Edema with pulmonary tuberculosis
1. Mode depends on the clinical form of tuberculosis andseverity of the course, development of complications, can be bed, half-bed, ward. Inpatient treatment of patients is carried out in specialized anti-tuberculosis hospitals, dispensaries. At VK + patients are in boxes, poluboksah, m / s observes the corresponding san.-epidemic. mode when working in the pits. Twice a day, in wards and boxes, a wet cleaning is carried out using des. means, quartz chambers, boxes. Patients are provided with individual pocket spittoons, one-third filled with 5% of r-rum chloramine, dishes are disinfected in 5% of chloramine for 1 hour.
2. Diet: table number 11, strengthened nutrition withincreased amount of B, F, V, vitamins, the diet should be at least 100-110 g protein, and with exhaustion, sluggish disease, decay of tissues, attenuation exacerbation - 120-140 g. (high protein content is necessary for replenishing it Increased disintegration, to restore tissues in the focus of infection, strengthen the body's defenses.Po antibiotic treatment increases the need for vitamins, so the diet is enriched with fresh vegetables, fruits, broth of wild rose. Receiving food - 5 times a day, it is necessary to diversify the power to exclude the frequent recurrence of dishes on the menu to quench your thirst with a strong perspiration use water with lemon, fruit drinks, juices, broth hips, table mineral waters..
3. Preparation for research:
2. a general blood test;
3. biochemical blood test;
4. R-graphy of the thoracic gland organs, tomography;
5. sputum analysis on VC, bacteriological, on sensitivity to antibiotics.
5. Provision of urgent first aid:
- with hemoptysis, pulmonary hemorrhage: - urgently to call the doctor, to create rest to the patient, to raise the head end of the bed, to forbid the patient to talk, drink, eat, send a sputum tray, cold to the chest, prepare haemostatic drugs, antitussives, narcotic analgesics (↓ DC activity), eufillin - for unloading a small circle.
6. Care for seriously ill: with a high fever, with severe symptoms of intoxication, the patient is considered seriously ill.
7. Monitoring the state: m / s should monitor the temperature, blood pressure, BH, pulse, for general condition, monitor the intake of medications - patients take medication in the presence of a nurse!
8. M / s must fulfill all appointments of a doctor, to own all kinds of injections, to comply with the San epidemiological regime in the department and when working with patients.
9. Prevention: in the system of measures for the prevention of tuberculosisdistinguish between general social and preventive, sanitary and hygienic measures - nonspecific prevention and specific. Nonspecific prevention includes:
- improvement of working and living conditions;
- rehabilitation of foci of tuberculosis infection;
- Sanitary clearance. work;
- Sanitary and veterinary supervision;
- early detection and cure of tuberculosis for the first time.
Specific prevention: in the hospital for 3-5 days to all healthy children (whenApgar score of 8-9 points) on the border of the upper middle third of the left shoulder, after treatment with 70% alcohol v / c injected with BCG vaccine (weakened bovine mycobacterium).
Revaccination is performed at intervals of 7 years (7, 14,) under the control of Mantoux test.
Mantoux test: to determine infection with tuberculosis and identify patients with high tuberculin sensitivity, to select individuals for vaccination with BCG. Tuberculin diagnostic is performed in / to with 2 TE (0.1 ml), put a test on the inner surface of the middle third of the forearm. Results are evaluated after 72 hours, measuring a millimeter ruler. If there is a knock-off reaction (0-2 mm), the reaction is negative, only hyperemia without infiltration or infiltration up to 5 mm is doubtful, an infiltrate of 5 mm or more is a positive reaction, a hyperergic reaction in an adult is more than 21 mm, in children 17 mm. The Mantoux test is conducted until 16 years, from the age of 16, an annual fluorographic examination.
Chemoprophylaxis is carried out in a tuberculosis dispensaryafter the examination, and then at school conducts school m / s (carried out for children and adolescents who are in contact with patients with tuberculosis, cured of tuberculosis for the prevention of recurrence).
"D" observation: In the TB dispensary, depending on the clinical form, complications, VC- or VC +, 7 groups of observation are isolated.
- in the polyclinic, the district therapist will have the faces of R (+); with radiological changes in lungs of non-tuberculous nature - these persons visit the phthisiatrician once a year.
- sputum: - boiling in 2% r-re soda 15 minutes;
- pour 5% of r-rum chloramine (1: 2) for 12 hours;
- fall asleep with chlorine lime 200 g / l for 1 hour.
After decontamination, sputum is drained into the sewer.
- spittoons: - boiling in 2% r-re soda 15 minutes (exempt from sputum);
- in the activated chloramine solution 1% - 1 hour.