higjena oralestandartet baze te kujdesit ne pacientet me disafagi
TRANSCRIPT
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HIGJENA ORALESTANDARTET BAZE TE KUJDESIT NE PACIENTET ME DISAFAGI
Punoi:Aldo KryekurtiPerparim Visha
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Pikat e Prezantimit
Informacion i Pergjithshem Praktikat Aktuale Metodat e Zbatimit Standartet e Higjenes Orale
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Perberesit per Zhvillimin e Standarteve ne Higjenen Orale
Literatura
Konsultat me spitalet e tjera per standartet,praktikat dhe eksperiancat e tyre
Konsultat me departamente te tjera me eksperience ne kete fushe (psh,Infeksionistet)
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Pse duhet ti kushtojme rendesi higjenes orale ?
Shumica e Pneumonive Nosokomiale shkaktohen nga aspirimi baktereve te shumuara ne orofaring dhe pjeset e siperme te traktit GI
Pneumonia Nosokomiale ze rreth 10-15% te gjithe Infeksioneve Nosokomiale dhe rreth 20-50% e tere pacienteve te infektuar bejne Exit si pasoje e ketyre infeksioneve
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Kolonizimi(shumimi) Bakterial ne oropharynx eshte nje faktor i rendesishem risku edhe per Pneumonite dhe Infeksionet e tjera Nosokomiale ne pacientet intubuar
Shumime te mikrobe patogjene pergjegjese per Pneumonite Aspirative jane gjetur dhe ne dhembet e pacienteve
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Si ndodh Pneumonia Aspirative?
Aspirim
+
Baktere Gram-
+
Sistem Imunitar i Dobesuar
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Kur ndodh ky kolonizim?
Ne 48 oret e para pas pranimit ne spital,flora oropharyngeale e pacientit te semure ndryshon..
nga streptococc gram+ i zakonshem streptococci mikrobet patogjene dentale ne
organizma gram – duke perfshire dhe patogjenet qe shkaktojne Pneumonite Aspirative dhe Pneumonite e lidhura me Aparaturat e Frymemarjes se Drejtuar
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Si mund te ndalojme kete ndryshim ne
floren orale dhe pharyngeale?
Nderhyrjet e thjeshta praktike (larja me furcen e dhembeve)
Perdorimi i preparateve farmakologjike anti-microbiale (psh. Chlorhexidene)
Perdorimi i kombinuar i te dyjave
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Kerkimet mbi Higjenen Orale
Vetem trajtimi i higjenes orale ul perhapjen e zhvillimin e Pneumonise me rreth 30%
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Praktika Aktuale te Kujdesit Oral
Protokollet per kujdesin oral kane ne pergjithesi si qellim konfortin e pacientit me teper se heqjen e mikrobeve.
Procedurat e thjeshte te kujdesit oral jane te bazuara ne me shume ne traditen e perditshme(larja e dhembeve)
Ne nje pasqyrim te plote te praktikave te lidhura me strategjite per parandalimin e Pneumonive Aspirative eshte vene re se edhe sepse higjena orale konsiderohet si procedure standarte ne kujdesin infermieror,ajo shpesh neglizhohet ose behet shpejt.
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Praktikat standarte te sigurimit te kujdesit oral ne pacientet me pamundesi gelltitje(Dysphagi)
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Standardet ne Repartet e Terapise Intensive
E aplikueshme ne pacientet e R.T.I perfshire pacientet me frymemarje te drejtuar
Sigurimi kujdesit oral nga Infermieret. Vleresimi kavitetit oral 2 here ne dite. Dokumentimi i gjendjes se kavitetit oral pas vleresimit
( psh.ngjyra dhembeve,misherat e dhembeve,ererat). Njoftimi per cdo ndryshim ne kavitetin oral (psh.
gjendja e dhembeve, abceset). Sipas protokollit,ne pacientet kritike,higjena orale duhet
te aplikohet cdo 4 ore.
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Mjetet
Furca dhembesh Solucion peroksid hidrogjeni Chlorhexidene 0.12% oral rinse Spatula te vogla me garze sterile ne fund Burim per aspirim
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Proceduraa.Larja me furce
1. Lani duart dhe vendosni dorezat2. Merni furcen e dhembeve dhe njomeni me
solucionin me peroxid hidrogjeni duke patur dhe sonden e aspirimit afer
3. Ferkoni dhembet e pacientit,misherat dhe brenda faqeve
4. Aspironi me kujdes ne zonat e pastruara5. Shpelajeni furcen ne uje dhe perseriteni
proceduren rreth 4-5 here
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Procedurab.Shpelarja me Chlorhexidene 0.12%1. Kontrollohet pacienti per alergji ndaj chlorhexidene2. Merni urdherin e mjekut per perdorimin e
chlorhexidene3. Mbushini kupen e vete medikamentit me rreth 15ml
chlorhexidene4. Zhytni spatulen e mbuluar me garze ne
chlorhexidene5. Ferkoni dhembet,kryesisht gjuhen,mishrat dhe gjith
hapesiren e gojes6. Aspironi ne rast nevoje7. Njomeni dhe zonen e buzeve
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Kundraindikime
Mos i shtoni medikamente apo pasta te tjera soluconit te chlorhexidines
Mos jepni Nystatin within 2 oreve te perdorimit te chlorhexidines,e ben Nystatinen te paefekteshme
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Ju faleminderit per
vemendjen.
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Pyetje?
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Referenca
• Gaynor, E. (2001). A Rational for Oral Care. Nursing Standard 15(43): 33-36• Grap, M.J. (2003). Oral Care Interventions in Critical Care: Frequency and Documentation. American journal of
Critical Care, 12(2): 113-119 • Langmore, S.E. et al. (1998) Predictors of Aspiration Pneumonia; How important is Dysphagia? Dysphagia 13:
69-81• Langmore, S.E. et al. (2002) Predictors of Aspiration Pneumonia in Nursing Home Residents. Dysphagia 17: 298-
307• Marik, P. & Kaplan, D. (2003). Aspiration pneumonia and dysphagia in the elderly. Chest. 124(1):328-336.• McNeil. H. E. (2000). Biting back at poor oral hygiene. Intensive and Critical Care Nursing, 16: 367-372• Mojon, P. (2002) Oral health and respiratory infection. Journal of the Canadian Dental Association. 68(6):340-345.• Mojon, P. & Bourbeau, J. (2003). Respiratory infection: How important is oral health? Current Opinion in
Pulmonary Medicine. 9:166-170.• Okuda, K et al. (1998, Feb). The efficacy of antimicrobial mouth rinses in oral health care. The Bulletin of Tokyo
Dental College. 39(1):7-14• Perry, A.G. et. Al., Clinical Nursing Skills Techniques, Fifth edition (2002) • Shay, K. (2000) Denture Hygiene: A review and update. The Journal of Contemporary Dental Practice. 1(2):1-8.• Terpenning, M. et al. (2001). Aspiration pneumonia: Dental and oral risk factors in an older veteran population.
JAGS. 49:57-563.• Terpenning, M. & Shay, K. (2002). Oral Health is cost-effective to maintain but costly to ignore. Editorial in JAGS,
50:584-585.• Trieger, N. (2004), Oral Care in the Intensive Care Unit, American journal of Critical Care, 13(1): 24-33• Yoneyama, T et al. (2002). Oral care reduces pneumonia in older patients in nursing homes. JAGS. 50:430-433.