CPR (cardiopulmonary resuscitation) NURSING emergencies

CPR (cardiopulmonary resuscitation) NURSING emergencies

heart, emergency, nursing sciences, pulmonary, resuscitation, CPR
CPR (cardiopulmonary resuscitation) NURSING emergencies heart, emergency, nursing sciences, pulmonary, resuscitation, CPR
DEFINITION

CPR is an emergency measures due to circulatory and respiratory failure, to be returned to the optimal function in order to prevent death.

OBJECTIVE CPR:

Preventing cessation or cessation of respiration and circulation menggembalikannya to their normal functioning.
Providing external assistance to the reduction of circulating and ventilation of clients who will experience cardiac arrest and stopped breathing through CPR
Giving oxygen to the brain, heart and other vital organs temporarily in emergency conditions until the arrival of the proper handling medic to restore normal heart function and ventilation in stopping breathing and cardiac arrest.

ASSESSMENT

Clients experiencing breathing stopped characterized by the absence of chest movement and breathing air flow of clients. Stopping breathing may occur in the state: drowning, stroke, foreign body obstruction, epoglotitis, operdosis drugs, electric shock, infarction mikard etc.

Clients had a cardiac arrest, characterized by carotid pulse was not palpable

NURSING DIAGNOSES

Cardic decline in output-related absence of pulse
Impaired gas exchange related to the inability to breathe spontaneously
Impaired gas exchange associated with airway obstruction

PLANNING

1. Preparation tool

Disposable gloves: Prevent cross-contamination between the rescuer and the victim
Face shield: Preventing microorganism contamination in the mouth at the time a member of respiratory assistance without tools.

2. Preparation of client

Explain to the family about the procedure and purpose
The client is given the position of sleeping in a safe and flat

IMPLEMENTATION

Danger That vigilance against the danger that the helper should use PPE before doing rescue and rescuers had to secure a place of danger that could aggravate the helper and the victim, after the place and secure environment, the victim is put on a flat, hard and away from danger.
Checking the response victim awareness or response can be done verbally want any non-verbal. Her call name Kornan example as father / ibuk and in a way the victim’s shoulder pat. If there is no response we can check awareness by providing a pain stimulus (the nipple).
Shout for help / call for help if the patient does not respond, we can yell ask TOLONGGG !! in the neighborhood. Or you can call the health service as well as members of the mark on the scene
Fixing the position of the patient to perform effective CPR action should the patient in the supine position and placed in posisirata and hard.
Adjust the position of auxiliary views knees at shoulder level with clients within a single cell, to the right client.
check pulse
Checking the pulse conducted to ascertain whether the victim’s heart was still beating or not the adults do pengecekkan in carotid arteries and the children performed in the brachial pulse checking.
Circulation (aid circulation) That conversion chest if the victim is not palpable pulse means the heart stopped beating it must be done emphasis / conversion chest as much as 30x.

Caranaya: helper position parallel to the victim’s shoulder, place the heel of one hand on the breastbone and then put the other hand over the hand that has been placed in the sternum (2 fingers below sipoedeus). After that hit the victim’s chest to keep the elbow straight, hit the victim’s chest to a depth of 1/3 of the thickness of the chest or 3-5 cm – 1-2 inches (adult victims), 2-3 cm (in children), 1-2 cm in infants.

Airway Control (A) is opened the airway, after a further compression of the airway open. Before opening the airway first have to examine the airway. This action aims to determine whether there is a blockage of the airway by a foreign object. If there is a blockage to be cleared in advance, if the blockage in liquid form can be cleaned with the index finger or middle finger covered with a piece of cloth, while obstruction by a foreign object can be scraped hard or using the index finger is bent. The mouth can be opened with a finger sweep technique where the thumb is placed opposite to the index finger on the victim’s mouth.

Once the airway is ensured free of obstruction foreign body, usually in an unconscious patient muscle tone disappears, then the tongue and epiglottis to close the pharynx and larynx, this is one of the causes of airway obstruction. Liberation of the airway by the tongue can be done by Chin-Press Forehead Lift or abbreviated ADTD (Head tild – chin lift) and maneuver Pendorongn Lower jaw (Jaw Thrust Maneuver).

Lift Chin – Press Dahi (ADTD)

This technique is performed on patients who did not experience trauma to the head, neck and spine.

Here’s how:

Place your hand on the patient’s forehead. Use the hand closest to the patient’s head.
Press the forehead slightly toward the back with your palms until the patient’s head pushed into the background.
Place the tip of the other fingers under the tip of the lower jaw bones.
Lift dahu forward, do this movement simultaneously forehead pressure, until the head of the patient in the position of maximum extension. In patients with infants and small children is not done until the maximum but a bit extensions only.
Keep your hand on the patient’s forehead to keep your head fixed to the rear.
Open the patient’s mouth with the thumb to press the chin.

2. Under the maneuver is pushing jaw (Jaw Thrust Manaeuver)

This technique is used in lieu of press technique forehead lift chin. Keep in mind this technique is very difficult to do, but it is a safe technique to open the airway for patients who suffered trauma to the spine. With this new technique means that patients with head and neck are made in a natural position / normal.

Here’s how:

Kneel on the upper side of the patient’s head helper put both elbows aligned with the position of the patient, both hands holding the sides of the head.
Both sides of the lower jaw is held (if the patient is a child / baby, use two or three fingers on the side of the jaw).
Use both hands to move the lower jaw forward position slowly. This movement pushing the tongue upwards so the airway open.
Maintain the position of the patient’s mouth remains open.
Breathing Support (B) or give artificial breathing

If the patient is still palpable pulse it is necessary to check whether it was breathing or not. Respiratory checks done by looking at the presence or absence of chest movement (look), listening to the sound of breathing (listen) and a blast of breath (feel). If the patient is not breathing pulsating heart but then only given artificial breathing just as much as 12-20 times per minute. Breathing assistance can be done through the mouth to mouth, mouth to nose or mouth to the stoma (hole made in the throat).

Mouth to mouth

Eliminating the use of it is an appropriate and effective to deliver air to the lungs of the patient. At the time of exhalation from mouth to mouth, the rescuer should take a deep breath first and mouth helper must be able to cover the whole mouth pasiendengan well to prevent leakage when mengghembuskan breath and rescuers had to shut the nostrils of victims / patients with thumb and forefinger to prevent air out the back of the nose.

2. Mouth-to-nose

Mechanical ventilation is recommended if the efforts of the patient’s mouth is not possible, for example in the mouth Trismus or where the victim suffered serious injury, and vice versa if it is through the mouth to the nose, the helper should close the mouth of the victim / patient.

3. Mouth-to-Stoma

Patients who experience laringotomi has a hole (stoma) that connect the trachea directly to the skin. If the patient has difficulty breathing then it should be done vent from the mouth to the stoma.

If the patient still beating heart and still breathing, the victim is tilted to the left (recovery position) so that when the vomiting did not occur aspiration.

Patients who stopped his pulse / no palpable pulse then no respiratory examination because it is definitely stopped breathing, rescuers after compression and open the airway immediately give artificial breathing 2 times. The ratio of compression: artificial airway in adults either 2 or 1 helper helper ratio of 30: 2.

The frequency of breaths given as follows:

Adults: 10-12x Respiratory / min, respectively 1.5-2 seconds
Child (1-8 yrs): 20x Respiratory / min respectively 1-1.5 seconds
Infants (0-1 yrs): more than 20x respiratory / min respectively 1-1.5 seconds
Newborns: Respiratory 40x / min, respectively 1-1.5 seconds

CPR performed every 5 cycles. (5 x 30 compression) + (5 x 2 breaths). giving artificial breathing only performed every 2 minutes. And after the patient pulsating pulse and breathing the patient is tilted to the left.

CPR actions may be terminated if:

Patients recover.
Helper fatigue.
Taken over by the same power or more highly trained.
If there is a sure sign of death, do not do CPR.

EVALUATION

Inspection client chest wall movement during the procedure of artificial respiration. Monitor the adequacy of oral clients.
Observas movement of breathing and carotid pulse.
Kaji CPR complications that can occur:

A broken sternum and ribs
Leaking lungs
Bleeding in the lungs or chest cavity
Cuts and bruises in the lungs
A tear in the liver

References:

Boswick, John A.1997. Intensive Care Darurat.Jakarta: EGC.

Dervish, dr. Allan & Means, dr. Lita, dkk.2007.Pedoman Pertama.Jakarta Aid: Red Cross Indonesia.

Juliansyah, Rahmat Aswin.2009.Napas Artificial (Cardiac Pulmonary Resuscitation) .In www. duniakeperawatan. wordpress. com/2009/02/28/143/(Diakses on 4 September 2014)

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