt ccccchchchch trungtrungtrungtrung ththththcccc v tnh trng sc kho ca bnhnhn, aaaa rararara cccccccc ccccchchchch ggggiiiiiiii quyquyquyquytttt ccccpppp ccccu,u,u,u, l do ti sao chn cc cch ny, cchthc hin v hu qu c th c i vi mi cch gii quyt. Cng c th nu ccyu cu i vi ngi nh vic cp cu c hiu qu hn.

3.7.3.7.3.7.3.7. Kin nhn lng nghe kin phn hi ca bnh nhn cng nh ngi nh vng nghip. C th tho lun mt cch bbbbnhnhnhnh ng,ng,ng,ng, thothothothoiiii mmmmi,i,i,i, khkhkhkhngngngng pppp tttt v

7s chn la iu tr. Yu cu bnh nhn hoc ngi nh k giy cam kt ng nu c ch nh phu thut hoc phi thc hin mt th thut.

3.8.3.8.3.8.3.8. Thc hin ccccpppp ccccuuuu mmmmtttt ccccchchchch tttttttt nhnhnhnhtttt theo cch m bnh nhn v gia nh chn v khng qun m bo nguyn tc v khun. Tuy nhin, tu theo thctrng cng nh din bin ca tnh trng bnh, cng c th thay i cch x trnu thy cn thit m bo tnh mng bnh nhn, khng chn ch ng thic ngay ngi trong nhm ra thng bo cho gia nh. Ch lm ng mc cnthit cu sng bnh nhn. NNNNuuuu trtrtrtrngngngng hhhhpppp vvvvtttt ququququ khkhkhkh nnnnngngngng ccccaaaa mmmmnh,nh,nh,nh,c

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3.9.3.9.3.9.3.9. Sau iu tr phi thng bo cho bnh nhn v gia nh nhng vic mnh thc hin, cch theo di sau ny. Phi t vn cho bnh nhn cng nh ngi nhhiu v thay i hnh vi hoc li sng c th gp phn gy ra tnh trng cp cum h va tri qua.

3.10.3.10.3.10.3.10. Khng tit l nhng thng tin v bnh tnh v cch x tr c thc hincho ngi khc bit, tr trng hp do bnh nhn yu cu. Cn xem li cch iutr trc y cho bnh nhn ti khoa ca mnh hoc tuyn di rt kinhnghim cho bn thn, c s ca mnh v ng nghip cng nh c s tuyn di trnh 3 chm tr trong lm m an ton.

BBBBiiii ttttpppp ttttnhnhnhnh huhuhuhungngngng

Bn l bc s chuyn khoa cp 1 chuyn ngnh Ph Sn, cng tc ti bnhvin huyn. Bn vn m ly thai bnh thng.

- TTTTnhnhnhnh huhuhuhungngngng 1:1:1:1: Mt ph n c thai 35 tun, khi thai c 32 tun, ra tmu ti m o, n trm x x khm, nhng NHS ni khng vic g vcho v. Bn ngy sau, t nhin ht ra mu. Hm nay, thai ph khng au bngnhng ra mu m o, s lng khong 400g, ti ln mu cc. Vn yc c th hin trong trng hp ny nh th no?

- TTTTnhnhnhnh huhuhuhungngngng 2:2:2:2: Gi s chn on lm sng thai ph ra huyt l do rau tino th nguy c nh th no?

- TTTTnhnhnhnh huhuhuhungngngng 3:3:3:3: C s ca bn c my siu m, nhng khng c mu dtr bn s lm nhng g?

- TTTTnhnhnhnh huhuhuhungngngng 4:4:4:4: Nu l RT trung tm cn phi x tr ti c s ca bn thbn s lm g? Nu gia nh thai ph mun c hi chn thm th bn giiquyt nh th no?

- TTTTnhnhnhnh huhuhuhungngngng 5:5:5:5: Nu chuyn tuyn trn th bn s lm g?---- TTTTnhnhnhnh huhuhuhungngngng 6666: Qua trng hp ny, bn s lm g i vi Khoa ca bn

v tuyn di....

pppp nnnn ::::- TTTTnhnhnhnh huhuhuhungngngng 1:1:1:1: Phi chn on nguyn nhn, ra hng x tr ng thi

thng bo v tho lun vi gia nh cng hp tc tc gii quyt.

8- TTTTnhnhnhnh huhuhuhungngngng 2:2:2:2: Chy mu nhiu m s t vong, tr s sinh non thng,thng bo nhng nguy c ny cho gia nh bnh nhn v gia nh bit

- TTTTnhnhnhnh huhuhuhungngngng 3:3:3:3: Siu m xc nh loi rau tin o, thng bo kh khn tic s, khng c mu nu phi truyn mu, cng gia nh tho lun ngi chomu, chun b phng tin ly mu ti c s

- TTTTnhnhnhnh huhuhuhungngngng 4:4:4:4: Xem xt c s vt cht, kh nng k thut ca bn thn vi ng ng nghip h tr cho cuc m. Gii thch cho thai ph v gia nh ldo thc hin phu thut ti bnh vin bn v mi hi chn lnh o hoc thngtr.

- TTTTnhnhnhnh huhuhuhungngngng 5555: S cu ban u, gii thch cho gia nh l do ti sao lichuyn ln tuyn trn, chun b phng tin vn chuyn tt nht, c nhn vin ctrnh chuyn mn tt, a thai ph ln tuyn trn.

- TTTTnhnhnhnh huhuhuhungngngng 6:6:6:6: Rt kinh nghim chuyn mn cho nhn vin v cho Khoav t chc qun l, kim tra c s vt cht, tng cng cng tc ch o tuyn vy t x khng pht hin trng hp RT. Thng bo cho trm y t x rt kinhnghim, b tr lch xung kim tra, gim st v cp nht cho nhn vin y t xnhng chy mu 3 thng cui trong thai k.

GGGGiiii phphphphngngngng phphphphpppp gigigigingngngng ddddyyyy1. Gii thiu bi ri lm bi tp tnh hung.2. Da vo bi tp tnh hung s ng vai, sau khi kt thc thc hnh

s tng kt qu trnh thc hnh theo trnh t nh bi l thuyt.

TTTTiiii lilililiuuuu thamthamthamtham khkhkhkhoooo1. Victor Y.H (2006). Ethical problem in carring premature baby.Conference

book 14th congress of FAOPS. 2006 - pp: 209 - 214.2. Lim Ngok - Linh (2006). An overview of ethical problem in care of

newborn conference book 14th congress of FAOPS.2006 - pp: 217 - 222.3. Suibua B. Chilchareon (2006). Ethical problemin carring of pregnant

woman. Conference book 14th congress of FAOPS 2006 - pp: 223 - 226.4. Trng i hc Y H Ni (2006) - o c trong nghin cu y sinh hc.

NXB y hc 2006.5. B y t (2005) Hng dn chun quc gia v chm sc SKSS.

9B

B

B

B

i

i

i

i 2

2

2

2

VVVV KHUKHUKHUKHUNNNN TRONGTRONGTRONGTRONG CHCHCHCHMMMM SSSSCCCC ccccpppp ccccuuuu ssssnnnn khoakhoakhoakhoa

MMMMcccc titititiuuuu hhhhcccc ttttppppSau

Sau

Sau

Sau khi

khi

khi

khi h

h

h

h

c

c

c

c xong

xong

xong

xong b

b

b

b

i

i

i

i h

h

h

h

c

c

c

c n

n

n

n

y,

y,

y,

y, h

h

h

h

c

c

c

c vi

vi

vi

vi

n

n

n

n ph

ph

ph

ph

i:

i:

i:

i:

1. Ni c 4 i tng cn c v khun trong dch v chm sc sc khosinh sn ni chung v cp cu sn khoa ni ring.

2. Thc hin ng k thut ra tay v khun.3. Nu c nguyn tc s dng gng tay i vi tng loi dch v.4. M t c chnh xc cc bc trong quy trnh v khun dng c.5. Ni c cch x l dng c, gng, vt dng nhim khun.6. Ni c cch kh nhim, kh khun mc cao, tit khun v bo qun

dng c v khun.

PhPhPhPhngngngng titititinnnn ddddyyyy hhhhcccc- Bng lt.- Giy to kh A0.- Giy mu v bt d.

KKKK hohohohochchchch bbbbiiii gigigiging:ng:ng:ng: ThThThThiiii giangiangiangian 3333 tititititttt



PhPhPhPhngngngng phphphphp,p,p,p, phphphphngngngngtitititinnnn ddddy/hy/hy/hy/hcccc

HoHoHoHotttt ngngngnghhhhcccc vivivivinnnn


MMMMcccc titititiuuuu 1111: Ni c 4 i tng cn c v khun trong dch v chm sc sckho sinh sn ni chung v cp cu sn khoa ni ring.1.Mi trng

sch trongcc phng kthut

5 Thuyt trnh.Ghi ln bng mi kin ca hc vin.Bng lt, giy kh to,bt.

Nghe, ghing no trli.

Quan st hcvin.

2.Khch hng.Trc v saukhi lm ththut, phuthut.

5 Thuyt trnh.Ghi ln bng mi kin ca hc vin.Bng lt, giy kh to,bt.

ng no vvit vo ccmnh giy c2 mu khcnhau v dnln bng theomu.

Quan st hcvin.Nhn xt.

3.Ngi cungcp dch v.

5 Hi - gi tr li. Tr licu hi

Nhn xt

4.Dng c,phng tin

5 Hi - gi tr li. Tr licu hi

Nhn xt

10



PhPhPhPhngngngng phphphphp,p,p,p, phphphphngngngngtitititinnnn ddddy/hy/hy/hy/hcccc



MMMMcccc titititiuuuu 2:2:2:2: Thc hin ng k thut ra tay v khun5.Ra tay nn

lm vo lcno?

10 c v bnh lun tiliu.

6.K thut ratay.

10 Tho lun nhm nhti ch.

MMMMcccc titititiuuuu 3:3:3:3: Nu c nguyn tc s dng gng tay i vi tng loi dch v8. Nguyn tc

s dng gngtay.

10 Tho lun nhm nhti ch.Nhn xt v b sungca gio vin - hcvin.

9. Thc hnhra tay - igng.

35 Thc hnh ra tay igng v trong nhmnh S dng bng kim thc hnh v quanst ln nhau.Ging vin chun ba im, dng c cntheo bng kim.Chia nhm, a im,dng c v hng dns dng bng kim.

MMMMcccc titititiuuuu 4:4:4:4:M t c chnh xc cc bc trong quy trnh v khun dng c10.Quy trnh vkhun dng c.

20 Ging vin hi v ghinhanh mi cu tr litrn bng.

ng no trli.

nh gi,nhn xt, bsung kin.

MMMMcccc titititiuuuu 5:5:5:5: Ni c cc x l cc dng c, gng, vt dng nhim khun11.Cch x ldng c, gng,vt dng nhim khun.

15 Chia lp thnh 4 nhm,tho lun 4 ni dung:luc, ngm ho cht(kh khun cao v titkhun), hp t, sykh.

Tho lunnhm, vittrn giy khto, lin hthc t ti cs.


MMMMcccc titititiuuuu 6:6:6:6: Ni c cch kh nhim, kh khun mc cao, tit khun v boqun dng c v khun.12.Kh nhim,kh khun mc cao, titkhun v boqun dng c v khun.

15 Chia lp thnh 4 nhm,tho lun 4 ni dung:luc, ngm ho cht(kh khun cao v titkhun), hp t, sykh.

Tho lunnhm, vittrn giy khto, lin hthc t ti cs.


11

NNNNiiii dungdungdungdung bbbbiiii hhhhcccc1. Nguyn nhn gy nhim khunDo cc loi vi khun, virus v k sinh trng

Cc iu kin thun tin cho nhim khun:- C s vt cht: khng m bo tiu chun- Dng c, trang thit b: khng thc hin khng ch chng nhim khun- Quy trnh chng nhim khun: khng tun th ng- Ngi cung cp dch v: thiu kin thc, thc v chng nhim khun

C 4 ng ly truyn:- Mi trng- Khch hng (ngi s dng dch v)- Cn b y t (ngi cung cp dch v)- Dng c/ phng tin

1.1.M1.1.M1.1.M1.1.Miiii trtrtrtrng:ng:ng:ng:Cc phng k thut phi m bo mi trng trong sch.- V tr: sch s, t xa d ly nhim nh nh bp, nh v sinh, ng i- B tr; nn v tng khng thm nc, c th ra bng nc hoc x phng, ch thng kn dn nc thi, khng dng qut trn, c th dng qut bn hociu ha nhit . Ca s c knh m cao hn sn nh 1,5 m. Nu khng c knh,phi c li che hoc vi x trnh mui, rui.- Nguyn tc: khi khng lm th thut phi ng kn tuyt i, thay tm lt bnth thut, v sinh tm tri bn, v sinh thng xuyn cc vt dng khc trongphng th thut.

1.2.1.2.1.2.1.2. KhKhKhKhchchchch hhhhng/bng/bng/bng/bnhnhnhnh nhnhnhnhn:n:n:n:- Trc th thut, phu thut:

Khch hng/bnh nhn phi c tm ra, thay qun o sch, i tiu hoc lmrng bng quang, lm v sinh v st trng vng c phu thut.

- Sau th thut, phu thut:Error!Error!Error!Error! NotNotNotNot aaaa validvalidvalidvalid link.link.link.link.

1.3.C1.3.C1.3.C1.3.Cnnnn bbbb yyyy tttt//// NgNgNgNgiiii cungcungcungcung ccccpppp ddddchchchch vvvv::::- Tiu chun: cn b y t phi chm m/ khng l tc, khu trang che kn mi,i giy/dp ring, khng mc cc bnh truyn nhim.

1.4.1.4.1.4.1.4. DDDDngngngng cccc//// trangtrangtrangtrang thithithithitttt bbbb::::Tun th theo ng quy trnh v khun

2.Ra tayRa tay l thao tc khng ch nhim khun n gin nht v quan trng nht.-Th-Th-Th-Thiiii iiiimmmm rrrraaaa tay:tay:tay:tay:

B

B

B

B

ng

ng

ng

ng 1.

1.

1.

1. Th

Th

Th

Th

i

i

i

i

i

i

i

i

m

m

m

m r

r

r

r

a

a

a

a tay

tay

tay

tay

12

Trc

- Khi lm vic- Khm hay ly

mu- Vn chuyn dng

c sch- i gng v khun- Khi v nh

SAU

- Khi tay c th bnhim khun

- Dng dng c chm vo dch tithay cht bi tit cac th

- Khi tho gng- Khi i v sinh

---- CCCCcccc phphphphngngngng titititinnnn rrrraaaa tay:tay:tay:tay:o Nc sch, thng c vi, vi ng m khng phi dng tayo X phng dit khuno Bn chi mm, c luc hoc ngm trong dung dch st khuno Khn kh, sch, v khun

---- KKKK thuthuthuthutttt rrrraaaa tay:tay:tay:tay:o

o

o

o

R

R

R

R

a

a

a

a tay

tay

tay

tay th

th

th

th

ng

ng

ng

ng quy:

quy:

quy:

quy:

+ Bc 1: tho b ng h v trang sc tay, lm t v xoa xphng hoc dung dch ra tay vo bn tay, cng tay.+ Bc 2: st 2 lng bn tay vo nhau 10 ln+ Bc 3: dng lng bn tay ny st ln mu bn tay kia (10 ln)+ Bc 4: dng ngn tay v bn tay ny xoy v cun quanh ln lttng ngn ca bn tay kia

o

o

o

o R

R

R

R

a

a

a

a tay

tay

tay

tay ngo

ngo

ngo

ngo

i

i

i

i khoa:

khoa:

khoa:

khoa:

+ Bc 1: Mc o chong, i m che kn tc, tho b trang sc, ctngn mng tay, eo khu trang, tin hnh ra tay thng quy, khnglau tay.+ Bc 2: dng bn chI v khun v dung dch ra tay nh c vou, k, v cnh ca ngn tay theo chiu dc hoc xon c.+ Bc 3: nh c lng v mu bn tay+ Bc 4: nh c cng tay ln qu khyu 5cm+ Bc 5: ra tay di vi nc chy (nc v khun)+ Bc 6: lau kh bng khn v khun. Ngm tay vo dung dch stkhun trong 5 pht.

3. s dng gng tay

3.1.3.1.3.1.3.1. eoeoeoeo ggggngngngng tay:tay:tay:tay:M rng cc ngn tay, cho bn tay vo ng v tr cc ngn (phn bit gng bntri/ bn phi). c gng trm ln c tay o, ch bn tay cha i gng chchm vo mt trong ca gng. Lau sch phn bn ngoi gng trnh ri vo bng. Sau khi eo gng, lun tay pha trc.3.2.3.2.3.2.3.2. NguyNguyNguyNguynnnn ttttcccc ssss ddddngngngng ggggngngngng taytaytaytay

Hu ht cc dch v chm sc sc kho sinh sn u cn s dng gng tay.

13

B

B

B

B

ng

ng

ng

ng 2.

2.

2.

2. C

C

C

C

ch

ch

ch

ch s

s

s

s

d

d

d

d

ng

ng

ng

ng t

t

t

t

ng

ng

ng

ng lo

lo

lo

lo

i

i

i

i g

g

g

g

ng

ng

ng

ng

i

i

i

i v

v

v

v

i

i

i

i m

m

m

m

i

i

i

i lo

lo

lo

lo

i

i

i

i d

d

d

d

ch

ch

ch

ch v

v

v

v

TTTTTTTT TTTTnnnn ddddchchchch vvvvCCCCnnnn ddddngngngngggggngngngng taytaytaytay

CCCCnnnn ggggngngngng khkhkhkhkhukhukhukhunnnn caocaocaocao

CCCCnnnn ggggngngngng titititittttkhukhukhukhunnnn

1 Khm b phn sinh dc. + + -2 . + + +3 t, tho vng. + + -4 Ht thai. + + +5 No, ph thai. + - +6 Cy, tho Norplant. + - +

TTTTTTTT TTTTnnnn ddddchchchch vvvvCCCCnnnn ddddngngngngggggngngngng taytaytaytay

CCCCnnnn ggggngngngng khkhkhkhkhukhukhukhunnnn caocaocaocao

CCCCnnnn ggggngngngng titititittttkhukhukhukhunnnn

7 Phu thut, kim sot tcung, bc rau.

+ - +

8 Cp cu tr s sinh. + - +9 Rt mu, truyn mu. + + -10 Ty u dng c. + - -11 Ra dng c, lau sch

c th.+ - -

Ghi

Ghi

Ghi

Ghi ch

ch

ch

ch

:

:

:

: (

(

(

( -

-

-

- )

)

)

) kh

kh

kh

kh

ng

ng

ng

ng c

c

c

c

n,

n,

n,

n, (+)

(+)

(+)

(+) b

b

b

b

t

t

t

t bu

bu

bu

bu

c.

c.

c.

c.

B

B

B

B

ng

ng

ng

ng 3.

3.

3.

3. B

B

B

B

ng

ng

ng

ng ki

ki

ki

ki

m

m

m

m r

r

r

r

a

a

a

a tay

tay

tay

tay -

-

-

-

i

i

i

i g

g

g

g

ng

ng

ng

ng

ph

ph

ph

ph

u

u

u

u thu

thu

thu

thu

t

t

t

t

TTTTTTTT NNNNiiii dungdungdungdung CCCC KhKhKhKhngngngng GhiGhiGhiGhi chchchch1 C sn x phng chn, bn chi v khun, khn

kh v khun.2 Nc sch c vi, ng m khng dng bn

tay.3 Khng eo trang sc, mng tay ct ngn.4 Lm t cng tay v bn tay, dc bn tay, c

tay nc chy xung.5 Dng bn chi, x phng chi k bn tay, u

ngn tay, k mng tay, cng tay, khuu tay.6 Ra tay 3 ln mi ln 3 - 5 pht.7 Khng c chm tay vo bt k vt g.8 Trng bn tay, cng tay bng nc sch,

ngc ngn tay. 2 bn tay cao hn khuutay.

9 Lm kh tay bng khn v khun ri ngm tayvo dung dch st khun.

10 Khng s vo mt ngoi gng, khi eo ch cmvo c gng ln tri.

KKKKtttt lulululun:n:n:n: t Khng tNhNhNhNhnnnn nhnhnhnh

t:t:t:t: Thc hin y 10 im trong bng kim.KhKhKhKhngngngng tttt: Lm khng 10 im trong bng kim.

14

4. Quy trnh v khun dng c4.1.4.1.4.1.4.1. MMMMtttt ssss khkhkhkhiiii ninininimmmm cccc bbbbn:n:n:n:

B

B

B

B

ng

ng

ng

ng 4.

4.

4.

4. C

C

C

C

c

c

c

c kh

kh

kh

kh

i

i

i

i ni

ni

ni

ni

m

m

m

m c

c

c

c

b

b

b

b

n

n

n

n trong

trong

trong

trong v

v

v

v

khu

khu

khu

khu

n

n

n

n

V khun L nhng bin php phng nga s xm nhpca vi khun v cc mm bnh khc bng vicloi tr chng vi mc khc nhau trn b mtc th, c m b tn thng, v cc vt dng tipxc vi c th ngi v cc sinh vt khc.

St khun L qu trnh tiu dit phn ln cc vi khun vcc mm bnh khc bm vo y dng c va sdng xong trn c th ngi bnh.

Kh nhim L qu trnh tiu dit phn ln cc vi khun vcc mm bnh khc trn da, nim mc, v ccm b tn thng ca c th.

Lm sch L qu trnh vt l (c, ra bng nc, lau kh) loi b cc vt bn do bi, t hay mu vcht dch c th v cc vi khun hay cc mmbnh khc cn bm y /dng c

Kh khunmc cao

L quy trnh tiu dit phn ln cc loi vi khunv mm bnh khc nhng cha tiu dit ht ttc, c bit l nha bo.

Tit khun L qu trnh dit tt c cc vi khun v mmbnh khc, k c nha bo.

4.2.4.2.4.2.4.2. KhKhKhKh nhinhinhinhimmmm ddddngngngng cccc Kh nhim l bc u tin trong quy trnh v khun. Thit b: 1 x nha c quai xch vi chiu cao trn 35cm v mt gi

nha c quai hi nh hn lt vo x. Dung dch ha cht kh nhim: Chloramin 0,5% hoc

Glutaraldehyd. Dung dch ny s thay sau mi bui lm vic. Dng c sau khi lm th thut, phu thut phi cho ngay vo x, ngp

ht trong dung dch kh nhim, ngm trong 10 pht. Sau em ra rabng nc lnh.

4.3.4.3.4.3.4.3. LLLLmmmm sssschchchch ddddngngngng cccc Thit b: mt chu nha, vi nc sch, x phng, bn chi. Trong khi ra, ngi ra dng c cn i gng cao su v eo khu trang

trnh ly nhim. Dng bn chi v x phng nh sch dng c cho htmu v t chc c th bm li trn dng c.

C sch cc ni d bm bn nh rng, khe k ca dng c. Sau rasch x phng v lau kh bng khn sch. C ra di vi nc chy hiuqu hn c ra trong thng nc.

15

Yu cu: mu m v cc t chc t bo bm vo dng c nh rau thai,m, c... khng cn dnh li trn dng c.

4.4.4.4.4.4.4.4. KhKhKhKh khukhukhukhunnnn mmmmcccc caocaocaocao

Ng

Ng

Ng

Ng

m

m

m

m trong

trong

trong

trong h

h

h

h

a

a

a

a ch

ch

ch

ch

t

t

t

t

- Yu cu: cc dng c phi c ngm trong cc ha cht dng kh khunmc cao nh: Glutaraldehyd 2% hoc cc dung dch khc nhChloramin 0,5% trong 20 pht.

- Phng php ny p dng i vi cc dng c lm bng cht nha, cao su,khng p dng vi cc loi dng c bng kim loi, vi.

- Khi ngm phi dung dch ha cht ngp ton b dng c. Dng c vtra phi ra bng nc tit khun ri vo khay v khun c np y,lm kh ri mi s dng hoc bo qun.

Lu

Lu

Lu

Lu

c

c

c

c d

d

d

d

ng

ng

ng

ng c

c

c

c

- Thit b: hp luc dng c bng kim loi c np y kn, ln chadng c, di hp c h thng bp in hoc s dng mt bp ring (in,ga hoc du).

- Yu cu: dng c ra sch cho vo hp luc trn, nc sch vo hp saocho ngp cc dng c. Khi nc si, duy tr trong 20 pht, vt dng c dngngay khng c lu.

4.5.4.5.4.5.4.5. TiTiTiTitttt khukhukhukhunnnn

H

H

H

H

p

p

p

p

t

t

t

t

p

p

p

p l

l

l

l

c

c

c

c cao

cao

cao

cao

- Phng php ny dng cho tt c cc loi dng c y t tr nha (quno, gc, khn m, m, khu trang...) v cao su (sonde, gng cao su...). vi v cao su phi hp ring, v nhit , p sut, thi gian hp hailoi khc nhau.

- Thit b: ni hp t p lc cc loi.- Yu cu: khi nhit ln ti 1210C (p lc

1.5kg/cm 2 ) i vi dngc ng gi phi duy tr nhit nh vy trong 30 pht. i vi dng ckhng ng gi ch cn duy tr 20 pht.

S

S

S

S

y

y

y

y kh

kh

kh

kh

- Phng php ny ch dng cho cc dng c y t bng kim loi.- Thit b l t sy kh.- Yu cu:- Nu nhit 1700C phi duy tr 60 pht.- Nu nhit 1600C phi duy tr 120 pht.- Nhit 1500C phi duy tr 150 pht.- Nhit 1400C phi duy tr 180 pht.- Nhit 1210C phi duy tr 8 gi.

16

Ki

Ki

Ki

Ki

m

m

m

m tra

tra

tra

tra v

v

v

v

khu

khu

khu

khu

n

n

n

n

- Ngm trong ha cht: Sole, ng ht thai ngm trong 10 gi. Dng c vt raphi ra bng nc tit khun.- Kim tra dng c- Kim tra xem v khun cha? Trc khi hp, sy, dn mt giy bo

hiu an ton (trng) vo hp hay gi .- Sau khi hp hoc sy xong nu giy bo hiu i mu (en) l dng

c hp sy t yu cu.- Sau khi kim tra phi ghi r ngy v tn ngi hp sy dng c vo cc

hp v gi .

5.5.5.5. BBBBoooo ququququnnnn ddddngngngng cccc vvvv khukhukhukhunnnn- Ni bo qun dng c v khun phi sch s, kh ro, c ca ng kn.- C gi k v t ng dng c, c s sch ghi chp tn dng c, ngy x l

v khun, ngy nhp, xut dng c (ch nguyn tc nhp trc xuttrc).

- Khng ln dng c tit khun vi dng c cha tit khun.- Thi gian bo qun:- Khng bo qun nhng dng c tit khun m khng ng gi (loi ny

cn phi dng ngay sau khi tit khun).- Dng c kh khun cao ch c s dng trong vng 3 ngy.- Nhng dng c tit khun c ng gi hoc t trong hp tit khun,

c bo qun mt tun, sau mt tun nu cha dng cn phi hp sy li.- Khi vn chuyn dng c tit khun t ni bo qun n phng th thut

phu thut, phi che y trnh nhim bn.

B

B

B

B

ng

ng

ng

ng 5-

5-

5-

5- B

B

B

B

ng

ng

ng

ng ki

ki

ki

ki

m

m

m

m qui

qui

qui

qui tr

tr

tr

tr

nh

nh

nh

nh v

v

v

v

khu

khu

khu

khu

n

n

n

n d

d

d

d

ng

ng

ng

ng c

c

c

c

NNNNiiii dungdungdungdung CCCC KhKhKhKhngngngng GhiGhiGhiGhi chchchch1.1.1.1. KhKhKhKh nhinhinhinhimmmm- C sn dung dch Chloramin 0,5%.- Cho dng c ngp hon ton trong dung dch.- Ht dung dch chlorine vo bm v cc vt hnh ng

ri sc.- Tho ri cc dng c.- Ngm trong 10 pht.2.2.2.2. LLLLmmmm sssschchchch- Ra cc dng c bng x phng v nc sch.- Lm sch cc khp ni dng c.- Dng bn chi c ra cc dng c.- Sc cc vt hnh ng v bm tim.- Trng bng nc sch.3.3.3.3. KhKhKhKh khukhukhukhunnnn mmmmcccc caocaocaocao bbbbngngngng lulululucccc- Cho dng c ngp hon ton trong nc.- Bt u tnh gi t lc nc si.- un si trong 20 pht.

17

NNNNiiii dungdungdungdung CCCC KhKhKhKhngngngng GhiGhiGhiGhi chchchch- Ly cc dng c bng kp v trng v cho vo hp

ng c kh khun.- dng c t kh.- Bo qun trong hp ng c kh khun v c

np y.4.4.4.4. KhKhKhKh khukhukhukhunnnn mmmmcccc caocaocaocao bbbbngngngng hohohoho chchchchtttt- Cho dng c ngp hon ton trong dung dch kh

khun thch hp.- Ngm trong 20 pht.- Trng sch bng nc un si ngui v hong kh.- vo hp kh nhim c np y.5.5.5.5. HHHHpppp tttt- Gi dng c.- Xp ri nhau trong ni hp.- Vn hnh theo s hng dn ca ni sn xut.- Kh trng trong 30 pht cho cc dng c c gi v

20 pht cho cc dng c khng c gi 21oC (psut 1,5 kg/cm2).

- Ct dng c trong hp v khun v c np y.6.6.6.6. SSSSyyyy khkhkhkh- Dng c sau khi ra sch, lau kh cho vo hp c

np, tng b ring.- Bt u tnh gi khi nhit ln .- Thi gian v nhit chun: 170oC trong 1 gi.- Ct dng c trong hp v trng c np y.7.7.7.7. ThThThThiiii hhhhnnnn ssss ddddngngngng

---- Dng c kh khun cao ch c s dng trong 3ngy.

---- Dng c luc ch s dng trong 24 gi.

- Dng c tit khun c bo qun 1 tun.- Bt k dng c no m ti ch dng trong vng 24

gi.

TTTTiiii lilililiuuuu thamthamthamtham khkhkhkhoooo1. Qui nh chun mc v khun trong dck v KHHG (s 1267 BYT/Q

ngy 31 thng 12 nm 1994).2. Modul 2 - Khng ch nhim khun.3. Chng trnh Sc kho sinh sn - B Y t, Ti liu hun luyn ton din v

Sc kho sinh sn.

18

B

B

B

B

i

i

i

i 3

3

3

3

GiaoGiaoGiaoGiao titititipppp vvvviiii khkhkhkhchchchch hhhhngngngng vvvv giagiagiagia nhnhnhnhtrongtrongtrongtrong ccccpppp ccccuuuu ssssnnnn khoakhoakhoakhoa


Sau

Sau

Sau khi

khi

khi

khi k

k

k

k

t

t

t

t th

th

th

th

c

c

c

c b

b

b

b

i

i

i

i h

h

h

h

c

c

c

c n

n

n

n

y,

y,

y,

y, h

h

h

h

c

c

c

c vi

vi

vi

vi

n

n

n

n ph

ph

ph

ph

i:

i:

i:

i:

1. K c cc k nng cn thit khi giao tip vi khch hng v gia nh htrong cc dch v chm sc sn khoa cp cu (SKCC).

2. Thc hnh c vic trao i vi khch hng v gia nh h trong mt stnh hung c th vi cc k nng hc thng qua ng vai.

PhPhPhPhngngngng titititinnnn ddddyyyy hhhhcccc- Giy con.- Bng, bt d.- Giy trong, ba mu.

KKKK hohohohochchchch bbbbiiii hhhhc:c:c:c: (thi gian 2 tit)


ThThThThiiiigiangiangiangian(Ph(Ph(Ph(Pht)t)t)t)

PhPhPhPhngngngng phphphphp,p,p,p,phphphphngngngng titititinnnn ddddy/y/y/y/

hhhhcccc



MMMMcccc titititiuuuu 1:1:1:1: K c cc k nng cn thit khi giao tip vi khch hng v gianh h trong cc dch v chm sc sn khoa cp cu.Nhng nguyntc khi thc hnhgiao tip:

Cc k nng giaotip c bn:

10

20

Thuyt trnh ngn cminh ho trn giytrong.Gi tho lun.

Tho lun nhmnh ti ch:

ng nodn giy:

Mt HV tphp li cc kinging nhauxp thnhnhm.

GV nhnxt v bsung honchnh nidung.

MMMMcccc titititiuuuu 2:2:2:2: Thc hnh c vic trao i vi khch hng v gia nh h trongmt s tnh hung c th vi cc k nng c th thng qua ng vai.BBBBiiii ttttpppp ngngngng vaivaivaivaissss 1111:

30 Chia lp thnh nhm3 ngi, tho lun v2 nhm bc thm lnng vai.

Ni dungv khochng vai

19

BBBBiiii ttttpppp ngngngng vaivaivaivaissss 2222:

30 HV tho lun, rtkinh nghim theo shng dn ca GV.

trong bitp s1(trch trongEmOCtrang 49).

NNNNiiii dungdungdungdung bbbbiiii hhhhcccc

1.1.1.1. BBBBiiii ttttpppp ngngngng vaivaivaivai

HHHHngngngng ddddnnnnGing vin (GV) chia lp thnh cc nhm, mi nhm 3 hc vin (HV)

ng cc vai sau y: ngi cung cp dch v (BS hoc NHS), bnh nhn (BN)sau sinh b tai bin sn khoa (TBSK) v mt ngi trong vai ngi h tr i cngv BN. Ba HV ca mi nhm c k v tho lun vi nhau v tnh hung cnu di trong thi gian 5-10 pht, sau GV cho bc thm xem nhm noc ln ng vai trc lp. S HV cn li ca cc nhm khc quan st v gp kin nhn xt. Sau GV mi nhm th hai ln ng vai v cho lp hc tholun nhn xt nh gi. GV s cho lp tho lun cc cu hi (nu di y), tmtt kin nhn xt ca HV v phn hi cho h nhng iu h lm tt v rtkinh nghim v nhng iu cha tt.

1.11.11.11.1 BBBBiiii ttttpppp ngngngng vaivaivaivai 1.1.1.1.TrTrTrTrngngngng ttttm:m:m:m: S giao tip, trao i gia NHS ca trm y t vi BN v b dngian v nhng thng tin c a ra phi thch hp, gip vic h tr tnh cm vs an tm ca cc i tng c trao i.PhPhPhPhnnnn vai:vai:vai:vai: Ngi cung cp dch v: L mt BS hoc NHS c kinh nghim trong giao tip

vi BN v thn nhn gia nh hoc ngi h tr h tng BN. Bnh nhn: B A sinh con ti nh do b dn gian trc y 2 gi. Ngi h tr sn ph: B dn gian theo di v cho b A.

B A 36 tui, c mt b dn gian a n trm y t x v sau khisinh con ln th ba cch y 2 gi v b chy mu nng. Thi gian chuyn dko di 12 gi v theo b dn gian th khng c bin chng. NHS ca trm yt x khm ngay cho BN, iu tr chong v tnh trng t cung co hi km caSP. Mc du tnh trng chy mu gim ngay khi va n trm nhng t cungca b A th vn khng co li tt cho d xoa bp y TC v tim oxytocin. BA rt lo s khi phi chuyn ln BV x l thm. B dn gian cng lo lng vcm thy c li trong trng hp ca b A. NHS ca trm y t x phi gii thchv tnh hung ca b A v ca b dn gian v c gng h tr v tnh cm lmcho h yn tm cng nh chun b cho cuc vn chuyn BN ln BV.

CCCCuuuu hhhhiiii ththththoooo lulululunnnn sausausausau khikhikhikhi ngngngng vaivaivaivai

20

1- Ngi NHS ca trm y t x giithch v hon cnh ca b A v b dn gian cng nh vic cn thitphi chuyn bnh nhn ln Bnhvin nh th no?

2- Ngi NHS th hin s h trtnh cm v lm an tm nh th notrong khi tr chuyn vi b A v b dn gian?

3- Thi no ca b A v b dngian biu hin qua ngn ng ni vngn ng hnh th chng t hcm thy c h tr tnh cm vc an tm?

1.21.21.21.2 BBBBiiii ttttpppp ngngngng vaivaivaivai 2222TrTrTrTrngngngng ttttm:m:m:m: Cch ng x ca cn b y t, lm cho b B v ngi thn

trong gia nh h bit c con, chu h b d tt bm sinh, l s giao tip, traoi gia NHS vi sn ph v gia nh h. Nhng thng tin c a ra phi thchhp, gip vic h tr tnh cm v s an tm ca cc i tng c trao i k cvic iu tr d tt cho chu b th no. Mc tiu hc tp cao nht cn t c lb B v gia nh an tm chp nhn chu b v bit cch chm sc chu ng nnht.

PhPhPhPhnnnn vaivaivaivai Ngi cung cp dch v: Bc s hoc NHS va cho sn ph. Sn ph B va mi sinh con b d dng khng c pht hin t trc. Ngi thn trong gia nh: B chu b hoc m ca b B (b ngoi chu).

B B sinh con ln th hai ti bnh vin huyn, thng, khng c binchng. Chu b l con gi sinh ra khc ngay, nng 3000 gam nhng b d dngst mi v h hm ch. Thai b d tt khng c chn on t trc nn gy btng cho c b B, gia nh v nhn vin y t. Cuc giao tip din ra gia NHS lngi , b B v ngi thn trong gia nh b v d b chu b hoc b ngoica chu (m ca b B).1- NHS cho b B lm g c

th cho b B v gia nh tip cnchu b d tt?

2- NHS gii thch th no h trtnh cm v lm an tm b B v gianh trong khi tr chuyn vi h?

3- Thi no ca b B v gia nhbiu hin qua ngn ng ni v ngnng hnh th chng t h cmthy c h tr tnh cm v c antm?

21

2.2.2.2. BBBBngngngng kikikikimmmm vvvv tttt vvvvnnnn trongtrongtrongtrong ddddchchchch vvvv ccccpppp ccccuuuu ssssnnnn khoakhoakhoakhoaTTTTTTTT NNNNiiii dungdungdungdung CCCC KhKhKhKhngngngng GhiGhiGhiGhi chchchch

GGGGpppp gggg1111 Tip n, cho hi khch hng nim n, gy thin

cm h an tm ngay t khi tip xc. Mi khchhng ngi ngang hng vi ngi t vn.

2222 T gii thiu: tn, chc v, nhim v chnh ti cs y t ca ngi lm t vn.GGGGiiii hhhhiiii

3333 Hi tn, tui, a ch ca khch hng v l do cnt vn.

4444 Hi khch hng v hon cnh sinh sng, v gia nh,con ci, nhng thun li hoc kh khn chnh trongcuc sng ca khch hng (nu c).

5555 Hi v l do khch hng cn t vn.6666 T vn do khch hng t ra, gi hi thm cc

chi tit cn thit hiu r nhu cu ca khchhng; bit c nhn thc, quan nim, k c ni lolng ca khch hng.

7777 Thi thn mt, gn gi, lng nghe, quan tm,ng cm vi khch hng trong nhng vn hbiu l.GiGiGiGiiiii thithithithiuuuu ththththngngngng tintintintin

8888 Da trn nhu cu ca khch hng, cung cp nhngthng tin chnh xc, ph hp v cn thit chokhch hng.

9999 Cung cp thng tin tng vn v gii thiu ccgii php ngh khch hng suy ngh, la chn saocho ph hp vi hon cnh ca h.

10101010 Lun quan st thi c ch ca khch hng vthnh thong t cu hi cho khch tr li vnhng iu gii thiu nh gi h c hiung cc iu c nghe (phn hi).

11111111 Cn s dng tt c cc phng tin sn c vtruyn thng t vn ca c s kt hp vi phnngn ng gii thiu thng tin.GiGiGiGipppp

12121212 Gip khch hng hiu c thc cht vn tronghon cnh c th ca h t la chn mt gii phph cho l tt v ph hp vi h nht.GiGiGiGiiiii ththththchchchch

13131313 Gii thch y vi cch ni c th, d hiu, hnch t chuyn mn, ph hp trnh nhn thc cakhch hng v nhng gii php h la chn.

22

14141414 Cn phn tch rt khch quan mt thun li, uim v c cc mt khng thun li, nhc imca gii php khch hng chn la. Khng chni mt tt hoc ngc li ch ni mt khng tt.

15151515 Nu pht hin khch hng c nhng quan nimhay hiu bit cha ph hp v gii php h chpnhn th nh nhng gp , gii thch. Khng ct thi bc dc, coi thng h.

16161616 Khuyn khch khch hng t cu hi hoc ni ranhng suy ngh hoc thc mc ca h v nhngiu c gii thch.GGGGpppp lllliiii

17171717 Cn dn nhng trng hp c th cn tr li ngayc s t vn.

TTTTiiii lilililiuuuu thamthamthamtham khkhkhkhoooo1. Chng trnh Sc kho sinh sn B Y t, TTTTiiii lilililiuuuu huhuhuhunnnn luyluyluyluynnnn totototonnnn didididinnnn vvvvs

s

s

s

c

c

c

c kho

kho

kho

kho

sinh

sinh

sinh

sinh s

s

s

s

n.

n.

n.

n.

23

B

B

B

B

i

i

i

i 4

4

4

4

NHNHNHNH GIGIGIGI NHANHNHANHNHANHNHANH BANBANBANBAN UUUU VVVV XXXX TRTRTRTR CHOCHOCHOCHONGNGNGNG


Sau

Sau

Sau khi

khi

khi

khi h

h

h

h

c

c

c

c xong

xong

xong

xong b

b

b

b

i

i

i

i h

h

h

h

c

c

c

c n

n

n

n

y,

y,

y,

y, h

h

h

h

c

c

c

c vi

vi

vi

vi

n

n

n

n ph

ph

ph

ph

i:

i:

i:

i:

1. M t c cc bc chn on nhanh ban u mt trng hp cp cu snkhoa.2. K c cc triu chng ca chong .3. M t c cch x tr mt trng hp chong bao gm x tr nhanh banu v iu tr tip tc.4. Gii quyt c tnh hung lm sng chong sn khoa theo bi tp tnhhung.5. Bc l c tnh mch theo ng bng kim trn m hnh.6. Thao tc x tr c mt trng hp chong qua ng vai.

PhPhPhPhngngngng titititinnnn ddddyyyy hhhhcccc: Bng, bt d, giy kh ln, giy trong, my chiu overhead, projecter, m hnh bc l tnh mch.

KKKK hohohohochchchch bbbbiiii gigigiging:ng:ng:ng: Thi gian 4 tit

NNNNiiii dungdungdungdung chchchch yyyyuuuu ThThThThiiiigiangiangiangian(ph(ph(ph(pht)t)t)t)

PhPhPhPhngngngng phphphphp,p,p,p,phphphphngngngng titititinnnnddddy/hy/hy/hy/hcccc


PhPhPhPhnnnnhhhhiiii

nhanhnhanhnhanhnhanhMucMucMucMuc titititiuuuu 1:1:1:1:M t c cc bc chn on nhanh ban u mt trng hpcp cu sn khoa.

1. nh gi h hhp.

2. nh gi h tunhon.

3. nh gi c quankhc.

10 Thuyt trnhMy chiuGiy trong

Nghe ging

MMMMcccc titititiuuuu 2:2:2:2: K c cc triu chng ca chong

4. Cc triu chngca chong:

nh ngha, cc triuchng...

10 t cu hiBng, bt vit.

ng no,tr li cuhi.

nh giqua cutr lica hcvin.

MMMMcccc titititiuuuu 3:3:3:3:M t c cch x tr mt trng hp chong bao gm x trnhanh ban u v iu tr tip tc.

24

5. X tr ban u mttrng hpchong.

6. iu tr tip tcchong.

7. X tr tip sau khiiu tr tch ccban u.

8. iu tr ccnguyn nhn.

20 t cu hi ng no,tr li cuhi.

nh gida trncu trli cahc vin.

MMMMcccc titititiuuuu 4:4:4:4: Gii quyt tnh hung lm sng

9. Nghin cu trnghp

50 Chia hc vinthnh hai nhm,mi nhm nghincu mt trnghp chong theohai tnh hunglm sng.

Hc vintho lun,sau trnhby trngiy khln.

Quan stccnhmtholun.

MMMMcccc titititiuuuu 5:5:5:5: Bc l tnh mch

10.K nng bc ltnh mch

45 Ging vin thaotc mu.Thc hnh lmsng.

Hc vinquan stging vinthao tc.Cc hc vinln lt thchnh.

nh giqua thchnh bcl tnhmchtrn mhnh, davo bngkim.

MMMMcccc titititiuuuu 6:6:6:6: Thao tc x tr c mt trng hp chong

11.Thao tc x trchong

45 -Chia nhmKch bn da trnhai tnh hunglm sng bnhnhn b chongdo mt mu vchong do nhimkhun.

Chia 2 nhmthc hnh xtr chongtheo hai kchbn cho sn

Da trnbngkimhngdn hctp x trchong.

NNNNiiii dungdungdungdung bbbbiiii hhhhcccc

1. nh gi nhanh ban u

25

1.1.1.1.1.1.1.1. nhnhnhnh gigigigi hhhh hhhh hhhhp:p:p:p: nh gi h h hp rt quan trng v ti cp, nungi bnh thiu oxy trong vng 3 pht c th nguy him n tnh mng.nh gi cc du hiu :

- Tm ti v mc , v tr : u chi, mi, nim mc mt- Mc kh th : Kh th th th ra hay ht vo, tn s th, co ko cc c

h hp.- Thm khm : nh gi mc xanh ti, do thiu oxy, nghe phi xem c

rale bt thng khng, v tr mt hay hai bn, nh gi thng thong ngth.

- Xc nh s b nguyn nhn gy chong+ Do thiu mu: Mt mu cp tnh do chy mu, bng huyt.+ Bnh l tim mch dn n suy tim, hen tim.+ Bnh l phi: Vim phi, hen ph qun, ph phi cp.+ Do chong phn v (d ng thuc).

1.2.1.2.1.2.1.2. nhnhnhnh gigigigi hhhh tutututunnnn hohohohonnnn- nh gi cc du hiu mch, huyt p (cc ch s).- Cc bnh l ca tim, mch nu c.- Tinh thn ca ngi bnh: Tnh to hay hn m, ht hong.- Da xanh ti hay hng ho.

1.3.1.3.1.3.1.3. nhnhnhnh gigigigi cccccccc tritritritriuuuu chchchchngngngng ccccpppp ccccuuuu khkhkhkhcccc- St: st bao nhiu , din bin ca st, km theo rt run khng? C

km theo cc triu chng nhim khun cc c quan khc khng nh nhimkhun ng tit niu, h hp hay nhim khun vng tiu khung.

- Ra mu m o: Ra mu trong thi k thai nghn hay ngoi thi k thainghn, hay sau , mc ra mu. Ra mu khi c thai c th do da sy thai, non, rau tin o, v t cung hay rau bong non. Ra mu sau c th do tcung bng huyt, st rau.

- au bng: cn xc nh bnh nhn c thai hay khng, au do thainghn hay khng, mc au, tnh cht au, v tr au.

2. Chong

nh

nh

nh

nh ngh

ngh

ngh

ngh

a

a

a

a : Chong l mt tnh trng suy sp tun hon do nhiunguyn nhn khc nhau, lm gim hoc ngng cung cp mu, oxy n nuidng cc c quan c bit l cc c quan quan trng nh tim, phi, no. y ltnh trng nguy him i hi nhn vin y t phi c thi x tr kp thi v tchcc mi c kh nng cu sng bnh nhn.

Trong sn khoa chong thng gp l chong do mt mu (bng huyt,sy thai...) hoc do nhim khun (ph thai nhim khun...).

2.1.2.1.2.1.2.1. BiBiBiBiuuuu hihihihinnnn- Mch nhanh nh (mch thng nhanh > 110ln /pht), c khi khng

u, mch ngoi bin khng bt c.- Huyt p tt < 90/60mmHg.- Da xanh ti (quanh mi, mi mt v lng bn tay ).

26

- V m hi.- Tay chn lnh do co mch ngoi vi.- Nhp th nhanh nng (nhp th thng trn 30 l/pht).- L m, vt v hoc hn m.- Thiu niu hoc v niu.- Tu tng nguyn nhn gy chong m c biu hin tnh trng chong

do nhim trng nhim c hay chong do mt mu.

2.2.2.2.2.2.2.2. TTTThhhhiiii xxxx trtrtrtr2.2.1

2.2.1

2.2.1

2.2.1 X

X

X

X

tr

tr

tr

tr

ban

ban

ban

ban

u

u

u

u

ng trc mt trng hp chong x tr tch cc ban u l rt quantrng nhm cu bnh nhn qua cn nguy kch.

- Ku gi mi ngi n gip , cng cp cu bnh nhn.- Kim tra cc du hiu sinh tn: Mch huyt p, nhp th , nhit .- m bo thng thong ng th bng cch cho bnh nhn nm t th

u nga thp (hoc quay v mt bn nu nh bnh nhn nn), t th nyng th s c thng thong, ng thi tim v no s nhn c nhiu muhn, ht m di nu bnh nhn tit nhiu m di v cho bnh nhn th oxyqua mi vi tc 6- 8l/pht. Ti tuyn x nu khng c bnh oxy c th chobnh nhn th oxy qua ti ng oxy, tt nht nn cho oxy i qua mt bnh chanc m bo m.

- B khi lng tun hon bng truyn tnh mch tc nhanh 60-80git/pht cc dung dch ng trng (Ringerlactat) hoc dung dch keo(Gelafuldin), khng nn dng cc dung dch ng bi ph li khi lngtun hon, trong trng hp nguy cp cn lp nhiu ng truyn cng mt lc.Tc truyn c th ti 1lt/15-20 pht, trong gi u tin phi truyn c 2 ltdch. C gng bi ph dch vi tc nhanh nu nh chong do chy mu vkhi lng dch b vo gp 2-3 ln khi lng dch mt. Trong trng hpkh ly tnh mch (v lc ny tt c cc mch mu u b xp xung) th phibc l tnh mch, tuyt i khng c gng b nc cho bnh nhn bng cch choung nc.

- Trong trng hp mt mu (do bng huyt) cn phi truyn mu chobnh nhn. Vic quyt nh truyn mu hay khng ch yu da vo xt nghimmu bao gm: s lng hng cu < 2tr, Hemoglobin < 5 g/100ml, Hematocrite 30ml/pht).- Nu tnh trng bnh nhn ci thin th tip tc iu tr duy tr, nng huyt

p v cn bng lng nc vo v ra, ng thi iu tr nguyn nhn gy chong.- Nu tnh trng bnh nhn khng ci thin th phi tip tc iu tr tch

cc, tip tc truyn dch.- Tip tc theo di truyn dch.- Lm cc xt nghim cn thit tin lng v chn on nguyn nhn.- Tu theo nguyn nhn m lc s tin hnh x tr theo nguyn nhn,

v d chong do nhim khun hu sn th phi m ct t cung. Chong dochy mu phi m tht ng mch t cung, h v hoc ct t cung tu tnghon cnh c th.

BBBBiiii ttttpppp ttttnhnhnhnh huhuhuhungngngng 1111: Chn on, x tr nhanh trng hp chong do bnghuyt sau .

28

T

T

T

T

nh

nh

nh

nh hu

hu

hu

hu

ng

ng

ng

ng: Sn ph A 37 tui c a n bnh vin trong tnh trng l m,ra mu m o rt nhiu, thm t ht qun, ngi nh khai sn ph thai lnth 4 ti nh trc 2 gi, rau bong ra ngoi nhng sau chy mu rtnhiu nn gia nh a n bnh vin ngay.

pppp nnnn

1. Bn phi lm g khi tipnhn ngi bnh?

- Nhanh chng tp trung mi ngi cnggip .

- nh gi tnh trng chong (mch,nhit , HA, nhp th...), tinh thn, mu sc da.

- Thng bo cho bnh nhn v ngi nhcc bc s lm, gii thch tnh trng bnh nhn.

- Nu bnh nhn hn m th phi tnm nghing, m bo thng thong ng th.

Khi khm cho bnh nhn bn thy:Nhit 37 0C, mch quay 120 ln/p, nh, huyt p tt 80/50 mmHg, th

nhanh 35 l/p, da xanh, lnh nim mc nht.2. Theo bn ch A gp phi

nhng vn g- Ch A b chong.

3. Bn phi lm g tiptheo?

- Chun b dng c v dung dch truyn,dch mn hoc ringerlactat. Tc truyn1000ml/15-20 pht.

- Ly mu lm xt nghim (hemoglobin,ng mu).

- Th oxy tc 5 lt/pht.- Thng i, o lng nc tiu.- Xc nh s b nguyn nhn.- Gi m.- K chn cao.

Tip tc thm khm thy:Ra mu m o rt nhiu, thm t ht qun, v bng v sinhT cung co rt km cao trn rn, mt mm

4. Bn lm g tip theo? Tisao

- Tip tc hi sc chng chong bngtruyn dch.

- Xoa y t cung cm mu.- Cho cc thuc tng co bp t cung.- Khi sn ph n nh hn c th phi

KSTC ly ht rau, mu cc.Sau 15 pht sau khi x tr tch cc nh gi li thy t cung co hi chc

hn, khng ra mu m o na, tuy nhin mch nhanh 110 l/p, huyt p 90/60mmHg, th nhanh 30 l/p.5. Bn s lm g tip theo? - Tip tc cho truyn dch.

- Th oxy 5l/pht.- Duy tr dch v thuc co hi t cung,

theo di co hi t cung.

29

- Nu c thiu mu cn xem xt truynmu.

- Theo di lng nc tiu.Ton trng sn ph A hi phc dn, tnh to hn, kt qu xt nghim

Hemoglobin l 70g/l, s lng nc tiu 1000 ml/24h.6. Bn g s lm g tip

theo?- Tip tc cho truyn mu.- Dng khng sinh.- Cho thuc co hi t cung.

BBBBiiii ttttpppp ttttnhnhnhnh huhuhuhungngngng 2222: Chn on v x tr chong do nhim khun

T

T

T

T

nh

nh

nh

nh hu

hu

hu

hu

ng

ng

ng

ng: Sn ph B 26 tui sau 5 ngy ti trm x x, sau v nh i lirt t, cng khng thay bng v sinh. Gia nh bnh nhn cho bit b st cch y2 ngy nhng gia nh ch cho chm mt v sau 1 ngy thy ngi mt nhiusau l m dn v gi hi khng bit nn c a n bnh vin.

pppp nnnn

1. Bn lm g khi tip cntnh hung ny?

- Nhanh chng tp trung mi ngi cnggip .

- nh gi tnh trng chong (mch,nhit , HA, th...), tinh thn, mu sc da.

- Thng bo cho bnh nhn v nginh cc bc s lm, gii thch tnh trng bnhnhn.

- t nm nghing, m bo thngthong ng th.

Khi khm cho bnh nhn bn thy:Nhit 400C, mch nhanh 130 ln/pht, huyt p 80/50 mmHg, nhp th

34 l/p, bnh nhn trong tnh trng hn m2. Theo bn sn ph B gp

rc ri no v ti sao?- Sn ph B b chong nhim khun

3. Bn s lm g? - Chun b dng c v dung dch truyn,dch mn hoc Ringer lactat.

- Ly mu lm xt nghim (Hemoglobin,ng mu).

- Th oxy.- Thng i, o lng nc tiu.- Xc nh s b nguyn nhn.- Gi m tuy nhin khng c qu nng.- K chn cao.

Tip tc thm khm cho bnh nhn B bn thy t cung to, mm ra mum o rt hi, hi chng bnh nhn th c bit khi ch cn b cho tay vot cung ly rau st nhng v nh ch khng ung khng sinh v cng khngv sinh g.

30

4. Nguyn nhn chnh nogy chong? Ti sao?

- Nguyn nhn ca chong do nhimkhun hu sn nng, do khng v sinh tt trongthi k hu sn.

5. Bn x tr tnh hungny nh th no?

- Thng bo tnh hnh cho chng bnhnhn

- Tim hydrocortisol 1000mg tnh mch- Dng khng sinh, kt hp lactam,

Aminoglycosid, Metronidazol, dng ng tnhmch.

- Cy sn dich, cy mu trc khi dngkhng sinh.

- Tip tc truyn dch nng huyt p.- Theo di nhit , ton trng (mch,

HA), s lng nc tiu.Sau 6 gi iu tr, nhit 380C, mch 100 l/pht, huyt p 100/60

mmHg, th 28 l/pht, bnh nhn tnh to hn6. Bn x tr tip tc nh

th no?- Tip tc theo di lng nc tiu.- Tip tc truyn khng sinh.- Thuc co hi t cung.

HNG DN HC TP X TR CHONG

HHHHngngngng ddddnnnn hhhhcccc ttttpppp xxxx trtrtrtr chochochochongngngng(Nhi(Nhi(Nhi(Nhiuuuu bbbbcccc ddddiiii yyyy ccccnnnn phphphphiiii ththththcccc hihihihinnnn ththththnhnhnhnh ththththo)o)o)o)CCCCcccc bbbbcccc ththththcccc hihihihinnnn nhnhnhnh gigigigi

XXXX trtrtrtr chungchungchungchung1. Nhanh chng huy ng, yu cu cc nhn

vin khc gip .2. Nh nhng thm hi bnh nhn.3. Nu bnh nhn vn tnh to v c th ni

chuyn th thng bo cho bnh nhn v nginh cc bc s tin hnh tip, lng nghe kin, tr li cu hi ca bnh nhn.

4. Thng xuyn ng vin an i bnh nhn.XXXX trtrtrtr ngayngayngayngay

1. Kim tra nhng du hiu sng:- Nhit - Mch- Huyt p- Nhp th

2. t bnh nhn nm nghing, thng thongng th, nu bnh nhn kh th cn hi sc.

3. Cho bnh nhn th oxy qua mt n hocqua xng tc 6 l/p.

4. p chn cho bnh nhn, gi m.

31

5. T th nm cao chn u thp nhm cungcp mu cho no.

LLLLyyyy mmmmuuuu llllmmmm xxxxtttt nghinghinghinghimmmm vvvv thaythaythaythay ddddchchchch truytruytruytruynnnn1. Ra tay bng x phng, lau kh hoc sy.2. Chun b dung dch truyn : mui ng

trng, Ringer lactate.3. Cm dy truyn v cho dch chy vo

ng.4. Chn im s ly tnh mch, nu kh

khn th bc l tnh mch.5. Qun garo trn ch s ly tnh mch.6. eo gng phu thut, tit trng.7. St khun vng da s ly tnh mch.8. S dng kim truyn hoc catheter.9. Ly mu mu lm xt nghim.10. Tho bm tim ra khi kim.11. Ni dy truyn vi kim.12. Dng bng keo c nh kim truyn.13. iu chnh tc truyn cho ph hp.14. Cho mu mu vo ng nghim lm xt

nghim.XXXXtttt nghinghinghinghimmmm ngngngng mmmmuuuu15. Nh 2 ml mu vo ng nghim thy tinh

lm xt nghim ng mu ti ch.- Dng bn tay gi cht ng nghim

gi nhit.- Sau khong 4 pht nghing ng nghim

xem mu ng cha.- C sau khong 1 pht th nghing ng

cho n khi mu ng hon ton c dc ngcng m mu khng chy ra.

- Nu mu khng ng hoc hoc khngvn cc sau 7 pht th chng t c ri lon ngmu.16. Vt b cht thai vo thng rc trc khi

tho gng tay.17. Thay gng v tin hnh cc bc v sinh,

tit trng khc.tttt ngngngng xxxxngngngng bbbbngngngng quangquangquangquang

1. i gng tit trng.2. V sinh b phn sinh dc ngoi.3. a ng thng qua niu o vo bng

quang sau ni ng xng vi ti nctiu, nh gi mu sc s lng.

32

4. C nh ng thng bng quang.5. Thay gng v ra tay.nhnhnhnh gigigigi lllliiii vvvv xxxx trtrtrtr titititipppp theotheotheotheo

6. Sau 30 pht kim tra li- Mch tr li bnh thng cha.- Huyt p tng ln.- Tinh thn n nh hn.- S lng nc tiu.

7. Nu bnh nhn hi phc tr li- iu chnh li lng dch truyn.- Tip tc theo di v x tr nguyn

nhn gy chong.8. Nu tnh trng bnh nhn khng c du

hiu hi phc tt ln- iu chnh tc v lng dch

truyn.- Tip tc cho th oxy.- Theo di st cc du hiu sng,

nc tiu.- Lm xt nghim b sung.

9. Thc hin mt s cc xt nghim khc,tm nguyn nhn x tr.

HNG DN HC K THUT BC L TNH MCH

Hng dn hc k thut bc l tnh mchCCCCcccc bbbbcccc TrTrTrTrngngngng hhhhppppChuChuChuChunnnn bbbb

Chun b phng tin cn thit bcl tnh mch.

Gii thch vi sn ph (v gia nh)nhng vic sp lm, lng nghe v tr li cccu hi v cc mi quan tm ca sn ph cngnh ca gia nh.

Lin tc h tr sn ph v mt tnh cmv lm an lng sn ph.

t thng tiu nu cn.eo khu trang, mang gng nu cn.

KKKK ThuThuThuThutttt- Xc nh v tr tnh mch hin trong.- Gy t ti ch bng dung dch

lidocain 0,5%.- Rch 2 cm ngang vung gc vi tnh

mch.- Dng kp khng rng tch t chc

33

di da bc l tnh mch.- Lun hai si ch vo di tnh mch

( c nh catheter), tht si ch v pha ngnchn.

- Rch mt ng nh dc tnh mch.- a catheter vo tnh mch.- Buc si ch cn li c nh

catheter.- Khu vt rch da.- Khu c nh catheter.- Kim tra tc truyn.

SauSauSauSau thththth thuthuthuthuttttTrc khi tho gng, b rc thi vo

mt hp hoc ti ng rc thi.Kh nhim dng c trong vng 10 p

bng dung dch chlorin 0,5%.Ngm c hai tay vo dung dch chlorin

0,5%. Tho gng bng cch lt t trong rangoi.

Nu khng dng li gng th b vo tinha ng rc thi.

Nu dng li gng th ngm trong dungdch kh nhim.

Ra tay bng bn chi vi dung dch stkhun hoc dung dch x phng, lau kh taybng khn sch hoc kh t nhin.

Ghi tin trnh th thut vo bnh n.

TTTTiiii lilililiuuuu thamthamthamtham khkhkhkhoooo1. WHO. X tr cc tai bin trong khi mang thai v sinh .2. B Y t. Hng dn chun quc gia v cc dch v chm sc sc khe

sinh sn.

34

B

B

B

B

i

i

i

i 5

5

5

5

ChChChChyyyy mmmmuuuu trongtrongtrongtrong ththththiiii kkkk uuuu thaithaithaithai nghnghnghnghnnnn

MMMMcccc titititiuuuu hhhhcccc ttttppppSau khi hc xong bi hc ny, hc vin phi:

1. Trnh by c cc du hiu, triu chng chy mu m o trong thi ku ca qu trnh thai nghn.

2. Chn on xc nh c cc nguyn nhn gy chy mu trong thi ku ca qu trnh thai nghn.

3. Trnh by c cch chm sc v x tr i vi tng nguyn nhn.

PhPhPhPhngngngng titititinnnn hhhhcccc ttttpppp- Bng, bt.- Giy trong, giy Ao, giy mu cc loi.- My chiu, Projector.

KKKK hohohohochchchch bbbbiiii gigigiging:ng:ng:ng: ThThThThiiii giangiangiangian 4444 tititititttt


ThThThThiiiigiangiangiangian(Ph(Ph(Ph(Pht)t)t)t)

PhPhPhPhngngngng phphphphp,p,p,p, phphphphngngngngtitititinnnn ddddy/y/y/y/ hhhhcccc

HoHoHoHottttngngngng hhhhccccvivivivinnnn


MMMMcccc titititiuuuu 1:1:1:1: TrTrTrTrnhnhnhnh bbbbyyyy dddduuuu hihihihiu,u,u,u, tritritritriuuuu chchchchngngngng chchchchyyyy mmmmuuuu mmmm oooo

M u. 5 ng no ,dn giy. Hc vinvit lngiy mu01nguynnhn chymu.

Quan sthc vin.Nhn xt .

MMMMcccc titititiuuuu 2:2:2:2: ChChChChnnnn oooon,n,n,n, xxxxcccc nhnhnhnh nguynguynguynguynnnn nhnhnhnhnnnnChy mu trongna u thai k.

25 c ti liu.Giy mu cc loi

Mi hcvin cti liu vphn tch.

MMMMcccc titititiuuuu 3:3:3:3: xxxxcccc nhnhnhnh ccccchchchch xxxx trtrtrtr iiii vvvviiii ttttngngngng nguynguynguynguynnnn nhnhnhnhnnnnTnh hung s 1 50 Bi tp tnh hung s 1.

Chia nhm, tho lun.Ging vin cung cp bitp tnh hungA0, bt vit, ba mu

Tho lunnhm .Bo co

Ging vintm tt vkt lun.

Hi -p

35

Tnh hung s 2 50 Bi tp tnh hung s 2.Chia nhm tho lun.Bo co,tm tt chnh.Giy Ao.Bt vit bng.Ba mu.

GV cungcp tnhhung.Chia 3nhm tholun.i dinnhm boco.GV hi,hc vintr li


Tnh hung s 3

---- T lng gi

45

5

Bi tp tnh hung 3.Tho lun nhm.i din nhm bo co.GV cung cp tnh hungth 3.

Ging vin ra cu hi.

Chia 3nhm tholun.i dinnhm boco.

Hc vintr li.


GiGiGiGiiiii thithithithiuuuu bbbbiiii hhhhccccTrong na u ca thi k thai nghn c 3 nguyn nhn gy chy mu :

- Do sy thai - Sy thai.- Cha ngoi t cung.- Cha trng.

Cn b y t cn phi pht hin c sm cc nguyn nhn x tr tuyn c s hoc chuyn tuyn kp thi.

NNNNiiii dungdungdungdung1. Do sy thai - Sy thai

nhnhnhnh nghnghnghnghaaaaSy thai l trng hp thai v rau b tng ra khi bung t cung trc 22

tun (k t ngy u ca k kinh cui).SSSSyyyy thaithaithaithai baobaobaobao ggggmmmm

- Do sy thai.- ang sy thai.- Sy thai hon ton.- Sy thai khng hon ton.- Sy thai nhim khun.

1.1.1.1.1.1.1.1. DoDoDoDo ssssyyyy thaithaithaithai1.1.1.

1.1.1.

1.1.1.

1.1.1. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng

ng

ng

ng c

c

c

c

n

n

n

n

ng

ng

ng

ng

36

- Tt kinh.- C triu chng nghn.- Ra mu m o s lng t.- au bng m hoc tng cn.

1.1.2.

1.1.2.

1.1.2.

1.1.2. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng

ng

ng

ng th

th

th

th

c

c

c

c th

th

th

th

- C t cung cn di, ng kn.- Kch thc thn t cung to tng ng vi tui thai.

1.1.3.

1.1.3.

1.1.3.

1.1.3. X

X

X

X

t

t

t

t nghi

nghi

nghi

nghi

m

m

m

m

- Xt nghim hCG bng que th nhanh dng tnh.- Siu m thy hnh nh ti i trn u, m vang thai v tim thai trong

bung t cung.

1.1.4.

1.1.4.

1.1.4.

1.1.4. X

X

X

X

tr

tr

tr

tr

-

-

-

-

Tuyn x

+ Nm ngh tuyt i, n nh, chng to bn.+ T vn cho bnh nhn v gia nh v nhng tin trin c th xy ra.+ Papaverin 40 mg x01 ng x 2 ln (sng, chiu) hoc ung 02vin x

2ln.+ Ba ngy khng phi chuyn ln tuyn trn.+ Nu au bng v ra mu tng phi chuyn tuyn trn ngay khng c

gi li tuyn c s, trc khi chuyn cho Papaverin 40 mg x 01 ngtim bp.

- Tuyn huyn

+ Nu mun gi thai Thuc gim co Papaverin 40 mg x 02 ng tim bp, chia lm 2 ln.

C th dng Sparmaverin hoc Spasfon. Nm ngh tuyt i, n nh, chng to bn.

+ Nu khng mun gi thai th chm dt thai nghn bng ht hay no.

1.2.1.2.1.2.1.2. angangangang ssssyyyy thaithaithaithai1.2.1.

1.2.1.

1.2.1.

1.2.1. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng

ng

ng

ng

- au bng nhiu vng h v, au tng cn.- Mu ra ngy cng nhiu, c khi chong.- Thm m o: c t cung xo, m, c th thy rau, thai hoc c t cung

hnh con quay v on di phnh to do khi thai xung on di.

1.2.2.

1.2.2.

1.2.2.

1.2.2. X

X

X

X

tr

tr

tr

tr

- Tuyn x: nu thai v rau thp th c t cung th dng tay hay kphnh tim ly thai ra ri chuyn tuyn trn, nu c chong truyn dch trong khichuyn tuyn hoc ch tuyn trn xung x tr.- Tuyn huyn

+ Nong c t cung nu cn ri gp bc thai ra, ht hay no.+ Nu c chong: truyn dung dch mn ng trng 0,9%.+ Cho oxytocin 5 n v x 1 ng tim bp sau no, c th cho oxytocin 2 ln

37

nu cn chy mu.+ Cho khng sinh : Amoxilin 500mg x 2 vin x 2 ln/ ngy x 5 ngy.

1.3.1.3.1.3.1.3. SSSSyyyy thaithaithaithai hohohohonnnn totototonnnn1.3.1.

1.3.1.

1.3.1.

1.3.1. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng

ng

ng

ng

- Thng gp khi sy thai trong 6 tun u.- Sau khi au bng, ra mu, thai ra c bc, sau ra mu t dn.- Khm thy c t cung ng, t cung co hi bnh thng.

1.3.2.

1.3.2.

1.3.2.

1.3.2. X

X

X

X

tr

tr

tr

tr

- Tuyn x

+ Cho ung khng sinh.+ T vn cho ngi bnh v ngh ngi, n ung, theo di nu c cc triu

chng bt thng nh: au bng, ra mu, st ti khm chuyn tuyn trn.- Tuyn huyn: Siu m bung t cung, nu sch khng cn ht hay no

li.

1.4.1.4.1.4.1.4. SSSSyyyy thaithaithaithai khkhkhkhngngngng hohohohonnnn totototonnnn :::: sssstttt rau.rau.rau.rau.1.4.1.

1.4.1.

1.4.1.

1.4.1. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng:

ng:

ng:

ng:

- Sau khi thai sy, mu vn ra.- Cn au bng.- C t cung m v t cung cn to.

1.4.2.

1.4.2.

1.4.2.

1.4.2. X

X

X

X

tr

tr

tr

tr

- Tuyn x

+ T vn.+ Cho khng sinh v chuyn tuyn trn.- Tuyn huyn

+ Cho khng sinh.+ Nu siu m thy bung t cung cn nhiu m vang bt thng th cn

tin hnh ht v no li hoc c th cho Misoprostol (c 3-4 gi cho ung400mcg. Ti a ch cho 3 ln). Ngy hm sau siu m kim tra li.

+ Nu khng c siu m, tin hnh ht hay no sch bung t cung i vitt c cc trng hp. Trc khi ht hay no cho oxytocin 5 n v x 1 ng timbp.

1.5.1.5.1.5.1.5. SSSSyyyy thaithaithaithai nhinhinhinhimmmm khukhukhukhunnnn1.5.1.

1.5.1.

1.5.1.

1.5.1. Tri

Tri

Tri

Tri

u

u

u

u ch

ch

ch

ch

ng

ng

ng

ng

- Thng sau mt ph thai khng an ton (khng bo m v khun) hocsy thai st rau.

- C t cung m.- T cung mm, n au.- Ra mu ko di v hi, c khi c m.- St cao, mt mi kh chu, tim p nhanh.

1.5.2.

1.5.2.

1.5.2.

1.5.2. X

X

X

X

tr

tr

tr

tr

38

- Tuyn x

+ T vn.+ Phi cho khng sinh Gentamycin 80 mg x 01 ng (tim bp) hoc+ Amoxilin500 mg x 02 vin (ung) v chuyn tuyn trn ngay.- Tuyn huyn

+ Cho khng sinh liu cao, phi hp.+ Nu mu chy nhiu, tin hnh hi sc v ht hoc no ngay.+ Nu mu ra t, dng khng sinh 4 6 gi sau ht hay no rau cn st

li trong t cung. Cho oxytocin 5 n v x 01 ng tim bp trc khi no.+ Trong trng hp chy mu v nhim khun nng phi tin hnh ct t

cung.T vn cho ngi bnh v gia nh nhng bin chng v tai bin nguy himc th xy ra cho ngi bnh. V vy, phi tun th nhng ch nh iu tr ca y,bc s.

2. Cha ngoi t cung (CNTC)2.1.

2.1.

2.1.

2.1.

nh

nh

nh

nh ngh

ngh

ngh

ngh

a

a

a

a v

v

v

v

ph

ph

ph

ph

n

n

n

n lo

lo

lo

lo

i

i

i

i

- CNTC l trng hp non sau khi th tinh khng lm t v pht trintrong bung t cung m pht trin bn ngoi bung t cung.

- CNTC c th gp :+ Vi trng: cha vi t cung l loi hay gp nht. Tu theo v tr ca phi

lm t trn on no ca vi t cung, ngi ta chia ra: CNTC k, CNTC eo,CNTC bng, CNTC loa.

+ Bung trng: cha bung trng t gp hn.+ Trong bng: cha trong bng cng rt t gp.+ ng c t cung: cha trong ng c t cung cng l loi rt him gp,

nhng rt nguy him v chy mu d di.- CNTC d l cha v tr no cng l mt tai bin v thai nghn c th gy

t vong cho ngi bnh. Ti vi t cung, CNTC ti y s lm vi t cung gincng ra v b v gy chy mu trong bng rt nng.

V vy: ChChChChaaaa ngongongongoiiii tttt cungcungcungcung llll mmmmtttt ccccpppp ccccuuuu ccccnnnn cccc phphphphtttt hihihihinnnn ssssmmmm vvvvggggiiii iiii iiiiuuuu trtrtrtr ssssmmmm cccc ssss cccc khkhkhkh nnnnngngngng phphphphuuuu thuthuthuthut.t.t.t.

2.2.

2.2.

2.2.

2.2. H

H

H

H

nh

nh

nh

nh th

th

th

th

i

i

i

i CNTC

CNTC

CNTC

CNTC

V hnh thi ca CNTC c th gp th cha v, th v gy lt mu trong bng, th huyt t thnh nang, th gi sy thai, th cha trong bng.

Ba hnh thi hay gp ca cha ngoi t cung l:

2.2.1.

2.2.1.

2.2.1.

2.2.1. Ch

Ch

Ch

Ch

a

a

a

a ngo

ngo

ngo

ngo

i

i

i

i t

t

t

t

cung

cung

cung

cung ch

ch

ch

ch

a

a

a

a v

v

v

v

- Triu chng c nng+ C chm kinh hoc ri lon kinh nguyt, c th c triu chng nghn.+ au bng m vng bng di v au v bn vi t cung c trng lm

t, thnh thong c cn au nhi.+ Rong huyt: mu ra t mt m o vi c im mu en, ln cn (nh

b c ph) v ra trong nhiu ngy.- Triu chng thc th

39

Thn t cung hi to hn bnh thng, cnh t cung c mt khi n, ranhgii khng r, n au. Khi khm ngn tay chm vo c t cung th au tng ln.

- Cn lm sng tuyn huyn xt nghim hCG bng que th nhanh cho kt qu dng

tnh. Nu siu m s khng thy hnh nh ti i hoc m vang thai nhi trongbung t cung; c th thy nhng m vang bt thng mt bn vi t cung.

- X tr+ Tuyn x: Khi nghi ng CNTC phi t vn v chuyn ngay ln tuyn trn,

ni c kh nng phu thut.+ Tuyn huyn: Chn on xc nh v m ct b khi thai CNTC.

2.2.2.

2.2.2.

2.2.2.

2.2.2. Ch

Ch

Ch

Ch

a

a

a

a ngo

ngo

ngo

ngo

i

i

i

i t

t

t

t

cung

cung

cung

cung v

v

v

v

(

(

(

( Th

Th

Th

Th

l

l

l

l

t

t

t

t m

m

m

m

u

u

u

u

b

b

b

b

ng)

ng)

ng)

ng)

- Nu CNTC cha v khng c pht hin v x tr th s n giai onvi t cung b v. Bnh cnh s din ra t ngt v rt nguy kch.

+ C cn au bng t ngt, d di, c th lm cho ngi bnh b ngt.+ Tnh trng b chong do mt mu: Xanh xao, nht nht, v m hi, lnh

tay chn, mch nhanh nh, huyt p h.+ Thm khm: Bng chng nh, nn au nhiu hn mt bn h chu (ni

c khi CNTC b v). Thnh bng c phn ng v cm ng phc mc, g cvng thp.

+ Khm m o thy c t cung ng c t huyt theo tay, cc ti cng yc bit ti cng sau phng v n ngn tay vo ngi bnh rt au (tht ln), tcung di ng nh bi trong nc.

- Thi x tr+ Tuyn x: Phi hi sc chng chong v phi chuyn i bng phng tin

nhanh nht n ni c kh nng phu thut gn nht hoc mi kp phu thut vhi sc tuyn trn xung x tr. Khi di chuyn cn c cn b y t i h tng vc thuc hi sc em theo.

+ Tuyn huyn: Phi hi sc chng chong v m ct khi thai cm mucng sm cng tt. C th truyn mu hon hi nu c iu kin.

B

B

B

B

ng

ng

ng

ng 6.

6.

6.

6. B

B

B

B

ng

ng

ng

ng ph

ph

ph

ph

n

n

n

n bi

bi

bi

bi

t

t

t

t CNTC

CNTC

CNTC

CNTC ch

ch

ch

ch

a

a

a

a v

v

v

v

v

v

v

v

v

v

v

v

KhiKhiKhiKhi chchchchaaaa vvvv KhiKhiKhiKhi bbbb vvvv- Chm kinh, ri lon kinh nguyt.- Tnh trng nghn.- au bnh m mt bn h chu,thnh thong au nhi.- Rong huyt: m o ra mu t mt,en, nhiu ngy.- C t cung ng ; chm vo ticng sau m o au tng ln, hocmt bn ti cng au.

- Trc c cc triu chng caCNTC cha v, t nhin xut hin:- Cn au d di.- Ton trng nguy kch do mt mu.- Bng c phn ng thnh bng, cmng phc mc. C TC ng, ti cngsau y, n vo rt au.

2.2.3.

2.2.3.

2.2.3.

2.2.3. Ch

Ch

Ch

Ch

a

a

a

a ngo

ngo

ngo

ngo

i

i

i

i t

t

t

t

cung

cung

cung

cung th

th

th

th

huy

huy

huy

huy

t

t

t

t t

t

t

t

th

th

th

th

nh

nh

nh

nh nang

nang

nang

nang

- Khai thc tin s bnh nhn c triu chng ca cha ngoi t cung.+ Ngi bnh xanh xao, thiu mu v lun au bng m h v, thng c

40

du hiu ri lon tiu tin, i kh, i rt do khi mu t chn p, c th c rilon i tin: to bn hoc hi chng gi l do khi huyt t ti cng sau kchthch v chn vo trc trng, c khi xut hin hi chng bn tc rut do quai rutb dnh gy nn.

+ Thm m o kt hp s nn bng thy c mt khi u h v, khng nnr ranh gii t cung, n vo khi bnh nhn au.

- X tr+ Tuyn x: nu pht hin c hoc nghi ng cn phi t vn v gi i

bnh vin sm v c th c hai bin chng xy ra: v gy chy mu li trong bng v nhim khun.

+ Tuyn huyn: chn on xc nh v m c chun b ly khi mu t,ct vi t cung v, khu p cm mu v dn lu khi tht cn thit. Nu thy khkhn th chuyn tuyn tnh hoc mi tuyn tnh n x tr. Cho khng sinh saum.

2.3.

2.3.

2.3.

2.3. Ph

Ph

Ph

Ph

ng

ng

ng

ng b

b

b

b

nh

nh

nh

nh

hn ch t l cha ngoi t cung cn phi t vn- Thc hin tt v sinh hng ngy, v sinh kinh nguyt, v sinh khi giao

hp, khi sy, trnh vim nhim.- Khm ph khoa nh k hoc c triu chng bt thng phi i khm ph

khoa ngay pht hin sm cc bnh vim nhim ng sinh dc v phi iutr tch cc.

- Khi c thai cn phi i khm sm ngay nhng ngy u thy chm kinh c th kp thi pht hin cc tai bin sm ca thai nghn, trong c changoi t cung.

- La chn bin php trnh thai thch hp hn ch t l no ht thai.- Dng khng sinh liu sau no sy, ph thai.

3. Cha trng3.1.

3.1.

3.1.

3.1.

nh

nh

nh

nh ngh

ngh

ngh

ngh

a

a

a

a

Cha trng l bnh ca rau thai trong gai rau thoi ha thnh cc timng nc. Cha trng bao gm cc triu chng sau:

- Triu chng c nng: ngi c thai b cha trng c 4 triu chng c nngthng gp

+ Mt kinh nh nhng trng hp thai nghn khc.+ Tnh trng nghn nng hn bnh thng: nn ma nhiu, mt mi, ngi

xanh xao, gy st, c khi xut hin y cc triu chng ca tin sn git nhcao huyt p, ph, protein niu.

+ Ra mu m o t mt, mu en, dai dng nhiu ngy, ban m muthng ra nhiu hn.

+ au bng (nu bt u hin tng sy trng).- Triu chng thc th: 4 triu chng thc th thng gp :+ T cung to hn tui thai (thai 2-3 thng nhng t cung to bng

thai 5-6 thng, tr cha trng thoi trin).+ Thm khm ngoi v khm qua m o u thy t cung mm.+ Nn qua thnh bng khng thy cc phn thai nhi (d t cung to).

41

+ Nghe tim thai khng thy.- Xt nghim :+ Th hCG trong nc tiu tng rt cao, gip chn on xc nh mt cch

chc chn.+ Siu m c hnh nh tuyt ri l hnh nh in hnh ca cha trng.

3.3.

3.3.

3.3.

3.3. X

X

X

X

tr

tr

tr

tr

- Tuyn x : t vn v chuyn ngay ln tuyn trn, khng c gi li theodi tuyn c s v c th gy sy trng bng huyt, nguy him cho ngi bnh.- Tuyn huyn

+ Xc nh chn on, chuyn tuyn tnh ngay c x tr sm v binchng ca cha trng ngoi tnh trng bng huyt nng khi sy trng, gychong c th t vong, cn c th bin thnh ung th rau.

+ Ch no ht trng khi ang sy v sau chuyn ngi bnh v bnhphm ln tuyn tnh.

+ Cn phi theo di, nhc nh ngi bnh i thm khm y , ng nhk tuyn trn v khng nn c thai trong vng 2 nm.

4. Kt lunTrong na u ca thi k thai nghn chy mu l du hiu nguy c cao

c th dn n cc tai bin nghim trng v c th gy t vong cho b m. Vvy hu ht cc trng hp chy mu phi c pht hin sm v chuyn lntuyn trn x tr kp thi.

BBBBiiii ttttpppp ttttnhnhnhnh huhuhuhungngngng1111.... TTTTnhnhnhnh huhuhuhungngngng ssss 1111

C A, 22 tui, 1 con, khng thy kinh nguyt 3 thng, b ra mu thm qua. Bt u t v tng nhiu vo hm nay, mu long ln mu cc kmtheo au bng di tng cn, mt mi.

Anh

Anh

Anh

Anh ch

ch

ch

ch

s

s

s

s

l

l

l

l

m

m

m

m g

g

g

g

trong

trong

trong

trong b

b

b

b

n

n

n

n b

b

b

b

c

c

c

c c

c

c

c

b

b

b

b

n

n

n

n sau

sau

sau

sau

y:

y:

y:

y:

BBBBcccc 1111:::: nhnhnhnh gigigigi banbanbanban u.u.u.u.CCCCuuuu hhhhiiii 1111: Bn lm nhngg nh gi ban u tnhtrng sc kho ca c A?

- Cho hi thn thin vi c A v nhngngi i cng c.

- nh gi nhanh nu c A b chong cn hisc/cp cu:+ Mch nhanh trn 90 ln/ph.+ Huyt p tm thu gim < 90mmHg.+ Nhit 370C.+ Ra m hi, da xanh.+ Th nhanh hoc khng tnh to.

- Thu thp thm thng tin v tin s:+ C sy ra thai khng?+ Tn sut, di k kinh.+ Bin php trnh thai hin ang s dng.+ Cc triu chng sn khoa khc (nu c).

42

CCCCuuuu hhhhiiii 2:2:2:2: Nguyn nhn gychy mu cn phi loi trgm nhng nguyn nhnno?

- Sy thai (do sy, ang sy, sy thai honton, sy thai khng hon ton, sy thainhim khun).

- Thai ngoi t cung.- Cha trng.

BBBBcccc 2222:::: ChChChChnnnn oooonnnn xxxxcccc nhnhnhnh nguynguynguynguynnnn nhnhnhnhnnnn ggggyyyy chchchchyyyy mmmmu.u.u.u.- Hi tin s v bnh s: C A c kinh nguyt u, chu k 30 ngy, ra kinh

5 ngy, c mt con 2 tui v khng s dng bin php trnh thai. C A thybun nn t 2 thng trc v khng thy du hiu nghn khc. C thy ra muv cho bit c ra mt t t chc mm, vo sng nay.

- Khm thc th+ C A hon ton tnh to v da khng xanh. Mch 100 ln/pht,

HA110/70 mmHg, nhp th 25 l/ph, nhit 370C.+ Khm bng: khng au, khng c khi u, t cung khng s thy.+ Khm m o: thy c chy mu nhiu, c mu cc, c t cung

m 2cm, thy m rau thai thp th l ngoi c t cung, c t cung v phn phkhng au. T cung to bng thai 8 tun.

BBBBcccc 3333:::: ChChChChmmmm sssscccc vvvv xxxx trtrtrtrCCCCuuuu hhhhiiii 4:4:4:4:Da theo chn on trnk hoch chm sc v x tr cho cA l nh th no ?

- H tr tm l, ng vin v gii thchcho c A.- Cn lm sch v ht sch bung tcung ngay.- Tip tc theo di cc du hiu sinhtn khi lm th thut v cho n 2 gisau th thut.

BBBBcccc 4444:::: nhnhnhnh gigigigi kkkktttt ququququ chchchchmmmm sssscccc vvvv xxxx trtrtrtr3 gi sau th thut, c A phc hi tt, mch 80l/ph, HA 120/70 mmHg,

nhp th 18 l/ph, nhit 370C, ra mu rt t. C sn sng ra vin.CCCCuuuu hhhhiiii 5:5:5:5: Theo kt qu trn, khoch chm sc tip theo cho c Al g? Ti sao?

- Tnh trng n nh cho ra vin.- Cn tr li khm ngay nu c: aubng, ra mu ko di, ra mu nhiu,ngt, st rt run hoc lnh.- ng vin c A v kh nng cthai ln sau v c khuyn nn honc thai cho n khi hi phc.

CCCCuuuu hhhhiiii 3:3:3:3:Theo kt qu trn chnon l g?

- Triu chng v du hiu ca c Al ph hp vi chn on ssssyyyy thaithaithaithai khkhkhkhngngngnghohohohonnnn totototonnnn (tt kinh, ra mu nhiu, aubng tng cn, c t cung m, c t chcthp th c t cung, t cung nh hntui thai).

43

- T vn v cc bin php trnh thaiph hp.- Xc dnh s dng cc dch vCSSKSS khc m c A c th c nhucu (khm v iu tr vim nhimng sinh dc, tim phng).

CCCCuuuu hhhhiiii llllngngngng gigigigi1. Hy k 3 nguyn nhn chy mu trong na u ca thai k

A................................B................................C...............................

2. Hy k 3 triu chng ca sy thai st rauA..................................B..................................C..................................

3.3.3.3. Hy k 5 triu chng chnh ca c AA.............................B.............................C.............................D............................E.............................

4. Chn on xc nh bnh ca c A l g?5. Trnh by cch x tr cho c A tuyn x

A...........................B...........................C..........................D..........................

pppp nnnnCu 1.

A. Do sy thai Sy thai.B. Cha ngoi t cungC. Cha trng

Cu 2. A. Sau sy cn ra mu ko diB. Cha ngoi t cung.C. C t cung m v t cung cn to.

Cu 3. A. Sy thai st rau.B. Ra mu tng.C. au bng tng cn.D. Ra mt t chc mm, .E. C t cung m v rau thai thp th.

Cu 4. Sy thai st rau.

44

Cu 5. A.T vn.B. cho khng sinh.C. C th ly t chc rau thp th bng 2 ngn tay hoc kp hnh

tim.D. Chuyn tuyn trn.

2.

2.

2.

2.

TTTTnhnhnhnh huhuhuhungngngng ssss 2222Ch B 30 tui, c thai ln th 4, mt kinh 3 thng, ra mu t 4 ngy nay.

Ch khng mun gi thai ny. Ch c b lang vn cho t thuc vo mo. Ch B thng bo c ra mu t khi t thuc . T ngy hm qua s chymu tng dn, ch thy au qun bng di, sy ra thai, mt mi v chng mt,st 39o.BBBBcccc 1111:::: nhnhnhnh gigigigi banbanbanban u.u.u.u.

CCCCuuuu hhhhiiii 1:1:1:1: Khi nh gi ban uv tnh trng sc kho ca ch Bbn lm nhng g? Ti sao?

- Cho hi ch B v chng ch n cn vlch s.- Thng bo v nhng g s c lmsp ti v gii p nhng cu hi ca haiv chng h yn tm.- nh gi nhanh cc du hiu sinh tn cn iu tr cp cu/ hi sc (mchnhanh > 90 l/ph, HA tm thu

45

hn tui thai, cng au.BBBBcccc 3333:::: ChChChChmmmm sssscccc vvvv xxxx trtrtrtrCCCCuuuu hhhhiiii 4:4:4:4: Da theo chn ontrn k hoch chm sc v x trcho ch B nh th no? Ti sao?

- Nu trm y t x cho ung khngsinh, chng chong (nu c) v chuyntuyn trn ngay.- Tim tnh mch ngay Ampicillin 2 g6g/ln v Gentamycin 5mg/kg cn nng24g/ln v Metronidazol 500 mg 8g/l.- Cn iu tr chong nu c.- Ch B cn c khm kim tra tcung, m o, i trng. Nu c tnthng cn c chuyn m ngay.- m o cn phi c v sinh, stkhun cn thn, ly cc vt hoc thucl c trong m o.- Cn lm sch bung t cung ngay bnght chn khng.- ng vin v gii thch cho ch B vgia nh v nhng lo lng.

Bc 4: nh gi kt qu chm sc v x tr.Tnh trng sc kho sau x tr ca ch B tin trin kh dn ln. Dch m

o t dn sau 2 ngy iu tr, nhit 370C, mch 86l/ph, HA 110/70mmHg,nhp th 18 l/ph, khng au bng, i tiu tin bnh thng.

CCCCuuuu hhhhiiii 5:5:5:5: Da theo kt qu trnk hoch chm sc tip theo choch B l g? Ti sao?

---- Cn dng khng sinh sau khi ht sttrong 48 gi.- Ch B cn phi ti khm ngay nu ccc du hiu: au qun bng ko di qumt vi ngy, ra mu ko di trn 2tun, ra mu nhiu hn mu kinh, ngt,st rt run hoc kh chu.- Ch B cn c t vn ph thai khngan ton, t vn KHHG v cung cpbin php trnh thai cho ch B trc khira vin (nu khng mun c thai).- Nu mun c thai, ch B cn c giithch v kh nng c thai v khuynkhch hon c thai cho n khi honton hi phc.- Xc nh s dng cc dch v CSSKSSkhc (iu tr vim nhim ng sinhdc, cc bnh ly truyn qua ng tnhdc, tim chng).

46

CCCCuuuu hhhhiiii llllngngngng gigigigi1. Hy k 6 triu chng chnh ca ch B

A..................................B..................................C....................................D...................................E....................................F..................................

2. Chn on xc nh bnh ca ch B l g?3. Trnh by cch chm sc v x tr bnh ca ch B tuyn huyn

A................................B................................C...............................D..............................E..............................F...............................

pppp nnnnCu 1 A. C thai 3 thng khng mun .

B. Chy mu m o.C. B lang vn t thuc.D. Sy thai st rau.E. St 39o.F. Dch m o c mu, mi hi.

Cu 2. Sy thai nhim khun.

Cu 3 A. T vn cho ch B v gia nh.B. Cho khng sinh phi hp trc 4 6 gi.C. V sinh st khun m o, c t cung.D. Ht bung t cung.E. Theo di chy mu v du hiu sinh tn.F. Hng dn bin php trnh thai.

3.

3.

3.

3. TTTTnhnhnhnh huhuhuhungngngng ssss 3333Ch B 20 tui, c thai ln th 2, n trm y t x 2 ngy trc y v ra

mu m o bt thng, au bng di v vng chu

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