第六节狂犬病病人的护理课件

治疗要点 ❖ 本病目前无特效疗法，应及时正确处理伤口及对
症治疗。 ❖ 保持病人安静，减少风、光、声等刺激，狂躁时
用镇静剂；加强监护治疗，保持呼吸道通畅，吸 氧，必要时行人工呼吸器辅助呼吸；维持内环境 平衡。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
病情观察
❖ 观察病人生命体征、意识状态的变化。 ❖ 有无呼吸肌痉挛等严重并发症。 ❖ 观察病人的心理和情绪反应。
一旦发现病情变化，及时报告医生，积极配合处 理。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
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护理诊断
❖ 皮肤完整性受损 与病犬、病猫等动物咬伤或抓伤有 关。
❖ 有受伤的危险 与病人兴奋、狂躁、出现幻觉等精神 异常有关。
❖ 有窒息的危险 与病毒损害中枢神经系统导致呼吸肌 痉挛有关。
❖ 有误吸的危险 与发作性咽肌痉挛致吞咽困难有关。
❖ 恐惧 与疾病引起死亡的威胁有关。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
流行病学
项目
传染源 传播途径
易感人群
内容
主要传染源是狂犬，其次是猫、猪、狼等家畜和兽类
主要通过咬伤传播，也可由带病毒的唾液经伤口、抓 伤、舔伤的黏膜和皮肤侵入，少数可通过对病犬 宰杀而感染
人群普遍易感，被病犬咬伤后发病率为15%～30%， 当咬伤部位为头面部、颈部及手部等神经血管分 布丰富的部位时，发病率增加
1 2 3 4
主要内容
疾病概述 护理评估 护理诊断 护理措施
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
1
疾病概述
定义 临床表现 病原体 流行病学
预后
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
临床表现
❖ 临床主要表现为特有的恐水、怕风、恐惧 不安、流涎和咽肌痉挛、进行性瘫痪等。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
辅助检查
血常规及脑脊液检查
❖ 白细胞计数正常或轻、中度增多，中性粒细胞占80%以上。脑脊 液细胞数及蛋白质稍增高，糖及氯化物正常。
免疫学检查
❖ 检测脑组织、唾液和尿沉渣中的病毒抗原，阳性率约40%；检测 血液或脑脊液中的中和抗体，对未接种疫苗者有诊断价值。
病原学检查
❖ 取病人的唾液、脑脊液、泪液接种鼠脑分离病毒，对狂犬病动物 及病人死后脑组织进行切片染色，镜下找内格里小体，或用PCR 检测狂犬病毒RNA。
病原体
❖ 狂犬病毒属于弹状病毒科，为RNA病毒 ❖ 对外界的抵抗力不强，对紫外线、碘液、
乙醇等一般的理化消毒方法敏感，但可耐 受低温
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
恐水为本病的特征，典型者不敢饮水、闻水声、
见水及提及水，严重发作时可有全身肌肉阵发性 血压上升
抽搐或呼吸肌痉挛致呼吸困难、发绀。另外，病
人体温可升至38℃～40℃，有交感神经功能亢进 发绀等
的表现。发作过程中，病人神志清楚。
约6～18h。肌肉痉挛停止，全身弛缓性瘫痪，逐 渐进入昏迷状态，最后因呼吸、循环衰竭而死亡。
第十章传染病的护理 第六节 狂犬病病人的护理
闫瑞芹
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
一般护理
项目
内容
环境
将病人安置于安静、避光的单人房间，由专人护理，保持病 人安静，减少风、光、声等刺激，对病人实施严密接触隔离。
有恐水及吞咽困难者应禁食禁饮，在痉挛发作的间歇期或应
饮食护理
用镇静剂后可鼻饲高热量流质饮食，必要时遵医嘱给予静脉 输液，保证每日摄入量及维持水电解质平衡，准确记录出入
量。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
身体状况
前驱期 兴奋期 麻痹期
症状
体征
约1～4天。起病时可有类感冒症状，继而出现恐 惧不安、烦躁失眠、对声、光、风等刺激有喉头 紧缩感。最有意义的早期症状为愈合伤口处及其 相应的神经支配区有痒、痛、麻及蚁走等异样感 觉。
体温升高
约1～3天。主要表现为高度兴奋、极度恐怖表情、
发作性咽肌痉挛、恐水、怕风、怕光、怕声等。 心率加快
预后
❖ 本病病情重，进展迅速，病死率几乎100%。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
心理-社会状况
❖ 评估病人及家属对疾病的认识程度。 ❖ 有无因症状明显、病情发展迅速而出现紧张、恐惧
不安等不良情绪。 ❖ 了解病人家庭和社会支持情况如何。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
健康史
❖ 询问是否接触过病犬，有无被病犬或其 他动物咬伤史。
❖ 有无接种过疫苗。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
2
护理评估
健康史 身体状况 心理-社会状况 辅助检查 治疗要点
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
4
护理措施
一般护理 病情观察 对症护理 用药护理
心理护理 健康指导
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
Байду номын сангаас定义
❖ 狂犬病（又称恐水症）是由狂犬病毒引起 的，以侵犯中枢神经系统为主的急性人畜 共患传染病。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
学习重点与难点
❖ 学习重点
狂犬病病人的身体状况、对症护理和健康指导
❖ 学习难点
狂犬病病人的伤口护理
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society