胆结石的护理查房课件ppt.ppt

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1、Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准

2、备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多普外一科6heart 胆结石患者护理查房胆结石患者护理查房兰州大学第二临床医学院兰州大学第二临床医学院2010级护理级护理薛敏薛敏Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure th

3、at our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chp1病例概要Chp2疾病简介Chp5术前护理Chp6术后护理Chp3相关检查Chp4治疗原则Chp7康复宣教目录页 CONTENTS PAGE Through this publicity campaign,further improve the sense of business integrity of tourism enterpri

4、ses to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.1病例概要过渡页 TRANSITION PAGE 4 Chp1 知识概述Through this publicity c

5、ampaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假

6、招工的陷阱很多1.1 病情介绍：病情介绍 The disease profile患者贾当杏，女，65岁；因“间断性右上腹疼痛伴肩背部疼痛2年余，加重一周”，于2014年8月5日入院，我科以“胆囊结石”收住；入院生命体征：T 36.4 P78次/分 R19次/分 Bp120/70mmHg;查体阳性体征：右上腹压痛，Murphy征阳性。病情介绍病情介绍5 Chp1 知识概述Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tou

7、rism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多1.1 病情介绍：诊疗过程2014年8月5日（入院当天）遵医嘱予以抗生素抗感染、静脉营养、保胃、保肝退黄治疗并完善相关检查；8月8日申请腹部“胆总管探查术”;8月11

8、日病人在全麻下行“胆囊切除术、胆总管探查术、腹腔引流术”，术晨给胃肠减压、留置导尿。病情介绍病情介绍6 Chp1 知识概述Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,he

9、althy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多1.1 病情介绍：病情介绍 The disease profile患者贾当杏，女，65岁；因“间断性右上腹疼痛伴肩背部疼痛2年余，加重一周”，于2014年8月7日入院，我科以“胆囊结石”收住；入院生命体征：T 36.4 P78次/分 R19次/分 Bp120/70mmHg;查体阳性体征：右上腹压痛，Murphy征阳性。病情介绍病情介绍Through this publicity campaign,further

10、improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.2

11、疾病简介过渡页 TRANSITION PAGE 8 Chp2 实施原则Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Deve

12、lopment.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多1胆石症是弹道系统多发病和多发病胆石症（cholelithiasis）:指发生于胆囊和胆管内的结石。是胆道系统常见病和多发病。发病率：我国0.9%10.1%，平均5.6%；女：男=2.57:1；趋势：胆管胆色素结石胆囊胆固醇结石；9 Chp1 知识概述Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to he

13、lp tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多1.4结石分类按化学成分按所在部位10 Chp1 知识概述Through this publicity campaign,further improve

14、the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多胆石成因胆道感染胆道感染多为胆色素

15、结石代谢因素代谢因素胆道异物胆道异物寄生虫、胆道术后线结可为结石核心胆道梗阻胆道梗阻胆汁淤积，细菌作用形成胆色素结石胆囊功能异常胆囊功能异常收缩功能减退，胆汁淤滞其他其他胆汁中胆固醇过饱和，析出、沉淀、结晶雌激素促进胆固醇过饱和；遗传.Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and

16、interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.3相关检查过渡页 TRANSITION PAGE 12 Chp2 实施原则Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to

17、help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多1B超是诊断胆道疾病的首选方法超声提示：1，胆囊结石伴慢性胆囊炎 2，胆总管扩张中上段结石可能（不排外胆泥组织）3，肝、胰未见明显异常优点：无创、简便

18、、可重复、经济且准确率高；术中可提高肝胆疾病诊断率，评估病变切除的可能性；胆管结石术后判定再有无结石；13 Chp2 实施原则Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,

19、healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多4实验室检查阳性指标：RBC2.77x1012/L TBIL36.5umol/L DBIL12.2umol/L IBIL24.3umol/L14 Chp2 实施原则Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consu

20、mers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多3MRCPMRCP印象：1，多发结石 2，胆总管末端可疑小结石，致肝外胆管轻度扩张；建议ERCP检查。优点：无创、胆道成像完整；术中可提高肝胆疾病诊断率，评估病变切除的可能性；胆管结石术

21、后判定再有无结石；Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校

22、生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.4治疗原则过渡页 TRANSITION PAGE 16 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our City

23、s tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多非手术治疗禁食水，胃肠减压输液，纠正水，电解质及酸碱代谢失衡使用维生素K1（解痉、止痛、防出血）；应用抗菌素溶石或排石疗法（危险大，效果不肯定）17 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of tourism enterpris

24、es to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多手术疗法：胆囊切除术（最佳选择）Through this publicity campaign,further improve the s

25、ense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.5术前护理过渡页 TRANS

26、ITION PAGE 19 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临

27、，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多疼痛疼痛 与与胆汁排空受阻致胆囊强烈收缩胆汁排空受阻致胆囊强烈收缩有关有关。知识缺乏知识缺乏 与学历层次、接受知识能力有限有关与学历层次、接受知识能力有限有关焦虑焦虑 与环境陌生有关与环境陌生有关有皮肤完整性受损的危险有皮肤完整性受损的危险 与疾病导致的皮肤瘙痒与疾病导致的皮肤瘙痒有关有关20 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of touris

28、m enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多疼痛疼痛 与胆汁排空受阻致胆囊强烈收缩有关与胆汁排空受阻致胆囊强烈收缩有关。评价：8.6：自述疼痛减轻8.7：述腹痛

29、明显减轻8.9-8.11：自述腹痛消失维生素k121 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Dev

30、elopment.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多知识缺乏知识缺乏 与学历层次、接受知识能力有限有关与学历层次、接受知识能力有限有关目标：患者一周内能部分了解疾病相关知识，能积极配合医目标：患者一周内能部分了解疾病相关知识，能积极配合医疗护理工作疗护理工作护理措施：护理措施：评估患者知识程度及知识接受能力，采取口头宣教形式；评估患者知识程度及知识接受能力，采取口头宣教形式；（小循环）（小循环）介绍疾病相关知识，使之了解疾病的病因相关、理解临床介绍疾病相关知识，使之了解疾病的病因相关、理解临床表现，便于更好的配合

31、治疗护理；表现，便于更好的配合治疗护理；指导病人合理饮食：低脂、高维生素饮食，忌辛辣刺激、指导病人合理饮食：低脂、高维生素饮食，忌辛辣刺激、油炸、油腻，限制动物脂肪摄入；油炸、油腻，限制动物脂肪摄入；评价：患者能理解对疾病的解释，能积极配合医护工作。评价：患者能理解对疾病的解释，能积极配合医护工作。22 Chp4 服务方式Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and opera

32、tors to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多焦虑焦虑 与环境陌生有关与环境陌生有关有皮肤完整性受损的危险有皮肤完整性受损的危险 与疾病导致的皮肤瘙痒有关与疾病导致的皮肤瘙痒有关目标：术前保持皮肤的完整性目标：术前保持皮肤的完整性护理措施护理措施：1、健康教育

33、、健康教育 说明皮肤破损的诱发因素及预防其发生的重要意义说明皮肤破损的诱发因素及预防其发生的重要意义；2、保持床单元的平整清洁；、保持床单元的平整清洁；3、避免挠抓皮肤、修剪指甲；、避免挠抓皮肤、修剪指甲；3、指导保持皮肤擦拭：温、指导保持皮肤擦拭：温 清清 水；水；4、勤翻身，避免皮肤长期受压、勤翻身，避免皮肤长期受压。评价：术前皮肤完整性保持良好。评价：术前皮肤完整性保持良好。Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to he

34、lp tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多手术情况手术情况：患者于2014年8月11日8：:00am在全麻下行“胆总管探查术、胆囊切除术”，手术切口右侧腹部，长约10cm，于胆囊窝处放置引流，于右

35、侧腹壁戳口引出引流管固定，术程顺利，麻醉满意。术后于1:30pm安返病房。Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated De

36、velopment.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.6术后护理过渡页 TRANSITION PAGE 25 Chp6 心理辅导师Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and inte

37、rests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多护理诊断护理诊断：26 Chp6 心理辅导师Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and

38、operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多手术患者术后复查RBC2.43,术前2.77，腹腔引流未见胆汁样，暂未出现并发症。评价出血胆瘘 潜在并发症 加强病情观察:若腹腔引流管引流出大量血性液体超过100ml/h，持续3小时以上并伴有心率增快、血

39、压波动时，提示腹腔内出血。改善和纠正凝血功能：遵医嘱予以Vk1 严密病情观察：若病人出现发热、腹胀、腹痛、等腹膜炎表现，或腹腔引流液呈黄绿色胆汁样，常提示发生胆瘘。维持水电酸平衡：按需补液防止胆汁刺激和损伤皮肤：及时更换引流管周围被胆汁浸湿敷料。目标：能及时发现患者出现的并发症27 Chp6 心理辅导师Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to sa

40、feguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多2、舒适的改变 与切口疼痛以及尿管、腹腔引流管的放置有关措施：提供适宜的环境禁食，胃肠减压及指导病人深呼吸放松遵医嘱给予消炎利胆、解痉止痛的治疗做好切口及引流管的护理鼓励患者表达自己的想法，尽可能的满足患者合理需求 评价：患者的舒适需

41、求基本得到满足目标：病人术后不适程度减轻，得到 较好休息28 Chp6 心理辅导师Through this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinate

42、d Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多目标：病人的需求得到满足措施：口腔护理向患者讲解床头铃的使用方法，以便需求能及时得到满足按时巡视病房，及时发现患者的需求同时鼓励病人在力所能及的情况下自我护理，充分发挥病人的主观能动性评价：病人住院期间的需求基本得到满足3 3、自理能力下降自理能力下降 与术后卧床、切口疼痛、放置引流管等有关与术后卧床、切口疼痛、放置引流管等有关Through this publicity campaign,further improve the sense of bu

43、siness integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多Chapter.7健康宣教过渡页 TRANSITION PAGE

44、 30 Chp7 PCA&EHPThrough this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕

45、业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多饮食宜饮食宜按时规律按时规律少少量量多餐，每天以多餐，每天以45餐为好餐为好，早餐要重视；，早餐要重视；宜清淡易消化，高维生素（胡萝卜、绿色深色蔬菜，少加工）宜清淡易消化，高维生素（胡萝卜、绿色深色蔬菜，少加工）,优质蛋白（鱼优质蛋白（鱼、豆类豆类、低脂奶少量）；低脂奶少量）；少吃少吃高高胆固醇食物胆固醇食物（动物（动物内脏、蛋黄内脏、蛋黄），多吃蔬菜水果，多吃蔬菜水果；少吃动物油、多吃植物油少吃动物油、多吃植物油（少吃油饼、糕点、桃酥、奶油等）（少吃油饼、糕点、桃酥、奶油等）；忌食辣椒、浓茶、咖啡忌

46、食辣椒、浓茶、咖啡.饮食31 Chp7 PCA&EHPThrough this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.

47、寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多n注意劳逸结合，注意劳逸结合，适量运动，充足睡眠，适量运动，充足睡眠，避免过度疲劳避免过度疲劳；n不久坐、不穿紧身衣物；不久坐、不穿紧身衣物；n术后术后6 6周内，应避免提周内，应避免提2 2公斤以上之重物，以防腹压增公斤以上之重物，以防腹压增加。加。n保持心保持心情愉快，情绪稳定，少忧虑悲伤，多乐观开朗情愉快，情绪稳定，少忧虑悲伤，多乐观开朗乐观、愉悦定期复查定期复查 如出现发热、如出现发热、腹痛、黄疸等症状，及时腹痛、黄疸等症状，及时复诊复诊！32 Chp7 PCA&EHPT

48、hrough this publicity campaign,further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests,to ensure that our Citys tourism sustainable,healthy and coordinated Development.寒假来临，不少的高中毕业生和大学在校生都选择去打工。准备过一个充实而有意义的寒假。但是，目前社会上寒假招工的陷阱很多 请各位老师点评指正请各位老师点评指正