第十一章 颈部疾病病人的护理

第十一章 颈部疾病病人的 护理 卵巢癌的护理查房优质护理服务内容doc优质护理服务内容肺癌的护理常规消毒供应室优质护理 学习重点和难点 , 学习重点:甲状腺功能亢进病人外科治疗的护理评估和护理措 施 。 , 学习难点:甲状腺功能亢进病人外科治疗的术前药物准备及术 后并发症的观察和护理。 甲 状 腺 合功 成能 贮 存 分 泌 第一节甲状腺功能亢进外科治疗 病人的护理 the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote , , , , , (三)心理-社会状况 , “精神过敏” ，急躁易怒 ;人际关系紧张 ;社交心理障 碍 。 (四)辅助检查 1.BMR:基础代谢率%=脉率+脉压-111。 2.摄I131率测定。 3.血清T3、T4含量测定等。 4.颈部X线。 (五)治疗要点及反应 , 治疗方法: 抗甲状腺药物治疗 内科治疗 放射性131I治疗 外科治疗——甲状腺大部切除术 手术指征: 1.继发性甲亢和高功能腺瘤。 2.中度以上的原发性甲亢。 the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote 3.应用抗甲状腺药物或131I治疗后复发者。4.甲状腺肿大明显，特别是呈结节性的或有压迫症状的。 甲状腺大部切除术后常见并发症 : 呼吸困难和窒息(最危急 ) 甲状腺危象 喉返神经损伤 喉上神经损伤 手足抽搐 [ 护理诊断 / 问题 ] 1(焦虑 2(营养失调 3(体象紊乱 4(潜在术后并发症 呼吸困难、窒息，喉返神经、喉上神经损伤，手足抽搐，甲状腺危象。 [ 护理 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 ] 1. 术前护理 (1)完善术前检查: X 线(食管吞钡 —— 气管) 心电图(心脏) 喉 镜(声带) Ca 、P (甲状旁腺功能) BMR 、T3 、 T4(选择手术时机) 测BMR(脉压、脉率 / 仪器) 1)停服影响甲状腺功能药物 2)测前晚充分睡眠(禁安眠药) 3)安静、空腹、静卧 4)检测器:排空大小便、卧床1h后进行 131I 测定 禁忌:妊娠12周?、哺乳期 - 检查前,周禁用含碘药物与食物 抗甲状腺药物、甲状腺 检查前空腹 the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote 测 T3 0.71-2.15nmol / L (4倍) T4 58.01-546.8nmol / L(2.5倍) (2)药物准备(控制甲亢) ? 轻度甲亢 即服碘剂 2-3 周。 ? 中度以上 先服抗甲状腺药物， 症状控制后服碘剂 2周。 ? 对碘、抗甲状腺药物无效， 心率仍快，可使用普萘洛尔。 * 碘的用法与作用 * 甲亢控制的指标 (3)做好心理护理、消除顾虑。 (4)饮食:高蛋白、热量、碳水化合物、 维生素, 禁中枢N兴奋食物(茶、咖啡等)。 (5)突眼的保护:头高位，眼睑不闭者戴眼罩，眼膏(睡)——防干燥、感染。 (6)颈过伸锻炼(头低肩高) 深呼吸、咳嗽训练(用手固定颈部) the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote 2.术后护理 (1)一般护理 床边常规放置气管切开包、吸痰设备、 氧气、急救物品(手套、消毒用品) * 平卧位?半卧位(保持头颈舒适位置) * 引流 24~48 小时 * 测生命体征，每30分钟一次至平稳 * 伤口情况。 减轻疼痛(止痛药) 保持呼吸道通畅 (深呼吸、咳嗽排痰，雾化吸入) * 饮食与营养 * 继续服用碘剂 / 普萘洛尔 (2)观察并发症及处理 ? 呼吸困难、窒息(48h内) the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote (注意生命体征、伤口情况) 原 因 处 理 血肿压迫 清除积血，止血 喉头水肿 吸氧、喷喉、 激素 气管塌陷 气管切开 粘痰堵塞 吸痰 双侧喉返N损伤 气管切开 ? 喉返N损伤: 单侧 — 声音嘶哑;双侧 — 失音 、 呼吸困难 ? 喉上N损伤: 外支 — 声音低 内支 — 呛咳、 误吞 ?手足抽搐(1~2天) 限制磷摄入 补充钙剂 促进钙吸收 (早期缺钙症状、防舌咬伤) ?甲状腺危象(12~36 h ) ,准备不足、甲亢未控制 症状:高热(,39?) 脉快(,120次 / 分) 神经症状 呕吐 、水泻 处理:碘剂、氢化可的松、肾上腺素能阻滞剂、 镇静、降温、输糖、吸氧、强心 the three. Third, seriously implement the Central, provincial, municipal and County party Committee on the establishment of a sound work style construction views of the long-acting mechanism and on the implementation of the three Suns calls for further strengthening of education administration and supervision of party members and cadres, from the ... Accept supervision and earnestly grasp, balance, two promotion, important job himself, the Secretary of development, major issues personally. 5. strongly supports accountability discipline discipline. Administrative provisions on strict enforcement of party members and cadres to ask all the discipline inspection and supervision cadres in accordance with the iron itself must be a hard requirement, adhere to the responsibilities and play, earnestly fulfill their duties of supervision and accountability for Zhi JI. Zhen into full play and the oversight role of the Commission, establish and improve the village rules and community conventions, promoting joint public and serving the sunshine publicly available implementation of the platform for action. Discipline in handling cases, adhere to find along with scrutiny, to appoint the interference and resistance, backed by courageous, find the problem corrected, powerful maintenance the seriousness of responsibility of uncorrupted. Actively promote the discipline Committee detailed switch and, casting, tree-generating activities. Promote