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Make patients get the best analgesic effect
Use ,make patients get the best analgesic effect ,and may reduce the incidence of complications ,reduce the operation of the medical staff ,at the same time disposable analgesic pump has the advantages of convenient use ,analgesic drug blood concentration is stable, persistent effect, dosing exact rapidly ,clinical analgesic effect.
Administration by first loading dose makes the medicine reach the blood concentration after continue to maintain method. In this paper, the test group using this method with satisfactory results.
The traditional intermittent intramuscular opioids for postoperative analgesia ,Adidas Jeremy Scott Wings,the effect is not satisfied. This paper test group analgesic effect is better than the control group ,and epidural morphine analgesia direct analgesic ,low concentration of bupivacaine and morphine can produce synergistic analgesic effect and no block of motor nerve .
Although the use of analgesic drugs may cause respiratory depression ,nausea ,vomiting, urinary retention ,and other adverse reactions, but as long as we strengthen the anesthesiology knowledge learning ,in the application of the close observation of changes in conditions ,the timely detection of potential or nursing problems and complications ,symptomatic treatment ,can make the analgesic effect in patients achieve satisfactory purpose ,facilitate postoperative rehabilitation.
:1 Huang Shenghuipractical hard ridge .Membrane external cavity nerve block .Ji :Shandong science and Technology Press ,1996,11.2 Lin Ying,Yang Guang .The impact of patient-controlled analgesia of subjective factors.
Anesthesiology forum ,1998,20(5):9.3 Li Zhonglian.Clinical pain therapeutics .Tianjin Tianjin :Science and Technology Press ,1997,444.4 Zhang Quanshuan.Pharmacology ,Second Edition .Beijing :People ,1988,114.
5 Liu Meilan.Air cushion bed in the prevention and treatment of pressure ulcers in rats. Chinese medicine and the Journal of nursing ,ADIDAS Porsche Design P5000,2001,9:88.6 Yang Suling.Patients at different postoperative analgesia effect observation and clinical nursing.
Journal of nursing ,2000,6(4):250(received date :2007- 01- 09)(text editor: Weidong ) in 1 liver transplantation patients with ventilator dependent patients successfully weaning clinical care Zhang Jianfeng ,GE more red ,Zhang Ronghua ventilator dependence has relationship with many factors ,for long-term use of ventilator dependent patients undergoing ventilator weaning ,must be aimed at patients with different disease characteristics ,psychological state and tolerance ,making scientific plan of care ,physical and mental nursing of two aspects .
In ventilator-dependent respiratory care clinical problem today ,though The nursing research has made some achievements ,but in many ways still need further discussion. This paper introduces 1 cases after liver transplantation patients with ventilator dependent patients from admission to discharge successfully weaning of the nursing process ,for respiratory dependent clinical nursing to provide reference and reference.
mechanical ventilation ventilator ;liver transplantation ;dependence of R473 of B article ID 1681- 5122(2007): 02 - 0121- 02mechanical ventilation isthe treatment of various diseases of respiratory failure complicated by commonly used treatment method .
It as a respiratory support therapy ,does not eliminate the respiratory failure ,when patients with spontaneous breathing capacity to restore to an appropriate level ,should prompt withdrawal of ventilator .
The ventilator dependence is due to prolonged mechanical ventilation patients have been accustomed to passive auxiliary breathing ,for ventilator dependent ,weaned from the ventilator after unable to breathe, interference and prolonged weaning process .
As a respiratory support therapy ,clinical finding generally ventilator the use of more than 2 weeks ,will produce the ventilator dependent .I Division in 2006 Augusttreated 1 patients after liver transplantation with ventilator dependent patients The patients ,through careful treatment and nursing ,offline smoothly ,discharged.
The nursing experience reports as follows .1 clinical dataof patients ,male ,63 years old.Because " ;after liver transplantation in patients with ventilator dependent 3 months " ;from the level of hospital to ICU in our hospital .
Patients on May this year in the hospital liver transplantation ,postoperative has been in ,head CT examination shows: the right basal ganglia hemorrhage. Given anti-inflammatory ,rejection ,dewatering lowering intracranial pressure after treatment of consciousness recovery ,ventilator ,offline ,family members of patients required to treatment in our hospital.
Physical examination :T 3616,P 81 / min,R 15 time / min( ventilator assisted breathing ) ,BP 130 / 95 mmHg,was clear, both pupils anemia appearance ,such as circle ,diameter of about 310 mm,light reflection ,tracheal intubation ,two pulmonary respiratory sound rough ,audible and sputum tone ,the abdomen flat ,right upper quadrant operation about a scar 15 cm,healing ,skin ,sclera mild yellow dye ,bilateral upper arm can be seen scattered in the ecchymosis ,caudal has 1 215 cmt215cm sizeof pressure ulcers ,the offside limb muscle strength III ,left limb muscle strength for level 0 .
Laboratory examination Author company :Jiangsu 215228 Wujiang,Wujiang third People Center ICU check :leukocyte 419t 109 / L2114t 1012 /L ,Slimming products rank the product effect reducing weight is ranked,red blood cell ,Click Here,hemoglobin g / L 71,AST 75 U/ L ,ALT 89 U/ L ,BUN 817 mmoL/ L ,total bile acid of 42190 mmol / L.
During hospitalization patients body temperature rose to 3812 degrees ,two lung auscultation hear and obvious wet and dry rale ,sputum culture and Acinetobacter lwoffii ,chest CT :right pleural effusion .
Treatment: (1 )resistance to infection :two Ye Xian 210 BID,012 QDLuo Jie ,static drop ;( 2)closed drainage of pleural cavity drainage ,while giving the hepatoprotective ,antihypertensive ,rejection ,decreasing intracranial pressure ,albumin and nutrition therapy.
Assisted mechanical ventilator :model V - SIMV ,VT 580 ml,F 10 / min,PEEP 2 cmH 2O,oxygen concentration 40% . August 23rd night spontaneous breathing ,Adidas Jeremy Scott,modified spont model ,August 24th September 5th offline ,extubation ,September 15th 2211 carerehabilitation hospital.
Nursing care of respiratory tract of respiratory tract management ,maintain respiratory tract unobstructed ,treatment of sputum vital by Zhao Qing et al . summary of the " ;the three step expectoration ,namely: ( " ;a suction through inhalation ,dissolution ,dilution dry sputum ) ,second ( turn back ,make its attachment to the alveolar around ,bronchial wall Sputum loosening ,shed, easy to absorb ,( three ) suction sputum suction ) ,each L ~ 2 hsuctioning 1 times,each time not more than 15 s.
Before suctioning first with saline lubricating catheter end ,insertion depth should be appropriate, with 15 ~ 20cm suitable,not too deep or too shallow .Notice aseptic manipulation and suction catheter disinfection ( infectious patients using a catheter for disposable ) ,fully sucking sputum ,securing the airway patency.
When suctioning sputum properties and observe ,observe the patients have no cyanosis and dyspnea .Pay close attention to the changes of peripheral blood oxygen saturation ,if less than 85% stop sucking sputum operation.
To attract another ,spaced at least 3 min,strict aseptic manipulation ,suctioning ?121?Of Modern Nursing Journal Journal of Chinese Modern Nursing 2007 fourth volume second issue supplies strict disinfection and sterilization .
212 ventilatorventilator pipe pipeline management is the important part of bacterial parasite ,attention to the airway humidification machine ,wet bottle containing distilled water to remain in the lowest scale line above ,a nebulizer or oxygen humidification bottle sterile liquid shall be 24 h replaced 1 times ;atomizer needs to replenish the liquid should be abandoned to the remaining liquid, cleaning A sterile liquid ,oxygen humidification bottle sterilized weekly 1 .
Temperature maintained at 30 degrees to 32 degrees Celsius,prevent cold ,overheat stimulation patients. Indoor air to keep the suitable temperature (22 degrees C ) and humidity (RH 60% above) ,so as to avoid the secretion of mucous scab .
Available for 1 ~ 2layersterile physiological saline gauze covered on the trachea cannula .Every 2 ~ 4 hinto sleeve trickle a few drops containing antibiotics ,a - chymotrypsin or a solution of 1% sodium bicarbonate saline.
213strengthening the basicnursing care given daily for 2 ~ 3 times oforal care in the prevention of oral infection ,oral care ,Eat more carrots are good for vitiligo vitiligo which Jining family hospital is cured is best,must in the case of airbag inflator .Oral nursing liquid according to oral pH value choice.
Commonly used 2% ~3% boric acid solution,2% sodium bicarbonate,1% ~3% hydrogen peroxide.On oral secretions for bacterial monitoring ( 1 times a week) .Oral nursing principles to keep clean sheets and clothes changed every day .
,and give the body ,keeping the skin clean and dry without damage .214 nutritional supportwhich is capable of ventilator weaning in patients with underlying conditions. The establishment of artificial airway ,so that patients can not eat .
On the other hand ,disease on the body of the consumption ,if not timely supplement nutrition ,The body will appear negative nitrogen balance ,so that no further exacerbation of respiratory muscle endurance ,easy to cause the ventilator dependence .
Can also result in downtime after respiratory muscle work ,patients will once again enter the hypoxia ,resulting in weaning failure. After admission to a comprehensive assessment of the nutritional status of patients ,given sufficient nutritional support ,provide enough calories and nitrogen source ,the daily heat supply capacity of 188 ~ 230 kJ /kg ,115~ 215 g /kg protein ,nutritional supplement the digestive tract and venous pathways combine ,enteral nutrition ,feeding mainly to ensure full ,matter from thin to thick ,from less to more gradually increased ;amino acid and the fat emulsion and intravenous input ,with sufficient heat to ensure full play the role of amino acids in protein synthesis .
Minimize the carbohydrate intake ,due to a high carbohydrate intake will increase the production of carbon dioxide ,exacerbations of respiratory load .215effectivefunctional training of the respiratory muscles due to long time of mechanical ventilation ,resulting in respiratory muscle function all patients with ventilator dependent ,has been generated .
Therefore ,carries on the effective function of respiratory muscle training is very important. There are reports, through effective respiratory muscle training can significantly improve respiratory muscle Muscular strength and endurance ,improve exercise capacity ,and can prevent respiratory muscle fatigue ,to improve function ,enhance physical function .
In weaning period of transition ,the church in patients with abdominal breathing ,pursed lips breathing ,deep breathing and breathing patterns. Principles for the training process without dyspnea and patients are not tired ,if not to stop immediately.
In the weaning process using SIMV / PSV ventilator mode to reduce its overcome their thorax and alveolar elastic recoil of the physiological function ,prevent respiratory muscle fatigue ,facilitates weaning .
216psychological interventionbecause patients dependent on a ventilator breathing ,reduce their burden ,so used for a long time, the machine produced dependence .Stop once ,patients psychologically unbearable ,think weaned from the ventilator after causes difficulty breathing ,emotion plays a great fluctuation.
Therefore ,has carried on the careful explanation ,telling patients using ventilator help patients through the dangerous period ,present condition has been basically stable ,as long as with the treatment of Mechanical ventilation withdrawal ,will be able to breathe on their own ,make its understanding to stop the importance and the necessity.
At the same time ,stopping by nurses guard in the bedside ,Who is like the image project of the initiator of evil,to teach the patient The correct breath method :if breathing can be deep and slow breath ;when weaning from mechanical ventilation due to psychological factors and dare not breathe ,can be opened by simulating the lung ventilator ventilator ,voice can make the most of patients with symptomatic remission ;if the shallow breathing and guide its mention chest deep and slow breathing exercise .
In the weaning process, because the patient is gradually trained off-line ,and not one step ,will often think they cannot break away from the machine to the patient breathing ,then explain, stop using m m machine shutdown just to let it have a process of adaptation .
The elimination of tension ,fear and unnecessary concerns ,and nurses with a common treatment ,strive for early stopping. 217when stoppingclinical monitoring of 21711 respiratory monitoringdowntime when given oxygen inhalation in 5 L/ min ,such as patients with quiet ,ending a warm ,limb ,no sweat ,thoracic and in good condition ,two pulmonary respiratory symmetry ,breath smooth ,can continue to stop .
If there respiratory frequency increased significantly faster or reduced ,superficial breathing ,thoracic breathing is not obvious ,thoracoabdominal motion coordination, respiratory secretions substantial retention ,significantly increased heart rate ,blood pressure instability ,nasal Wing working ,cold sweats, cyanosis ,dysphoria ,immediately granted with ventilator to avoid respiratory muscle fatigue leading to respiratory failure.
21712hemodynamicmonitoring of continuous monitoring of ECG ,BP ,SpO 2 ,if BP elevation and respiration suggests that PCO 2increased,if the S - T improving ECG myocardial ischemia ,consideration should be given to PO decreased in 2, and SpO 2 <95%,immediately for arterial blood gas analysis ,once the blood gas analysis in PO 2 <60 mmHg,PCO 2 >45 mmHg,and SpO 2 <95%,can be used to adjust the ventilator ,based on arterial blood gas of ventilator parameters.
If the stop after 30 minmeasurement of arterial blood gases were normal and differ not quite ,can continue to be shut down. 3 discussionwith the value of human life improve ,critically ill patients in the medical care and rescue of the ventilator are increasingly common ,nursing staff ,especially the ICU nurses must learn seriously ,proficiency in a variety of ventilator use method and nursing care ,to with a high sense of responsibility ,strict observation of patients and physiological ,psychological needs ,only the correct application of ventilator in order to improve the success rate of rescue of respiratory failure ,otherwise the counter And may have adverse consequences.
Ventilator dependent on the occurrence and related factors of ventilator dependent ,today or respiratory care clinical problem ,for long-term use of ventilator dependent patients undergoing ventilator weaning ,must be aimed at patients with different disease characteristics ,Nike Air Force 1 Mid,psychological state and tolerance ,making scientific plan of care ,the body and mind two aspects nursing ;at the same time on the ventilator dependent patients ,need a progressive weaning process ,at the same time it needs to grasp the shutdown of the principle ,but also to do ideological work, relieve patients psychological burden ,get fit ,step by step, in order to achieve satisfactory results .