护理业务学习ppt课件
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【护理措施】
(一)一般护理
1.大咯血绝对卧床,患侧卧位 2.高热量、高蛋白、高维生素饮食,
每天饮水1500ml以上
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
病理
感染和支气管阻塞互为因果 易发部位:炎症性多见于下叶、左下叶
肺结核多见于上叶 支扩特点:柱状和囊状扩张 毛细血管扩张、动脉瘤形成导致反复咯血
4来自百度文库
do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(二)身体状况
2.反复咯血
从小量到大量不等,与病情严重度及病变范围不一致 可以是唯一症状,称干性支气管扩张 可以发生窒息死亡
3.反复肺部感染 4.全身中毒症状 :发热、乏力、盗汗、消瘦、
贫血
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(三)促进排痰的护理
指导有效咳嗽 体位引流 遵医嘱用祛痰剂或β2受体激动剂
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
2.病因
气管-肺感染和支气管阻塞:婴幼儿百日咳、
麻疹、支气管肺炎、肿瘤、异物吸入
先天发育缺陷、遗传因素:巨大气管-支气
管症、肺囊性纤维化
30%病因不明可能是机体免疫功能失调
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
支气管扩张病人的护理 护理业务学习 呼吸一科2013-3月
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【护理评估】
(一)健康史
-幼儿时期麻疹、百日咳、支气管肺 炎、呼吸道感染反复发作史 -异物、肿瘤、肺结核 病史 -先天发育缺陷 -免疫功能失调性疾病
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
体位引流
原理:重力使痰液从支气管→气管→体外 准备:解释 体位:病变部位 用药:抗生素、化痰药物 时间:饭前,1-3次/天;15-20分钟/次 观察:脸色、脉搏、眩晕等症状
引流后护理:舒适体位;口腔护理;引流效果
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(二)身体状况
1.慢性咳嗽、大量脓痰
量:可达数百毫升,与体位有关 色:黄色或绿色 静置分三层:上层:泡沫;
中层:粘液; 下层:坏死组织
合并厌氧菌感染可有恶臭味
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
5.体征
早期或干性支气管扩张无异常肺部体征 典型肺部体征可听到固定持久的湿罗音 有气道痉挛或狭窄时可听到哮鸣音 慢性者可见到杵状指(趾) 营养不良、贫血等体征
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(四)辅助检查
1.影像学检查 :X线胸片 胸部CT 支气管碘油造影
2.纤维支气管镜检查
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【概 述】 1.概念
直径大于2mm的支气管 管壁的肌肉和弹性组织破坏 慢性持久异常扩张 临床特点
慢性咳嗽 大量脓痰 反复咯血
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
【护理问题】
1.清理呼吸道无效 与痰液黏稠和无效咳嗽 有关
2.有窒息的危险 与痰多、痰液黏稠或大咯 血造成气道阻塞有关
3.营养失调(低于机体需要量) 与反复感染 导致机体消耗增加有关
4.恐惧 与突然或反复大咯血有关
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(二)病情观察
咳痰、咯血的颜色、性质、量 生命体征 窒息的先兆 发现窒息先兆立即报告医生,配合抢救
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(五)预防窒息的护理
避免屏气 床旁备好急救设备 发现窒息先兆:
头低脚高45°俯卧位,头偏向一侧 清除血块 机械吸痰 高浓度吸氧 气管插管或气管切开
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
发病机制
咳嗽
脓痰 感染 支气管扩张 血管扩张 咯血
V/Q比值↓
缺氧
小动脉痉挛
肺心病、右心衰
肺动脉高压
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
实验室检查: 血常规:WBC N 痰涂片和痰培养:致病菌
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(三)心理-社会状况 焦虑、沮丧 自卑、孤独、回避 恐惧
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians
(五)治疗要点
原则:保持呼吸道引流通畅
控制感染
处理咯血
必要时手术治疗
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do we simplify complex fractions and complex rational Disorders Building a Community of Support Immunizations American Acade my of Family Phy sicians