护理医学中医护理学课件心悸.ppt

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1、心悸心悸PalpitationPalpitationDefinitionDefinition Palpitation 是指病人自觉心中悸动，惊慌不安，是指病人自觉心中悸动，惊慌不安，甚则不能自主为主要表现的一种病证。心悸包括惊甚则不能自主为主要表现的一种病证。心悸包括惊悸和怔忡两方面，因惊而悸者谓之惊悸，时发时止，悸和怔忡两方面，因惊而悸者谓之惊悸，时发时止，病情较轻；若无外因而悸者，谓之怔忡，发作无定病情较轻；若无外因而悸者，谓之怔忡，发作无定时，病情较重。时，病情较重。金匮要略首提惊悸金匮要略首提惊悸济生方首提怔忡济生方首提怔忡Cause of Disease and Cause of D

2、isease and PathomechanismPathomechanism Palpitation 的病位在心，其发病与脾、肾、的病位在心，其发病与脾、肾、肝、肺四脏功能失调相关。本病为本虚标实，肝、肺四脏功能失调相关。本病为本虚标实，本为气血不足，阴阳亏损；标为气滞，血瘀，本为气血不足，阴阳亏损；标为气滞，血瘀，痰浊，水饮。痰浊，水饮。PalpitationAnalyses of pathological conditionsAnalyses of pathological conditions心虚胆怯心虚胆怯(timidity due to heart-deficiency)心血不足心

3、血不足(insufficiency of heart blood)阴虚火旺阴虚火旺(flaring of fire due to yin-asthenia)心阳不振心阳不振(inactivation of heart-yang)水饮凌心水饮凌心(fluid retention invading heart)心血瘀阻心血瘀阻(stasis of heart blood)PalpitationAnalyses of pathological conditionsAnalyses of pathological conditionsTimidity due to heart-deficiency 心

4、悸，善惊易恐，坐卧不安，少寐多心悸，善惊易恐，坐卧不安，少寐多梦，舌苔薄白或如常，脉象动数或虚弦。梦，舌苔薄白或如常，脉象动数或虚弦。Insufficiency of heart blood 心悸，头晕，面色不华，倦怠乏力，心悸，头晕，面色不华，倦怠乏力，舌质淡红，脉象细弱。舌质淡红，脉象细弱。PalpitationAnalyses of pathological conditionsAnalyses of pathological conditionsFlaring of fire due to yin-asthenia 心悸不宁，心烦少寐，头晕目眩，手心悸不宁，心烦少寐，头晕目眩，手足心热

5、，腰酸耳鸣，舌质红，少苔或无苔，足心热，腰酸耳鸣，舌质红，少苔或无苔，脉象细数。脉象细数。Inactivation of heart-yang 心悸不安，胸闷气短，面色苍白，形心悸不安，胸闷气短，面色苍白，形寒肢冷，舌质淡白，脉象虚弱或沉细而数。寒肢冷，舌质淡白，脉象虚弱或沉细而数。PalpitationAnalyses of pathological conditionsAnalyses of pathological conditionsFluid retention invading heart 心悸，眩晕，胸脘痞满，形寒肢冷，心悸，眩晕，胸脘痞满，形寒肢冷，小便短少；或下肢浮肿，渴不欲

6、饮，恶心吐小便短少；或下肢浮肿，渴不欲饮，恶心吐涎，舌苔白滑，脉弦滑。涎，舌苔白滑，脉弦滑。Stasis of heart blood 心悸不安，胸闷不舒，心痛时作，或心悸不安，胸闷不舒，心痛时作，或见唇甲青紫，舌质暗或有瘀斑，脉涩或结代。见唇甲青紫，舌质暗或有瘀斑，脉涩或结代。Palpitation Problems of patientsProblems of patientsPalpitation 心输出量减少 恐惧 活动无耐力 睡眠形态紊乱 知识缺乏 潜在并发症Nursing goalsNursing interventionsNursing interventionsTimidity

7、 due to heart-deficiency Principle of nursing：镇惊定志，养心安神镇惊定志，养心安神 Entirety nursingLife care:Dietary care:Drugs care:Other nursing methods:PalpitationNursing interventionsNursing interventionsInsufficiency of heart blood Principle of nursing：补血养心，益气安神补血养心，益气安神 Entirety nursingLife care:Diet care:Drugs

8、 care:Other nursing methods:PalpitationNursing interventionsNursing interventionsFlaring of fire due to yin-asthenia Principle of nursing：滋阴请火，养心安神滋阴请火，养心安神 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:PalpitationNursing interventionsNursing interventionsInactivation of heart

9、-yang Principle of nursing：温补心阳，安神定悸温补心阳，安神定悸 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:PalpitationNursing interventionsNursing interventionsFluid retention invading heart Principle of nursing：振奋心阳，化气行水振奋心阳，化气行水 Entirety nursingLife care:Diet care:Drugs care:Other nursing

10、methods:PalpitationNursing interventionsNursing interventionsStasis of heart blood Principle of nursing：活血化瘀，理气通结活血化瘀，理气通结 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:PalpitationNursing evaluationNursing evaluationIntroduction on healthIntroduction on health积极治疗引起心悸的原发病。积极治疗

11、引起心悸的原发病。避避免免诱诱发发心心悸悸的的因因素素，如如寒寒热热变变化化、饮饮食食不不节节、情志不遂等。情志不遂等。保证充足的休息与睡眠是减轻病情的重要条件。保证充足的休息与睡眠是减轻病情的重要条件。Palpitation胸痹胸痹Chest blockage Chest blockage Definition Chest blockage 是以胸部闷痛，甚则胸痛彻背，短气，喘息不得卧为主症的一种疾病。轻者仅感胸闷如窒，呼吸欠畅；重者则有胸痛，严重者胸痛彻背，背痛彻心，手足青冷。最早的相关论述最早的相关论述见与内经，金见与内经，金匮要略首先正式提匮要略首先正式提出胸痹一名出胸痹一名Cause

12、 of Disease and Cause of Disease and PathomechanismPathomechanismChest blockage Chest blockage 的主要病机为心脉痹阻；病位以心为主，多与肝、脾、肾三脏功能失调有关，其病理变化主要表现为本虚标实，虚实夹杂。Analyses of pathological conditionsAnalyses of pathological conditionsAnalyses of pathological conditionsAnalyses of pathological conditions心血痹阻：心血痹阻：s

13、tasis of heart blood 痰浊壅塞：痰浊壅塞：stagnation and obstruction of turbid phlegm 阴寒凝滞：阴寒凝滞：stagnation of yin-cold心肾阴虚：心肾阴虚：asthenia of cardiac and renal yin气阴两虚：气阴两虚：asthenia of both qi and yin阳气虚衰：阳气虚衰：declination of yangqiChest blockage Analyses of pathological conditionsAnalyses of pathological conditi

14、onsStasis of heart blood 胸部刺痛，固定不移，入夜更甚，时或心胸部刺痛，固定不移，入夜更甚，时或心悸不宁，胸闷气短，舌紫暗，脉沉涩。悸不宁，胸闷气短，舌紫暗，脉沉涩。Stagnation and obstruction of turbid phlegm 胸闷如窒而痛，或痛引肩背，气短喘促，肢胸闷如窒而痛，或痛引肩背，气短喘促，肢体沉重，形体肥胖，痰多，苔浊腻，脉滑。体沉重，形体肥胖，痰多，苔浊腻，脉滑。Chest blockage Analyses of pathological conditionsAnalyses of pathological conditions

15、Analyses of pathological conditionsAnalyses of pathological conditionsStagnation of yin-cold 胸痛彻背，感寒痛甚，胸闷气短，心悸，重则胸痛彻背，感寒痛甚，胸闷气短，心悸，重则喘息，不能平卧，面色苍白，四肢厥冷，舌苔白，喘息，不能平卧，面色苍白，四肢厥冷，舌苔白，脉沉细。脉沉细。Asthenia of cardiac and renal yin 胸闷且痛，心悸盗汗，心烦不寐，腰膝痰软，胸闷且痛，心悸盗汗，心烦不寐，腰膝痰软，耳鸣，头晕，舌红或有紫斑，脉细数或细涩。耳鸣，头晕，舌红或有紫斑，脉细数或细涩。C

16、hest blockage Analyses of pathological conditionsAnalyses of pathological conditionsAsthenia of both qi and yin 胸闷隐痛，时作时止，心悸气短，倦胸闷隐痛，时作时止，心悸气短，倦怠懒言，面色少华，头晕目眩，遇劳则甚，怠懒言，面色少华，头晕目眩，遇劳则甚，舌偏红或有齿印，脉细弱无力，或结代。舌偏红或有齿印，脉细弱无力，或结代。Declination of yangqi 胸闷气短，甚则胸痛彻背，心悸，汗胸闷气短，甚则胸痛彻背，心悸，汗出，畏寒肢冷，腰酸乏力，面色苍白，唇甲出，畏寒肢冷，腰酸

17、乏力，面色苍白，唇甲淡白或青紫，舌淡白或紫暗，脉沉细或沉微淡白或青紫，舌淡白或紫暗，脉沉细或沉微欲绝。欲绝。Chest blockage Problems of patientsProblems of patientsChest blockage Nursing goals 胸痛 恐惧 知识缺乏 活动无耐力Nursing interventionsNursing interventionsStasis of heart blood Principle of nursing：活血化瘀，通络止痛活血化瘀，通络止痛 Entirety nursingLife care:Diet care:Drugs

18、care:Other nursing methods:Chest blockage Nursing interventionsNursing interventionsStagnation and obstruction of turbid phlegm Principle of nursing：通阳泄浊，豁痰开结通阳泄浊，豁痰开结 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Chest blockage Nursing interventionsNursing interventionsStagna

19、tion of yin-cold Principle of nursing：辛温通阳，开痹散结辛温通阳，开痹散结 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Chest blockage Nursing interventionsNursing interventionsAsthenia of cardiac and renal yin Principle of nursing：滋阴益肾，养心安神滋阴益肾，养心安神 Entirety nursingLife care:Diet care:Drugs c

20、are:Other nursing methods:Chest blockage Nursing interventionsNursing interventionsAsthenia of both qi and yin Principle of nursing：益气养阴，活血通络益气养阴，活血通络 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Chest blockage Nursing interventionsNursing interventionsDeclination of yangqi P

21、rinciple of nursing：益气通阳，活血通络益气通阳，活血通络 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Chest blockage Nursing evaluationNursing evaluationNursing evaluationNursing evaluationIntroduction on healthIntroduction on health积积极极治治疗疗引引起起胸胸痹痹的的有有关关疾疾病病，如如高高血血压压，糖糖尿尿病等。病等。坚坚持持适适当当的的体体育育锻

22、锻炼炼，促促进进心心肺肺功功能能，使使气气血血调调畅，利于康复。畅，利于康复。饮饮食食以以素素食食为为主主，戒戒除除烟烟酒酒等等不不良良嗜嗜好好，不不偏偏食食偏嗜，不暴饮暴食。偏嗜，不暴饮暴食。参照参照内科护理学内科护理学相关知识。相关知识。Chest blockage 眩晕眩晕Dizziness/VertigoDizziness/VertigoDefinition 眩眩(blurred vision)即眼花，晕即眼花，晕(dizziness)即头晕，两者常同时并见，故统即头晕，两者常同时并见，故统称为称为“眩晕眩晕”。轻者闭目可止，重者如坐车，。轻者闭目可止，重者如坐车，旋转不定，不能站立，

23、或伴有恶心、呕吐、汗旋转不定，不能站立，或伴有恶心、呕吐、汗出、甚则昏倒等症状。出、甚则昏倒等症状。Cause of Disease and Cause of Disease and PathomechanismPathomechanism 肝阳上亢肝阳上亢：hyperactivity of liver-yang 肾精不足：肾精不足：deficiency of renal essence 气血亏虚：气血亏虚：asthenia of both qi and blood 痰浊中阻：痰浊中阻：turbid phlegm obstructing in midst 瘀血内阻：瘀血内阻：interior

24、retention of blood stasis Dizziness 多为本虚标实，实为风、火、痰、瘀；多为本虚标实，实为风、火、痰、瘀；虚则气血阴阳之虚。病变脏腑涉及肝、脾、肾，三者虚则气血阴阳之虚。病变脏腑涉及肝、脾、肾，三者之中，又以肝为主。之中，又以肝为主。Dizziness/VertigoAnalyses of pathological conditionsAnalyses of pathological conditionsHyperactivity of liver-yangAsthenia of both qi and bloodDeficiency of renal ess

25、enceTurbid phlegm obstructing in midst瘀血阻络：瘀血阻络：blood stasis obstructing collateralsDizziness/VertigoAnalyses of pathological conditionsAnalyses of pathological conditionsHyperactivity of liver-yang 眩晕耳鸣，头痛且胀，每因烦劳或恼眩晕耳鸣，头痛且胀，每因烦劳或恼怒而头晕头痛加剧，面色潮红，急躁易怒，怒而头晕头痛加剧，面色潮红，急躁易怒，少寐多梦，口苦，舌质红，苔黄，脉弦。少寐多梦，口苦，舌质红，苔

26、黄，脉弦。Asthenia of both qi and blood 眩晕动则加剧，劳累即发，面色少华眩晕动则加剧，劳累即发，面色少华或萎黄，唇甲色淡，心悸少寐，神倦懒言，或萎黄，唇甲色淡，心悸少寐，神倦懒言，纳呆，舌质淡，脉细弱。纳呆，舌质淡，脉细弱。Dizziness/VertigoAnalyses of pathological conditionsAnalyses of pathological conditionsDeficiency of renal essence 眩晕，目花，健忘少寐，精神萎靡，眩晕，目花，健忘少寐，精神萎靡，腰膝酸软，遗精耳鸣。偏阴虚者，兼见五心腰膝酸软，遗精

27、耳鸣。偏阴虚者，兼见五心烦热，舌质红，脉细数。偏阳虚者，兼见四烦热，舌质红，脉细数。偏阳虚者，兼见四肢不温，形寒怯冷，舌质淡，脉沉细弱。肢不温，形寒怯冷，舌质淡，脉沉细弱。Dizziness/VertigoAnalyses of pathological conditionsAnalyses of pathological conditions Turbid phlegm obstructing in midst 眩晕而头重昏蒙，胸脘满闷，纳呆，恶心，眩晕而头重昏蒙，胸脘满闷，纳呆，恶心，体倦多寐，苔白腻，脉濡滑。体倦多寐，苔白腻，脉濡滑。Blood stasis obstructing co

28、llaterals 眩晕头痛，或健忘，失眠，心悸，精神不振，眩晕头痛，或健忘，失眠，心悸，精神不振，面或唇色紫暗，舌质有瘀斑瘀点，脉弦涩或细涩。面或唇色紫暗，舌质有瘀斑瘀点，脉弦涩或细涩。Dizziness/VertigoProblems of patientsProblems of patientsNursing goalsNursing goalsDizziness/VertigoNursing interventionsNursing interventions Hyperactivity of liver-yang Principle of nursing：平肝潜阳，滋补肝肾平肝潜阳，

29、滋补肝肾 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Dizziness/VertigoNursing interventionsNursing interventionsAsthenia of both qi and blood Principle of nursing：补益气血，健运脾胃补益气血，健运脾胃 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Dizziness/VertigoNursing int

30、erventionsNursing interventionsDeficiency of renal essence Principle of nursing：Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:偏阴虚者补肾滋阴偏阳虚者补肾助阳Dizziness/VertigoNursing interventionsNursing interventionsTurbid phlegm obstructing in midst Principle of nursing：燥湿祛痰，健脾和胃燥湿祛痰，健脾和胃 E

31、ntirety nursingLife care:Diet care:Drugs care:Other nursing methods:Dizziness/VertigoNursing interventionsNursing interventionsBlood stasis obstructing collaterals Principle of nursing：祛瘀通络，活血通窍祛瘀通络，活血通窍 Entirety nursingLife care:Diet care:Drugs care:Other nursing methods:Dizziness/VertigoNursing ev

32、aluationNursing evaluationIntroduction on healthIntroduction on health消消除除各各种种导导致致眩眩晕晕发发生生的的因因素素。中中年年以以上上之之人人，积积极防治眩晕，预防中风先兆的发生。极防治眩晕，预防中风先兆的发生。避避免免突突然然或或剧剧烈烈的的头头部部运运动动。眩眩晕晕病病人人康康复复后后不不宜宜高高空空作作业业，避避免免游游泳泳及及各各种种旋旋转转大大的的动动作作或或游游戏戏，必要时服用乘晕宁等药物预防必要时服用乘晕宁等药物预防积极治疗原发病，如高血压、贫血、脑部病变等。积极治疗原发病，如高血压、贫血、脑部病变等。Dizziness/Vertigo