Tab 3.2 Gespecialiseerde verpleegkunde
Inhoudsopgave
1 Beademing via een beademingsmachine............................................................................................7
1.1 Inleiding........................................................................................................................................7
1.2 Beademingstoestel of ventilator...................................................................................................7
1.2.1 Beademingsslang...................................................................................................................7
1.2.2 Kunstneus..............................................................................................................................7
1.2.3 Werking.................................................................................................................................7
1.3 Mechanische ventilatie versus spontane beademing...................................................................7
1.4 Beademingsparameters................................................................................................................7
1.5 Niet getriggerde beademing tegenover getriggerde beademing..................................................8
1.6 Beademingsmodi..........................................................................................................................8
1.6.1 Invasieve beademing.............................................................................................................8
1.6.2 Niet invasieve beademing......................................................................................................9
1.7 Invloed positieve druk................................................................................................................10
1.8 Begrippen: ventilatie, diffusie en perfusie..................................................................................10
1.8.1 Ventilatie.............................................................................................................................10
1.8.2 Diffusie.................................................................................................................................10
1.8.3 Perfusie................................................................................................................................10
2 Drukmeting........................................................................................................................................11
2.1 Centraal veneuze drukmeting.....................................................................................................11
2.1.1 Inleiding...............................................................................................................................11
2.1.2 Meting centraal veneuze druk.............................................................................................11
2.1.3 Mogelijke indicaties.............................................................................................................11
2.1.4 Beïnvloedende factoren.......................................................................................................11
2.2 Arteriële drukmeting..................................................................................................................11
2.2.1 Niet-invasieve bloeddruk meting.........................................................................................11
2.2.2 Invasieve bloeddruk meting.................................................................................................11
2.3 Cardiac output............................................................................................................................12
2.3.1 Swan-Ganz-katheter............................................................................................................12
2.3.2 Pulse intermittent en continuous cardiac output (PICCO catheter).....................................12
2.4 Intracerebrale ventrikeldrukmeting (ICP en CPP).......................................................................13
2.4.1 Intracraniële druk (ICP): 8 – 15 mmHg.................................................................................13
2.4.2 Cerebrale perfusiedruk (CPP): > 70 mmHg..........................................................................13
2.5 Intra-abdominale drukmeting (IAP): 5 – 7 mmHg.......................................................................13
,3 Endoscopieën....................................................................................................................................14
3.1 Gastroscopie...............................................................................................................................14
3.1.1 Indicaties..............................................................................................................................14
3.1.2 Tegenindicaties....................................................................................................................14
3.1.3 Complicaties........................................................................................................................14
3.1.4 Plaatsing van een PEG Sonde...............................................................................................16
3.2 Endoscopische Retrograde Cholangio Pancreaticografie (ERCP)................................................16
3.3 Anusscopie..................................................................................................................................17
3.3.1 Indicaties..............................................................................................................................17
3.3.2 Tegenindicaties....................................................................................................................17
3.3.3 Complicaties........................................................................................................................17
3.4 Rectoscopie................................................................................................................................17
3.4.1 Indicaties..............................................................................................................................17
3.4.2 Tegenindicaties....................................................................................................................17
3.4.3 Complicaties........................................................................................................................17
3.5 Colonoscopie..............................................................................................................................17
3.5.1 Indicaties..............................................................................................................................18
3.5.2 Tegenindicaties....................................................................................................................18
3.5.3 Complicaties........................................................................................................................18
3.5.4 Lichamelijke voorbereiding..................................................................................................18
3.6 Laparascopie...............................................................................................................................18
3.6.1 Indicaties..............................................................................................................................18
3.7 Rhinoscopie................................................................................................................................18
3.8 Pharyngoscopie..........................................................................................................................19
3.9 Laryngoscopie.............................................................................................................................19
3.9.1 Indicaties..............................................................................................................................19
3.10 Tracheoscopie...........................................................................................................................19
3.11 Bronchoscopie..........................................................................................................................19
3.11.1 Indicaties............................................................................................................................19
3.11.2 Tegenindicaties..................................................................................................................19
3.11.3 Complicaties......................................................................................................................20
3.12 Mediastinoscopie......................................................................................................................20
3.12.1 Indicaties............................................................................................................................20
3.13 Pleuroscopie.............................................................................................................................20
3.14 Urologisch stelsel......................................................................................................................20
3.14.1 Indicaties............................................................................................................................20
, 3.14.2 Tegenindicaties..................................................................................................................20
3.14.3 Complicaties......................................................................................................................20
4 Punctie...............................................................................................................................................21
4.1 Botpunctie..................................................................................................................................21
4.1.1 Botbiopsie en beenmergonderzoek.....................................................................................21
4.1.2 Intraosseus infuus................................................................................................................21
4.2 Leverpunctie...............................................................................................................................21
4.3 Puncties nefrologie-urologie.......................................................................................................22
4.3.1 Pericutane nierpunctie voor biopsiename...........................................................................22
4.3.2 Transjugular nierpunctie voor biopsiename........................................................................22
4.3.3 Transperianale prostaatpunctie voor biopsiename.............................................................22
4.4 Ascitespunctie.............................................................................................................................22
4.5 Lumbaalpunctie..........................................................................................................................22
4.6 Pericardpunctie...........................................................................................................................23
4.7 Pleurapunctie..............................................................................................................................23
5 Farmacologie.....................................................................................................................................24
5.1 De keten van geneesmiddelenvoorziening in het ziekenhuis.....................................................24
5.2 Medicatiefouten herkennen.......................................................................................................24
5.3 Farmacokinetiek en dynamiek....................................................................................................25
5.3.1 Farmacokinetiek..................................................................................................................25
5.3.2 Geneesmiddeleninteractie...................................................................................................25
5.3.3 TPN......................................................................................................................................28
5.3.4 Chemotherapie....................................................................................................................30
6 Onderwaterdrainage.........................................................................................................................32
6.1 Anatomie....................................................................................................................................32
6.2 Ingrepen op de longen................................................................................................................32
6.2.1 Pneumectomie.....................................................................................................................32
6.2.2 Lobectomie..........................................................................................................................32
6.3 Complicaties na longinterventies................................................................................................32
6.3.1 Bloeding...............................................................................................................................32
6.3.2 Pneumothorax.....................................................................................................................32
6.3.3 Subcutaan emfyseem..........................................................................................................32
6.3.4 Atelectase............................................................................................................................32
6.3.5 Empyeem.............................................................................................................................33
6.4 Traumata....................................................................................................................................33
6.4.1 Thoracale contusies.............................................................................................................33
, 6.4.2 Open of penetrerende traumata.........................................................................................33
6.4.3 Intra thoracale traumata.....................................................................................................33
6.4.4 Pneumothorax.....................................................................................................................33
6.4.5 Spanningspneumothorax.....................................................................................................33
6.4.6 Haemathorax.......................................................................................................................34
6.4.7 Doel thoraxdrainage............................................................................................................34
7 Bloedgassen.......................................................................................................................................35
7.1 Wanneer een bloedgasanalyse...................................................................................................35
7.2 Art. Radialis punctie....................................................................................................................35
7.2.1 Voorbereiding......................................................................................................................35
7.2.2 Voor de afname...................................................................................................................35
7.2.3 Na de afname......................................................................................................................35
7.2.4 Aandachtspunten.................................................................................................................36
7.3 De pulmonale gasuitwisseling.....................................................................................................36
7.3.1 Partiële druk........................................................................................................................36
7.3.2 Eliminatie van CO²...............................................................................................................36
7.3.3 Oxygenatie met O²...............................................................................................................36
7.3.4 Partiële zuurstofdruk (PaO²)................................................................................................36
7.4 pH waarde in het bloed..............................................................................................................37
7.4.1 Zuren, basen en zouten.......................................................................................................37
7.5 Stoornissen van de gasuitwisseling.............................................................................................37
7.5.1 Respiratoire insufficiëntie type 1.........................................................................................38
7.5.2 Respiratoire insufficiëntie type 2.........................................................................................38
7.5.3 Hyperventilatie....................................................................................................................38
7.6 Interpretatie van bloedgaswaarden...........................................................................................38
7.6.1 Beoordeling ABG (Arterieel bloedgas).................................................................................38
7.6.2 Respiratoire alkalose (pH > 7,45 en pCO² < 35 mmHg)........................................................39
7.6.3 Respiratoire acidose (pH < 7,35 en pCO² > 45 mmHg).........................................................39
7.6.4 Metabole alkalose (pH > 7,45 en HCO³ > 26 mmol).............................................................39
7.6.5 Metabole acidose (pH < 7,35 en HCO³ < 22)........................................................................39
7.6.6 Gemengde stoornissen........................................................................................................40
7.6.7 Base excess..........................................................................................................................40
8 Bloedwaarden...................................................................................................................................41
8.1 Samenstelling van het bloed.......................................................................................................41
8.1.1 Plasma (55% vloeibaar gedeelte).........................................................................................41
8.1.2 Cellulaire elementen (45% vaste gedeelte).........................................................................41
Inhoudsopgave
1 Beademing via een beademingsmachine............................................................................................7
1.1 Inleiding........................................................................................................................................7
1.2 Beademingstoestel of ventilator...................................................................................................7
1.2.1 Beademingsslang...................................................................................................................7
1.2.2 Kunstneus..............................................................................................................................7
1.2.3 Werking.................................................................................................................................7
1.3 Mechanische ventilatie versus spontane beademing...................................................................7
1.4 Beademingsparameters................................................................................................................7
1.5 Niet getriggerde beademing tegenover getriggerde beademing..................................................8
1.6 Beademingsmodi..........................................................................................................................8
1.6.1 Invasieve beademing.............................................................................................................8
1.6.2 Niet invasieve beademing......................................................................................................9
1.7 Invloed positieve druk................................................................................................................10
1.8 Begrippen: ventilatie, diffusie en perfusie..................................................................................10
1.8.1 Ventilatie.............................................................................................................................10
1.8.2 Diffusie.................................................................................................................................10
1.8.3 Perfusie................................................................................................................................10
2 Drukmeting........................................................................................................................................11
2.1 Centraal veneuze drukmeting.....................................................................................................11
2.1.1 Inleiding...............................................................................................................................11
2.1.2 Meting centraal veneuze druk.............................................................................................11
2.1.3 Mogelijke indicaties.............................................................................................................11
2.1.4 Beïnvloedende factoren.......................................................................................................11
2.2 Arteriële drukmeting..................................................................................................................11
2.2.1 Niet-invasieve bloeddruk meting.........................................................................................11
2.2.2 Invasieve bloeddruk meting.................................................................................................11
2.3 Cardiac output............................................................................................................................12
2.3.1 Swan-Ganz-katheter............................................................................................................12
2.3.2 Pulse intermittent en continuous cardiac output (PICCO catheter).....................................12
2.4 Intracerebrale ventrikeldrukmeting (ICP en CPP).......................................................................13
2.4.1 Intracraniële druk (ICP): 8 – 15 mmHg.................................................................................13
2.4.2 Cerebrale perfusiedruk (CPP): > 70 mmHg..........................................................................13
2.5 Intra-abdominale drukmeting (IAP): 5 – 7 mmHg.......................................................................13
,3 Endoscopieën....................................................................................................................................14
3.1 Gastroscopie...............................................................................................................................14
3.1.1 Indicaties..............................................................................................................................14
3.1.2 Tegenindicaties....................................................................................................................14
3.1.3 Complicaties........................................................................................................................14
3.1.4 Plaatsing van een PEG Sonde...............................................................................................16
3.2 Endoscopische Retrograde Cholangio Pancreaticografie (ERCP)................................................16
3.3 Anusscopie..................................................................................................................................17
3.3.1 Indicaties..............................................................................................................................17
3.3.2 Tegenindicaties....................................................................................................................17
3.3.3 Complicaties........................................................................................................................17
3.4 Rectoscopie................................................................................................................................17
3.4.1 Indicaties..............................................................................................................................17
3.4.2 Tegenindicaties....................................................................................................................17
3.4.3 Complicaties........................................................................................................................17
3.5 Colonoscopie..............................................................................................................................17
3.5.1 Indicaties..............................................................................................................................18
3.5.2 Tegenindicaties....................................................................................................................18
3.5.3 Complicaties........................................................................................................................18
3.5.4 Lichamelijke voorbereiding..................................................................................................18
3.6 Laparascopie...............................................................................................................................18
3.6.1 Indicaties..............................................................................................................................18
3.7 Rhinoscopie................................................................................................................................18
3.8 Pharyngoscopie..........................................................................................................................19
3.9 Laryngoscopie.............................................................................................................................19
3.9.1 Indicaties..............................................................................................................................19
3.10 Tracheoscopie...........................................................................................................................19
3.11 Bronchoscopie..........................................................................................................................19
3.11.1 Indicaties............................................................................................................................19
3.11.2 Tegenindicaties..................................................................................................................19
3.11.3 Complicaties......................................................................................................................20
3.12 Mediastinoscopie......................................................................................................................20
3.12.1 Indicaties............................................................................................................................20
3.13 Pleuroscopie.............................................................................................................................20
3.14 Urologisch stelsel......................................................................................................................20
3.14.1 Indicaties............................................................................................................................20
, 3.14.2 Tegenindicaties..................................................................................................................20
3.14.3 Complicaties......................................................................................................................20
4 Punctie...............................................................................................................................................21
4.1 Botpunctie..................................................................................................................................21
4.1.1 Botbiopsie en beenmergonderzoek.....................................................................................21
4.1.2 Intraosseus infuus................................................................................................................21
4.2 Leverpunctie...............................................................................................................................21
4.3 Puncties nefrologie-urologie.......................................................................................................22
4.3.1 Pericutane nierpunctie voor biopsiename...........................................................................22
4.3.2 Transjugular nierpunctie voor biopsiename........................................................................22
4.3.3 Transperianale prostaatpunctie voor biopsiename.............................................................22
4.4 Ascitespunctie.............................................................................................................................22
4.5 Lumbaalpunctie..........................................................................................................................22
4.6 Pericardpunctie...........................................................................................................................23
4.7 Pleurapunctie..............................................................................................................................23
5 Farmacologie.....................................................................................................................................24
5.1 De keten van geneesmiddelenvoorziening in het ziekenhuis.....................................................24
5.2 Medicatiefouten herkennen.......................................................................................................24
5.3 Farmacokinetiek en dynamiek....................................................................................................25
5.3.1 Farmacokinetiek..................................................................................................................25
5.3.2 Geneesmiddeleninteractie...................................................................................................25
5.3.3 TPN......................................................................................................................................28
5.3.4 Chemotherapie....................................................................................................................30
6 Onderwaterdrainage.........................................................................................................................32
6.1 Anatomie....................................................................................................................................32
6.2 Ingrepen op de longen................................................................................................................32
6.2.1 Pneumectomie.....................................................................................................................32
6.2.2 Lobectomie..........................................................................................................................32
6.3 Complicaties na longinterventies................................................................................................32
6.3.1 Bloeding...............................................................................................................................32
6.3.2 Pneumothorax.....................................................................................................................32
6.3.3 Subcutaan emfyseem..........................................................................................................32
6.3.4 Atelectase............................................................................................................................32
6.3.5 Empyeem.............................................................................................................................33
6.4 Traumata....................................................................................................................................33
6.4.1 Thoracale contusies.............................................................................................................33
, 6.4.2 Open of penetrerende traumata.........................................................................................33
6.4.3 Intra thoracale traumata.....................................................................................................33
6.4.4 Pneumothorax.....................................................................................................................33
6.4.5 Spanningspneumothorax.....................................................................................................33
6.4.6 Haemathorax.......................................................................................................................34
6.4.7 Doel thoraxdrainage............................................................................................................34
7 Bloedgassen.......................................................................................................................................35
7.1 Wanneer een bloedgasanalyse...................................................................................................35
7.2 Art. Radialis punctie....................................................................................................................35
7.2.1 Voorbereiding......................................................................................................................35
7.2.2 Voor de afname...................................................................................................................35
7.2.3 Na de afname......................................................................................................................35
7.2.4 Aandachtspunten.................................................................................................................36
7.3 De pulmonale gasuitwisseling.....................................................................................................36
7.3.1 Partiële druk........................................................................................................................36
7.3.2 Eliminatie van CO²...............................................................................................................36
7.3.3 Oxygenatie met O²...............................................................................................................36
7.3.4 Partiële zuurstofdruk (PaO²)................................................................................................36
7.4 pH waarde in het bloed..............................................................................................................37
7.4.1 Zuren, basen en zouten.......................................................................................................37
7.5 Stoornissen van de gasuitwisseling.............................................................................................37
7.5.1 Respiratoire insufficiëntie type 1.........................................................................................38
7.5.2 Respiratoire insufficiëntie type 2.........................................................................................38
7.5.3 Hyperventilatie....................................................................................................................38
7.6 Interpretatie van bloedgaswaarden...........................................................................................38
7.6.1 Beoordeling ABG (Arterieel bloedgas).................................................................................38
7.6.2 Respiratoire alkalose (pH > 7,45 en pCO² < 35 mmHg)........................................................39
7.6.3 Respiratoire acidose (pH < 7,35 en pCO² > 45 mmHg).........................................................39
7.6.4 Metabole alkalose (pH > 7,45 en HCO³ > 26 mmol).............................................................39
7.6.5 Metabole acidose (pH < 7,35 en HCO³ < 22)........................................................................39
7.6.6 Gemengde stoornissen........................................................................................................40
7.6.7 Base excess..........................................................................................................................40
8 Bloedwaarden...................................................................................................................................41
8.1 Samenstelling van het bloed.......................................................................................................41
8.1.1 Plasma (55% vloeibaar gedeelte).........................................................................................41
8.1.2 Cellulaire elementen (45% vaste gedeelte).........................................................................41
