Medicatie en invasieve zorg
Geneesmiddelen ..................................................................................................................10
Causale of essentiële therapie ......................................................................................10
Symptomatische therapie ..............................................................................................10
Substitutie of vervanging ...............................................................................................10
Profylactisch ..................................................................................................................10
Placebo .........................................................................................................................10
Diagnostisch..................................................................................................................10
Regel van 5 ......................................................................................................................11
toedieningswijzen .............................................................................................................11
Oraal .............................................................................................................................11
❖ Op basis van galenische vormen ........................................................................11
• Vaste vorm ......................................................................................................11
• Vloeibare vorm ................................................................................................11
❖ Op basis van vrijstelling ......................................................................................12
• Gewone vrijstelling ..........................................................................................12
• Gecontroleerde of gereguleerde vrijstelling .....................................................12
Rectaal en vaginaal .......................................................................................................12
Dermaal en transdermaal ..............................................................................................13
❖ Dermaal ..............................................................................................................13
• Vaste preparaten: ............................................................................................13
• Halfvaste preparaten: ......................................................................................13
• Vloeibare preparaten: ......................................................................................13
❖ Transdermaal .....................................................................................................13
Implantaat .....................................................................................................................14
Toedieningsvormen ..........................................................................................................14
Neus, oor en oog ...........................................................................................................14
Inhalatie ........................................................................................................................14
❖ Dosisaerosol .......................................................................................................14
❖ Poederinhalator ..................................................................................................14
❖ Oplossing voor verneveling (aerosol) ..................................................................14
Nevel .............................................................................................................................14
Injectievloeistof en infuus ..............................................................................................15
❖ Eisen voor infuusvloeistoffen ..............................................................................15
❖ Toedieningsweg..................................................................................................15
❖ Vrijstelling: ..........................................................................................................15
, Gasvorm: toedienen van zuurstof ..................................................................................15
Farmacokinetiek ...............................................................................................................16
Compartimentenmodel ..................................................................................................16
First pass model ............................................................................................................17
❖ Resorptie ............................................................................................................17
❖ Biologische beschikbaarheid...............................................................................17
❖ Distributie = Uitdelen...........................................................................................18
❖ Depots en eiwitbinding ........................................................................................18
❖ Eliminatie ............................................................................................................19
❖ Therapeutische bloedspiegel ..............................................................................19
Therapeutische, sub-therapeutische en toxische zone ..................................................20
Therapeutisch venster en optimale spiegel....................................................................20
Cumulatie ......................................................................................................................20
Opstart- en onderhoudsdosis ........................................................................................21
Beïnvloedingsfactoren ...................................................................................................21
❖ Ziektetoestanden ................................................................................................21
• Lever ...............................................................................................................21
• Nieren .............................................................................................................21
• Maagdarmstelsel .............................................................................................21
❖ Genetische factoren ............................................................................................21
❖ Interacties van geneesmiddelen .........................................................................21
❖ Lichaamsgewicht ................................................................................................22
❖ Omgevingsfactoren.............................................................................................22
Gevaren bij het gebruik van geneesmiddelen ................................................................22
❖ Allergie ...............................................................................................................22
❖ Ideosyncrasie .....................................................................................................22
❖ Intolerantie ..........................................................................................................22
❖ Sexuele dysfunctie..............................................................................................22
❖ Intoxicatie= vergiftiging .......................................................................................23
❖ Toxicomanie .......................................................................................................23
Bewaring...........................................................................................................................23
Vaste geneesmiddelen ..................................................................................................23
Vloeibare geneesmiddelen ............................................................................................24
Gasvormige geneesmiddelen ........................................................................................24
Verpakking........................................................................................................................24
Terugbetaling ....................................................................................................................24
Aandachtspunten ..............................................................................................................24
, bij ouderen ....................................................................................................................24
bij kinderen ....................................................................................................................25
❖ Effect en dosis ....................................................................................................25
❖ Leeftijd ................................................................................................................25
bij zwangere en zogende patiënten ...............................................................................25
bij verschil in etniciteit ....................................................................................................25
Verantwoordelijkheid.........................................................................................................25
Farmacovigilantie= Geneesmiddelenbewaking .................................................................25
protocollen ........................................................................................................................26
toedienen van medicatie................................................................................................26
❖ rapportage ..........................................................................................................26
Toedienen van zuurstof .................................................................................................26
❖ Voorkomen van zuurstof in de verpleegkundige praktijk: ....................................26
• Gasflessen: .....................................................................................................26
❖ Berekenen van de inhoud van zuurstofcilinders ..................................................26
❖ Oorzaken van zuurstoftekort: ..............................................................................26
❖ Plots of geleidelijk tekort .....................................................................................27
• Zuurstoftekort kan plots optreden ....................................................................27
• Zuurstoftekort kan geleidelijk optreden ............................................................27
❖ Algemene symptomen van zuurstoftekort: ..........................................................27
• Symptomen van langzaam zuurstoftekort........................................................27
• Symptomen van chronisch zuurstoftekort → COPD ........................................27
• Fysiologie bij chronisch zuurstoftekort → complicatie ......................................27
❖ Veiligheid ............................................................................................................27
• Rookverbod .....................................................................................................27
• Open vuur: ......................................................................................................27
• Ontstekingsbronnen: .......................................................................................28
• Koppelstukken:................................................................................................28
• Vetten en oliën: ...............................................................................................28
Gasvorm: Zuurstof.........................................................................................................28
❖ Toe te dienen hoeveelheid zuurstof ....................................................................28
❖ Verpleegkundige aandachtspunten bij zuurstoftoediening: .................................28
❖ Toedieningsmethoden ........................................................................................28
• Toediening via nasofaryngeale katheter ..........................................................28
• Toediening via zuurstofbril...............................................................................29
• Toediening via zuurstofmasker ........................................................................29
• Toediening via zuurstoftent .............................................................................29
, • Toediening via (hyperbare)zuurstofkamer .......................................................29
• Toediening via kunstmatige beademing ..........................................................29
• Toediening via incubator .................................................................................29
Inspuiting ..............................................................................................................................30
Definitie.............................................................................................................................30
Indicaties ..........................................................................................................................30
Soorten .............................................................................................................................30
Door verpleegkundigen .................................................................................................30
Door arts met assistentie van verpleegkundigen ...........................................................30
Materiaal ...........................................................................................................................30
Spuiten: .........................................................................................................................30
Naalden: ........................................................................................................................30
Geneesmiddel: ..............................................................................................................31
Gevaren ............................................................................................................................31
Voor de patiënt: .............................................................................................................31
Voor de verpleegkundige:..............................................................................................31
❖ Prikaccident ........................................................................................................31
Intramusculaire inspuiting .................................................................................................31
Voorwaarden: ................................................................................................................31
Plaatsen: .......................................................................................................................31
❖ m. gluteus ...........................................................................................................31
• gluteus maximus .............................................................................................31
• gluteus medius ................................................................................................32
❖ m. deltoides= deltaspier ......................................................................................32
❖ m. quadriceps femoris= vierhoofdige dijspier ......................................................33
complicaties ..................................................................................................................33
Zigzagmethode of Z-track..............................................................................................33
Versteken ......................................................................................................................34
Subcutaan ........................................................................................................................34
Indicaties: ......................................................................................................................34
Plaatsen: .......................................................................................................................34
Techniek:.......................................................................................................................34
❖ Afhankelijk van de naald: ....................................................................................34
• korte SC naald (+/- 10 mm) .............................................................................34
• lange SC naald (+/- 25 mm) ............................................................................34
complicaties = gevaren..................................................................................................35
Anticoagulantia therapie ................................................................................................35
, intradermaal ......................................................................................................................35
Indicaties: ......................................................................................................................35
Plaats: ...........................................................................................................................35
Aandachtspunten bij toediening ........................................................................................35
Bloedafname ........................................................................................................................36
bepaling ............................................................................................................................36
bloedafname is ..............................................................................................................36
doel...................................................................................................................................36
Proefpunctie: .................................................................................................................36
Evacuerende punctie: ....................................................................................................36
❖ aderlating= derivatie ...........................................................................................36
❖ Wisseltransfusie..................................................................................................36
soorten bloedonderzoek ...................................................................................................36
Onderzoeken op bloed met anticoagulantia...................................................................36
❖ EDTA= Ethyleen Diamine Tetra Acetaat .............................................................36
• Cytologisch onderzoek ....................................................................................37
• Bloedgroep: 4 systemen..................................................................................37
❖ natriumcitraat ......................................................................................................38
• Sedimentatie ...................................................................................................38
• Bloedstollingstesten ........................................................................................39
❖ heparine .............................................................................................................39
• pH ...................................................................................................................39
• Bloedgassen ...................................................................................................39
• L.E. cellen = Lupus erythematodes cellen .......................................................39
❖ kaliumoxalaat + natriumfluoride ..........................................................................39
Onderzoeken op gestold bloed (serum) .........................................................................39
❖ Ionen → Ionogram ..............................................................................................39
❖ Ijzer.....................................................................................................................40
❖ Serumeiwitten of Proteïnen .................................................................................40
❖ enzymen .............................................................................................................40
• Transaminase .................................................................................................40
• Fosfatasen ......................................................................................................40
• LDH: ................................................................................................................40
• Gamma GT: ....................................................................................................40
❖ Lipiden ................................................................................................................40
❖ Substraten ..........................................................................................................41
❖ Toxicologie .........................................................................................................41
, ❖ Immunologie .......................................................................................................41
❖ Hormonologie .....................................................................................................42
Speciale onderzoeken ...................................................................................................42
❖ Bloedingstijd = Dukes test...................................................................................42
❖ Hemoculturen: ....................................................................................................42
venapunctie ...................................................................................................................42
❖ Materiaal .............................................................................................................42
Bloedafname .................................................................................................................43
❖ Tijdstip van afname en bewaring ........................................................................43
❖ aderkeuze ...........................................................................................................43
❖ Aanleggen afbindsnoer .......................................................................................43
❖ Verwikkelingen voorkomen .................................................................................43
❖ Pediatrische aspecten en aanpassingen .............................................................44
❖ Geriatrische aspecten en aanpassingen .............................................................44
Bloedwaarden ...............................................................................................................44
❖ Overzicht van de bloedcellen ..............................................................................44
Infusen .................................................................................................................................44
Toedieningswegen ............................................................................................................44
Perifeer: ........................................................................................................................44
Centraal: .......................................................................................................................44
Infusie: Aanwijzingen: doel................................................................................................45
Soorten oplossingen .........................................................................................................45
Volgens osmotische druk ..............................................................................................45
❖ Osmose: .............................................................................................................45
❖ Osmotische druk: ................................................................................................45
❖ Isotone oplossing: ...............................................................................................45
❖ Hypertone oplossing ...........................................................................................45
❖ Hypotone oplossing ............................................................................................45
❖ Colloïdale oplossingen ........................................................................................46
❖ Op infuuszak altijd vermeld: ................................................................................46
Volgens samenstelling...................................................................................................46
❖ Elektrolyten zonder calorietoevoer ......................................................................46
❖ Oplossingen met calorietoevoer..........................................................................46
• Suikeroplossingen zonder elektrolyten ............................................................46
• Elektrolyten met calorieën ...............................................................................47
❖ Eiwitoplossingen .................................................................................................47
❖ vetoplossingen ....................................................................................................47
, ❖ Colloïdale oplossingen ........................................................................................47
Infusie: materialen ............................................................................................................47
Verpakking vloeistof: .....................................................................................................47
Toedieningssysteem: ....................................................................................................48
Hulpstukken: .................................................................................................................48
Inbrengmateriaal: ..........................................................................................................48
regelsysteem .................................................................................................................48
Verbandmateriaal ..........................................................................................................48
Inloopsnelheid...................................................................................................................48
Aandachtspunten: .........................................................................................................48
❖ Overvulling..........................................................................................................48
❖ Ondervulling .......................................................................................................48
❖ Niet lopen van het infuus ....................................................................................49
Druppels per minuut: .....................................................................................................49
Milliliter per uur: .............................................................................................................49
Punctieplaats.................................................................................................................50
Infusie: complicaties..........................................................................................................50
Verpleegkundige aandachtspunten bij lucht in de leiding...............................................51
❖ Bij zeer weinig lucht in de leiding ........................................................................51
❖ Bij veel lucht in de leiding ....................................................................................51
infusie en medicatie ..........................................................................................................51
Continu ..........................................................................................................................51
Periodisch .....................................................................................................................51
Diabetes ...............................................................................................................................52
basiskennis .......................................................................................................................52
definitie ..........................................................................................................................52
Verminderde insulineproductie ......................................................................................52
Insuline resistentie.........................................................................................................52
bloedwaarden ................................................................................................................52
❖ Normaal ..............................................................................................................52
❖ Hyperglycemie ....................................................................................................52
❖ hypoglycemie ......................................................................................................53
Soorten diabetes ...........................................................................................................53
❖ Type 1 ................................................................................................................53
❖ Type 2 ................................................................................................................54
❖ Zwangerschapsdiabetes .....................................................................................54
Behandeling ......................................................................................................................54
, Bloedsuikerverlagende middelen ...................................................................................54
Aanpassing levensstijl ...................................................................................................54
acute complicaties ............................................................................................................55
Hypoglycemie................................................................................................................55
❖ Oorzaken ............................................................................................................55
❖ symptomen .........................................................................................................55
• Autonome symptomen ....................................................................................55
• Neuroglycopenische symptomen.....................................................................55
❖ Verpleegkundige aandachtspunten .....................................................................55
• Bewuste patiënt...............................................................................................56
• Onbewuste patiënt ..........................................................................................56
Hyperglycemie ..............................................................................................................56
❖ Oorzaken ............................................................................................................56
❖ Symptomen ........................................................................................................56
❖ Verpleegkundige aandachtspunten .....................................................................56
Keto-acidose .................................................................................................................56
Onderzoeken ....................................................................................................................57
Capillaire bloedafname ..................................................................................................57
❖ Materiaal .............................................................................................................57
• Prikmateriaal ...................................................................................................57
• teststrookjes ....................................................................................................57
• glucosemeter...................................................................................................57
❖ Factoren die de meting beïnvloeden ...................................................................57
perifere bloedafname ....................................................................................................57
❖ glycemiemeting ...................................................................................................57
• Klinisch belang ................................................................................................57
Glucose dagprofiel of dagcurve .....................................................................................57
Orale Glucose Tolerantie test (OGTT) ...........................................................................58
Hemoglobine A1c (HbA1c) ............................................................................................58
Urineonderzoeken .........................................................................................................58
insuline .............................................................................................................................58
soorten ..........................................................................................................................58
❖ Oorsprong...........................................................................................................58
• Humane insuline .............................................................................................58
• Analoge insuline ..............................................................................................58
• Verschil ...........................................................................................................58
❖ werkingsprofiel ....................................................................................................59
, • Snelwerkend ...................................................................................................59
• traagwerkend = basale insuline .......................................................................60
• Gemengde werking .........................................................................................61
Bijspuitschema ..............................................................................................................62
❖ Voorbeelden .......................................................................................................62
• Hele actrapidregel: ..........................................................................................62
• Halve actrapidregel: ........................................................................................62
Verpakkingen ................................................................................................................62
Bewaring .......................................................................................................................62
❖ Ongeopend .........................................................................................................62
❖ Geopend .............................................................................................................62
❖ Let op .................................................................................................................62
mengen in & spuit..........................................................................................................63
Toedieningsmateriaal ....................................................................................................63
Insulinepomp .................................................................................................................63
❖ Wat: ....................................................................................................................63
Injectieplaatsen .............................................................................................................63
❖ Buik: ...................................................................................................................63
❖ Dij: ......................................................................................................................63
❖ Bil: ......................................................................................................................64
❖ Arm: ....................................................................................................................64
❖ De resorptie van insuline wordt beïnvloed door ..................................................64
Verpleegkundige aandachtspunten ...............................................................................64
Rotatieschema ..............................................................................................................64
Injectietechniek .............................................................................................................64
Weefselbeschadiging ....................................................................................................65
Intraveneuze toediening ................................................................................................65
❖ Gebruik ...............................................................................................................65
Chronische verwikkelingen ...............................................................................................65
Macro-angiopathie.........................................................................................................65
Micro-angiopathie ..........................................................................................................65
Neuropathie...................................................................................................................66
Diabetesvoet .................................................................................................................66
Situatie gebonden aspecten..............................................................................................66
Pediatrische aspecten ...................................................................................................66
Geriatrische aspecten ...................................................................................................66
, Medicatie en invasieve zorg
Geneesmiddelen
Inleiding
Definitie
➢ Het is een Preparaat:
o Plantaardige oorsprong
o Dierlijke oorsprong
o Synthetische oorsprong
➢ Het dient op Ziekte:
o Voorkomen
o Genezen
o verzachten
➢ het dient om Diagnose stellen
Afkomst
➢ Overlevering door de natuurproducten (tijdens WOII)
➢ Toevallige ontdekking vb. penicilline en orale anticoagulantia
➢ Gericht onderzoek
➢ Alternatieve geneesmiddelen
Indeling
Causale of essentiële therapie
➢ Geneesmiddelen die de oorzaak van de ziekte bestrijden
➢ Vb. antibioticum
Symptomatische therapie
➢ Geneesmiddelen die de verschijnselen van een ziekte (pijn, misselijkheid, braken,
jeuk) bestrijden
➢ Vb. Dafalgan, Primperan
Substitutie of vervanging
➢ Geneesmiddelen die een stof die voor het lichaam onmisbaar is vervangen of
aanvullen
➢ Vb. hormonen, vitaminen
Profylactisch
➢ Geneesmiddelen die dienen ter voorkoming van ziekten.
➢ Vb. vaccinatie, …
Placebo
➢ De gesuggereerde (voorgestelde) werking ( het placebo-effect) is onafhankelijk van
het toegediende geneesmiddel. Je krijgt een bepaald geneesmiddel maar de nodige
werkzame stof zit er niet in.
Diagnostisch
➢ contraststoffen geven om galwegen, bloedvaten … op RX te kunnen weergeven
Geneesmiddelen ..................................................................................................................10
Causale of essentiële therapie ......................................................................................10
Symptomatische therapie ..............................................................................................10
Substitutie of vervanging ...............................................................................................10
Profylactisch ..................................................................................................................10
Placebo .........................................................................................................................10
Diagnostisch..................................................................................................................10
Regel van 5 ......................................................................................................................11
toedieningswijzen .............................................................................................................11
Oraal .............................................................................................................................11
❖ Op basis van galenische vormen ........................................................................11
• Vaste vorm ......................................................................................................11
• Vloeibare vorm ................................................................................................11
❖ Op basis van vrijstelling ......................................................................................12
• Gewone vrijstelling ..........................................................................................12
• Gecontroleerde of gereguleerde vrijstelling .....................................................12
Rectaal en vaginaal .......................................................................................................12
Dermaal en transdermaal ..............................................................................................13
❖ Dermaal ..............................................................................................................13
• Vaste preparaten: ............................................................................................13
• Halfvaste preparaten: ......................................................................................13
• Vloeibare preparaten: ......................................................................................13
❖ Transdermaal .....................................................................................................13
Implantaat .....................................................................................................................14
Toedieningsvormen ..........................................................................................................14
Neus, oor en oog ...........................................................................................................14
Inhalatie ........................................................................................................................14
❖ Dosisaerosol .......................................................................................................14
❖ Poederinhalator ..................................................................................................14
❖ Oplossing voor verneveling (aerosol) ..................................................................14
Nevel .............................................................................................................................14
Injectievloeistof en infuus ..............................................................................................15
❖ Eisen voor infuusvloeistoffen ..............................................................................15
❖ Toedieningsweg..................................................................................................15
❖ Vrijstelling: ..........................................................................................................15
, Gasvorm: toedienen van zuurstof ..................................................................................15
Farmacokinetiek ...............................................................................................................16
Compartimentenmodel ..................................................................................................16
First pass model ............................................................................................................17
❖ Resorptie ............................................................................................................17
❖ Biologische beschikbaarheid...............................................................................17
❖ Distributie = Uitdelen...........................................................................................18
❖ Depots en eiwitbinding ........................................................................................18
❖ Eliminatie ............................................................................................................19
❖ Therapeutische bloedspiegel ..............................................................................19
Therapeutische, sub-therapeutische en toxische zone ..................................................20
Therapeutisch venster en optimale spiegel....................................................................20
Cumulatie ......................................................................................................................20
Opstart- en onderhoudsdosis ........................................................................................21
Beïnvloedingsfactoren ...................................................................................................21
❖ Ziektetoestanden ................................................................................................21
• Lever ...............................................................................................................21
• Nieren .............................................................................................................21
• Maagdarmstelsel .............................................................................................21
❖ Genetische factoren ............................................................................................21
❖ Interacties van geneesmiddelen .........................................................................21
❖ Lichaamsgewicht ................................................................................................22
❖ Omgevingsfactoren.............................................................................................22
Gevaren bij het gebruik van geneesmiddelen ................................................................22
❖ Allergie ...............................................................................................................22
❖ Ideosyncrasie .....................................................................................................22
❖ Intolerantie ..........................................................................................................22
❖ Sexuele dysfunctie..............................................................................................22
❖ Intoxicatie= vergiftiging .......................................................................................23
❖ Toxicomanie .......................................................................................................23
Bewaring...........................................................................................................................23
Vaste geneesmiddelen ..................................................................................................23
Vloeibare geneesmiddelen ............................................................................................24
Gasvormige geneesmiddelen ........................................................................................24
Verpakking........................................................................................................................24
Terugbetaling ....................................................................................................................24
Aandachtspunten ..............................................................................................................24
, bij ouderen ....................................................................................................................24
bij kinderen ....................................................................................................................25
❖ Effect en dosis ....................................................................................................25
❖ Leeftijd ................................................................................................................25
bij zwangere en zogende patiënten ...............................................................................25
bij verschil in etniciteit ....................................................................................................25
Verantwoordelijkheid.........................................................................................................25
Farmacovigilantie= Geneesmiddelenbewaking .................................................................25
protocollen ........................................................................................................................26
toedienen van medicatie................................................................................................26
❖ rapportage ..........................................................................................................26
Toedienen van zuurstof .................................................................................................26
❖ Voorkomen van zuurstof in de verpleegkundige praktijk: ....................................26
• Gasflessen: .....................................................................................................26
❖ Berekenen van de inhoud van zuurstofcilinders ..................................................26
❖ Oorzaken van zuurstoftekort: ..............................................................................26
❖ Plots of geleidelijk tekort .....................................................................................27
• Zuurstoftekort kan plots optreden ....................................................................27
• Zuurstoftekort kan geleidelijk optreden ............................................................27
❖ Algemene symptomen van zuurstoftekort: ..........................................................27
• Symptomen van langzaam zuurstoftekort........................................................27
• Symptomen van chronisch zuurstoftekort → COPD ........................................27
• Fysiologie bij chronisch zuurstoftekort → complicatie ......................................27
❖ Veiligheid ............................................................................................................27
• Rookverbod .....................................................................................................27
• Open vuur: ......................................................................................................27
• Ontstekingsbronnen: .......................................................................................28
• Koppelstukken:................................................................................................28
• Vetten en oliën: ...............................................................................................28
Gasvorm: Zuurstof.........................................................................................................28
❖ Toe te dienen hoeveelheid zuurstof ....................................................................28
❖ Verpleegkundige aandachtspunten bij zuurstoftoediening: .................................28
❖ Toedieningsmethoden ........................................................................................28
• Toediening via nasofaryngeale katheter ..........................................................28
• Toediening via zuurstofbril...............................................................................29
• Toediening via zuurstofmasker ........................................................................29
• Toediening via zuurstoftent .............................................................................29
, • Toediening via (hyperbare)zuurstofkamer .......................................................29
• Toediening via kunstmatige beademing ..........................................................29
• Toediening via incubator .................................................................................29
Inspuiting ..............................................................................................................................30
Definitie.............................................................................................................................30
Indicaties ..........................................................................................................................30
Soorten .............................................................................................................................30
Door verpleegkundigen .................................................................................................30
Door arts met assistentie van verpleegkundigen ...........................................................30
Materiaal ...........................................................................................................................30
Spuiten: .........................................................................................................................30
Naalden: ........................................................................................................................30
Geneesmiddel: ..............................................................................................................31
Gevaren ............................................................................................................................31
Voor de patiënt: .............................................................................................................31
Voor de verpleegkundige:..............................................................................................31
❖ Prikaccident ........................................................................................................31
Intramusculaire inspuiting .................................................................................................31
Voorwaarden: ................................................................................................................31
Plaatsen: .......................................................................................................................31
❖ m. gluteus ...........................................................................................................31
• gluteus maximus .............................................................................................31
• gluteus medius ................................................................................................32
❖ m. deltoides= deltaspier ......................................................................................32
❖ m. quadriceps femoris= vierhoofdige dijspier ......................................................33
complicaties ..................................................................................................................33
Zigzagmethode of Z-track..............................................................................................33
Versteken ......................................................................................................................34
Subcutaan ........................................................................................................................34
Indicaties: ......................................................................................................................34
Plaatsen: .......................................................................................................................34
Techniek:.......................................................................................................................34
❖ Afhankelijk van de naald: ....................................................................................34
• korte SC naald (+/- 10 mm) .............................................................................34
• lange SC naald (+/- 25 mm) ............................................................................34
complicaties = gevaren..................................................................................................35
Anticoagulantia therapie ................................................................................................35
, intradermaal ......................................................................................................................35
Indicaties: ......................................................................................................................35
Plaats: ...........................................................................................................................35
Aandachtspunten bij toediening ........................................................................................35
Bloedafname ........................................................................................................................36
bepaling ............................................................................................................................36
bloedafname is ..............................................................................................................36
doel...................................................................................................................................36
Proefpunctie: .................................................................................................................36
Evacuerende punctie: ....................................................................................................36
❖ aderlating= derivatie ...........................................................................................36
❖ Wisseltransfusie..................................................................................................36
soorten bloedonderzoek ...................................................................................................36
Onderzoeken op bloed met anticoagulantia...................................................................36
❖ EDTA= Ethyleen Diamine Tetra Acetaat .............................................................36
• Cytologisch onderzoek ....................................................................................37
• Bloedgroep: 4 systemen..................................................................................37
❖ natriumcitraat ......................................................................................................38
• Sedimentatie ...................................................................................................38
• Bloedstollingstesten ........................................................................................39
❖ heparine .............................................................................................................39
• pH ...................................................................................................................39
• Bloedgassen ...................................................................................................39
• L.E. cellen = Lupus erythematodes cellen .......................................................39
❖ kaliumoxalaat + natriumfluoride ..........................................................................39
Onderzoeken op gestold bloed (serum) .........................................................................39
❖ Ionen → Ionogram ..............................................................................................39
❖ Ijzer.....................................................................................................................40
❖ Serumeiwitten of Proteïnen .................................................................................40
❖ enzymen .............................................................................................................40
• Transaminase .................................................................................................40
• Fosfatasen ......................................................................................................40
• LDH: ................................................................................................................40
• Gamma GT: ....................................................................................................40
❖ Lipiden ................................................................................................................40
❖ Substraten ..........................................................................................................41
❖ Toxicologie .........................................................................................................41
, ❖ Immunologie .......................................................................................................41
❖ Hormonologie .....................................................................................................42
Speciale onderzoeken ...................................................................................................42
❖ Bloedingstijd = Dukes test...................................................................................42
❖ Hemoculturen: ....................................................................................................42
venapunctie ...................................................................................................................42
❖ Materiaal .............................................................................................................42
Bloedafname .................................................................................................................43
❖ Tijdstip van afname en bewaring ........................................................................43
❖ aderkeuze ...........................................................................................................43
❖ Aanleggen afbindsnoer .......................................................................................43
❖ Verwikkelingen voorkomen .................................................................................43
❖ Pediatrische aspecten en aanpassingen .............................................................44
❖ Geriatrische aspecten en aanpassingen .............................................................44
Bloedwaarden ...............................................................................................................44
❖ Overzicht van de bloedcellen ..............................................................................44
Infusen .................................................................................................................................44
Toedieningswegen ............................................................................................................44
Perifeer: ........................................................................................................................44
Centraal: .......................................................................................................................44
Infusie: Aanwijzingen: doel................................................................................................45
Soorten oplossingen .........................................................................................................45
Volgens osmotische druk ..............................................................................................45
❖ Osmose: .............................................................................................................45
❖ Osmotische druk: ................................................................................................45
❖ Isotone oplossing: ...............................................................................................45
❖ Hypertone oplossing ...........................................................................................45
❖ Hypotone oplossing ............................................................................................45
❖ Colloïdale oplossingen ........................................................................................46
❖ Op infuuszak altijd vermeld: ................................................................................46
Volgens samenstelling...................................................................................................46
❖ Elektrolyten zonder calorietoevoer ......................................................................46
❖ Oplossingen met calorietoevoer..........................................................................46
• Suikeroplossingen zonder elektrolyten ............................................................46
• Elektrolyten met calorieën ...............................................................................47
❖ Eiwitoplossingen .................................................................................................47
❖ vetoplossingen ....................................................................................................47
, ❖ Colloïdale oplossingen ........................................................................................47
Infusie: materialen ............................................................................................................47
Verpakking vloeistof: .....................................................................................................47
Toedieningssysteem: ....................................................................................................48
Hulpstukken: .................................................................................................................48
Inbrengmateriaal: ..........................................................................................................48
regelsysteem .................................................................................................................48
Verbandmateriaal ..........................................................................................................48
Inloopsnelheid...................................................................................................................48
Aandachtspunten: .........................................................................................................48
❖ Overvulling..........................................................................................................48
❖ Ondervulling .......................................................................................................48
❖ Niet lopen van het infuus ....................................................................................49
Druppels per minuut: .....................................................................................................49
Milliliter per uur: .............................................................................................................49
Punctieplaats.................................................................................................................50
Infusie: complicaties..........................................................................................................50
Verpleegkundige aandachtspunten bij lucht in de leiding...............................................51
❖ Bij zeer weinig lucht in de leiding ........................................................................51
❖ Bij veel lucht in de leiding ....................................................................................51
infusie en medicatie ..........................................................................................................51
Continu ..........................................................................................................................51
Periodisch .....................................................................................................................51
Diabetes ...............................................................................................................................52
basiskennis .......................................................................................................................52
definitie ..........................................................................................................................52
Verminderde insulineproductie ......................................................................................52
Insuline resistentie.........................................................................................................52
bloedwaarden ................................................................................................................52
❖ Normaal ..............................................................................................................52
❖ Hyperglycemie ....................................................................................................52
❖ hypoglycemie ......................................................................................................53
Soorten diabetes ...........................................................................................................53
❖ Type 1 ................................................................................................................53
❖ Type 2 ................................................................................................................54
❖ Zwangerschapsdiabetes .....................................................................................54
Behandeling ......................................................................................................................54
, Bloedsuikerverlagende middelen ...................................................................................54
Aanpassing levensstijl ...................................................................................................54
acute complicaties ............................................................................................................55
Hypoglycemie................................................................................................................55
❖ Oorzaken ............................................................................................................55
❖ symptomen .........................................................................................................55
• Autonome symptomen ....................................................................................55
• Neuroglycopenische symptomen.....................................................................55
❖ Verpleegkundige aandachtspunten .....................................................................55
• Bewuste patiënt...............................................................................................56
• Onbewuste patiënt ..........................................................................................56
Hyperglycemie ..............................................................................................................56
❖ Oorzaken ............................................................................................................56
❖ Symptomen ........................................................................................................56
❖ Verpleegkundige aandachtspunten .....................................................................56
Keto-acidose .................................................................................................................56
Onderzoeken ....................................................................................................................57
Capillaire bloedafname ..................................................................................................57
❖ Materiaal .............................................................................................................57
• Prikmateriaal ...................................................................................................57
• teststrookjes ....................................................................................................57
• glucosemeter...................................................................................................57
❖ Factoren die de meting beïnvloeden ...................................................................57
perifere bloedafname ....................................................................................................57
❖ glycemiemeting ...................................................................................................57
• Klinisch belang ................................................................................................57
Glucose dagprofiel of dagcurve .....................................................................................57
Orale Glucose Tolerantie test (OGTT) ...........................................................................58
Hemoglobine A1c (HbA1c) ............................................................................................58
Urineonderzoeken .........................................................................................................58
insuline .............................................................................................................................58
soorten ..........................................................................................................................58
❖ Oorsprong...........................................................................................................58
• Humane insuline .............................................................................................58
• Analoge insuline ..............................................................................................58
• Verschil ...........................................................................................................58
❖ werkingsprofiel ....................................................................................................59
, • Snelwerkend ...................................................................................................59
• traagwerkend = basale insuline .......................................................................60
• Gemengde werking .........................................................................................61
Bijspuitschema ..............................................................................................................62
❖ Voorbeelden .......................................................................................................62
• Hele actrapidregel: ..........................................................................................62
• Halve actrapidregel: ........................................................................................62
Verpakkingen ................................................................................................................62
Bewaring .......................................................................................................................62
❖ Ongeopend .........................................................................................................62
❖ Geopend .............................................................................................................62
❖ Let op .................................................................................................................62
mengen in & spuit..........................................................................................................63
Toedieningsmateriaal ....................................................................................................63
Insulinepomp .................................................................................................................63
❖ Wat: ....................................................................................................................63
Injectieplaatsen .............................................................................................................63
❖ Buik: ...................................................................................................................63
❖ Dij: ......................................................................................................................63
❖ Bil: ......................................................................................................................64
❖ Arm: ....................................................................................................................64
❖ De resorptie van insuline wordt beïnvloed door ..................................................64
Verpleegkundige aandachtspunten ...............................................................................64
Rotatieschema ..............................................................................................................64
Injectietechniek .............................................................................................................64
Weefselbeschadiging ....................................................................................................65
Intraveneuze toediening ................................................................................................65
❖ Gebruik ...............................................................................................................65
Chronische verwikkelingen ...............................................................................................65
Macro-angiopathie.........................................................................................................65
Micro-angiopathie ..........................................................................................................65
Neuropathie...................................................................................................................66
Diabetesvoet .................................................................................................................66
Situatie gebonden aspecten..............................................................................................66
Pediatrische aspecten ...................................................................................................66
Geriatrische aspecten ...................................................................................................66
, Medicatie en invasieve zorg
Geneesmiddelen
Inleiding
Definitie
➢ Het is een Preparaat:
o Plantaardige oorsprong
o Dierlijke oorsprong
o Synthetische oorsprong
➢ Het dient op Ziekte:
o Voorkomen
o Genezen
o verzachten
➢ het dient om Diagnose stellen
Afkomst
➢ Overlevering door de natuurproducten (tijdens WOII)
➢ Toevallige ontdekking vb. penicilline en orale anticoagulantia
➢ Gericht onderzoek
➢ Alternatieve geneesmiddelen
Indeling
Causale of essentiële therapie
➢ Geneesmiddelen die de oorzaak van de ziekte bestrijden
➢ Vb. antibioticum
Symptomatische therapie
➢ Geneesmiddelen die de verschijnselen van een ziekte (pijn, misselijkheid, braken,
jeuk) bestrijden
➢ Vb. Dafalgan, Primperan
Substitutie of vervanging
➢ Geneesmiddelen die een stof die voor het lichaam onmisbaar is vervangen of
aanvullen
➢ Vb. hormonen, vitaminen
Profylactisch
➢ Geneesmiddelen die dienen ter voorkoming van ziekten.
➢ Vb. vaccinatie, …
Placebo
➢ De gesuggereerde (voorgestelde) werking ( het placebo-effect) is onafhankelijk van
het toegediende geneesmiddel. Je krijgt een bepaald geneesmiddel maar de nodige
werkzame stof zit er niet in.
Diagnostisch
➢ contraststoffen geven om galwegen, bloedvaten … op RX te kunnen weergeven
