各级综合医院分级护理指导原则.pdf
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1、综合医院分级护理指导原则（试行）第一章总 则第一条为加强医院临床护理工作，规范临床分级护理及护理服务内涵，保证护理质量，保障患者安全，制定本指导原则。第二条分级护理是指患者在住院期间，医护人员根据患者病情和生活自理能力，确定并实施不同级别的护理。分级护理分为四个级别：特级护理、一级护理、二级护理和三级护理。第三条本指导原则适用于各级综合医院。专科医院、中医医院和其他类别医疗机构参照本指导原则执行。第四条医院临床护士根据患者的护理级别和医师制订的诊疗计划，为患者提供基础护理服务和护理专业技术服务。第五条医院应当根据本指导原则，结合实际制定并落实医院分级护理的规章制度、护理规范和工作标准，保障患者
2、安全，提高护理质量。第六条各级卫生行政部门应当加强医院护理质量管理，规范医院的分级护理工作，对辖区内医院护理工作进行指导和检查，保证护理质量和医疗安全。第二章分级护理原则第七条确定患者的护理级别，应当以患者病情和生活自理能力为依据，并根据患者的情况变化进行动态调整。第八条具备以下情况之一的患者，可以确定为特级护理：（一）病情危重，随时可能发生病情变化需要进行抢救的患者；（二）重症监护患者；（三）各种复杂或者大手术后的患者；（四）严重创伤或大面积烧伤的患者；（五）使用呼吸机辅助呼吸，并需要严密监护病情的患者；（六）实施连续性肾脏替代治疗（CRRT），并需要严密监护生命体征的患者；（七）其他有生命
3、危险，需要严密监护生命体征的患者。第九条具备以下情况之一的患者，可以确定为一级护理：（一）病情趋向稳定的重症患者；（二）手术后或者治疗期间需要严格卧床的患者；（三）生活完全不能自理且病情不稳定的患者；（四）生活部分自理，病情随时可能发生变化的患者。文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2
4、 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4
5、F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2
6、 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4
7、F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2
8、 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4
9、F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2第十条具备以下情况之一的患者，可以确定为二级护理:（一）病情稳定，仍需卧床的患者；（二）生活部分自理的患者。第十
10、一条具备以下情况之一的患者，可以确定为三级护理：（一）生活完全自理且病情稳定的患者；（二）生活完全自理且处于康复期的患者。第三章分级护理要点第十二条 护士应当遵守临床护理技术规范和疾病护理常规，并根据患者的护理级别和医师制订的诊疗计划，按照护理程序开展护理工作。护士实施的护理工作包括：（一）密切观察患者的生命体征和病情变化；（二）正确实施治疗、给药及护理措施，并观察、了解患者的反应；（三）根据患者病情和生活自理能力提供照顾和帮助；（四）提供护理相关的健康指导。第十三条 对特级护理患者的护理包括以下要点：（一）严密观察患者病情变化，监测生命体征；文档编码:CT1H1Z1G4L2 HB7C6F1O
11、9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:
12、CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O
13、9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:
14、CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O
15、9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:
16、CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O
17、9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2（二）根据医嘱，正确实施治疗、给药措施；（三）根据医嘱，准确测量出入量；（四）根据患者病情，正确实施基础护理和专科护理，如口腔护理、压疮护理、气道护理及管路护理等，实施安全措施；（五）保持患者的舒适和功能体位；（六）实施床旁交接班。第十四条对一级护理患者的护理包括以下要点：（一）每小时巡视患者，观察患者病情变化；（二）根据患者病情，测量生命体征；（三）根据医嘱，正确实施治疗、给药措施；（四）根据患者病情，正
18、确实施基础护理和专科护理，如口腔护理、压疮护理、气道护理及管路护理等，实施安全措施；（五）提供护理相关的健康指导。第十五条对二级护理患者的护理包括以下要点：（一）每 2 小时巡视患者，观察患者病情变化；（二）根据患者病情，测量生命体征；（三）根据医嘱，正确实施治疗、给药措施；（四）根据患者病情，正确实施护理措施和安全措施；（五）提供护理相关的健康指导。第十六条对三级护理患者的护理包括以下要点：文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6F1O9C3 ZA4A1B4F1X2文档编码:CT1H1Z1G4L2 HB7C6
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