硬膜下血肿双语教学查房

,护理教学查房Teaching wardround of nursing,Subdural hematoma,硬膜下血肿,目录 Contents,5,出院指导 Health ducation,护理诊断 Nursing diagnosis,专科知识 Specialist knowledge,4,教学目标 Teaching Objectives,1、Understand the related knowledge about the subdural hematoma2、Master nursing diagnosis and nur- ing measures about the subdural hemat- oma,1、理解硬膜下血肿的相关知识2、掌握硬膜下血肿的护理诊断和护理措施,教学目标 Teaching Objectives,3、掌握硬膜下引流的相关知识,3、Getting to know the related knowledge ab- out subdural drainage,病例汇报 case report,体格检查 Physical Examination,T P beats/min R times / min BP mmHg general:normal development good nutritionconsciousness：consciouspupil：Both sides pupil equal and round, 3mm diameter，Light reflex sensitivity physical examination：Left side - autonomic activity, normal muscle tone Right side autonomic activity, normal muscle tone,体温 脉搏次/分 呼吸次/分 血压mmHg一般情况：发育正常，营养良好意识清醒瞳孔：双侧瞳孔等大等圆,直径3mm,对光反射灵敏四肢查体:左侧-自主活动,肌张力正常右侧自主活动,肌张力正常,一、定义 Definition,Subdural hematoma refers to the bleeding in the subdural space between the endocranium and the arachnoid) and it is one of the common intracranial hematomas. It is divided into three types, i.e., acute, subacute and chronic subdural hematomas.,硬膜下血肿是指出血集聚在硬膜下隙（硬脑膜与蛛网膜之间）的出血，是常见的颅内血肿之一。分急性，亚急性和慢性三种。,辅助检查 Auxiliary examination,CT check,CT检查,二、解剖位置anatomy site,extradural hematoma,subdural hematoma,intracerebral hematoma,三、 病因 Cause of disease,Violence or indirect violent factors,暴力或间接暴力因素,四、 临床表现 Clinical manifestation,1,Acute and subacute subdural hematomas: disturbance of consciousness occurs from the period of a few hours after injury to 1-2 days; often, increased intracranial pressure and cerebral hernia symptoms (headache, nausea, hyperemesis) are progressively aggravated in 1-3 days.2, Chronic subdural hematoma: symptoms of chronic increased intracranial pressure: headache, nausea, vomiting and optic disc edema.,1、急性和亚急性硬膜下血肿：伤后数小时至1-2日意识障碍，颅内压增高及脑疝的征象（头痛、恶心、呕吐剧烈）多在1-3日内进行性加重。2、慢性硬膜下血肿：慢性颅内压增高表现：头痛，恶心，呕吐，视神经盘水肿。,五、意识状态的评估 Assessment of the state of consciousness,GCS评分包括哪几部分内容？,五、意识状态的评估 Assessment of the state of consciousness,Glasgow Rating:最高分为15分，表示意识清楚；1214分为轻度；911分为中度；8分以下为昏迷；最低3分，分数越低则意识障碍越重。,六、治疗要点 major treatment,处理原则：一经确诊，通常以手术清除血肿。,Treatment principles： Once confirmed，usuallyRemove the hematoma by operation.,六、治疗要点 major treatment,治疗要点Therapy Highlights,常用药物：甘露醇、速尿、甘油果糖、地米、白蛋白应用止血和抗凝药物,防止再出血Prevent rebleeding,凝血障碍疾病所致必须应用,进行降压处理常用的药物尼莫地平、硝普钠、速尿急性期血压骤降提示病情危重,常用的脱水利尿剂药物：甘露醇、甘油果糖、速尿。,控制血压Control blood pressure,控制脑水肿 Control edema,降低颅内压 Reduce ICP,七、护理诊断 Nursing Diagnosis,?,七、 护理诊断 nursing diagnosis,1,Brain perfusion abnormalities： related to high Intracranial pressure2,pain : related to operation3,Self-care deficiencies： related to consciousness disorder and operation4, Hyperthermia： related to absorption of hematoma,1、脑组织灌注异常：与颅内压升高有关；2、疼痛: 与手术有关3、自理能力缺陷：与意识障碍及手术有关4、体温过高 与血肿吸收有关,七、护理诊断 nursing diagnosis,6, Potential complications：Brain hernia, constipation, catheter shedding, epilepsy, pressure sores, and so on,6、潜在并发症：脑疝，便秘，导管脱落，癫痫，压疮等,八、护理措施 Nursing intervention,?,急性期绝对卧床休息，避免不必要的搬动。 Lying in bed避免情绪波动。 Emotional stability保持病房安静、光线柔和，减少探视. Quiet抬高床头1530，促进脑部血液回流，减轻脑水肿，保持术区引流通畅。 Smooth drainage密切观察患者意识、瞳孔、生命体征的变化。Consciousness 、Vital Signs 监测血压，保持血压平稳。 Blood pressure stable,八、护理措施 Nursing intervention1、脑组织灌注异常的护理Brain perfusion abnormalities,2、疼痛的护理措施pain（1）鼓励病人说出疼痛的感觉，给予心理安慰 encoursge console（2）各种护理工作应准确轻柔，减少不必要痛苦 soft work（3）教会病人分散注意力，如听轻音乐、聊天、缓慢深呼吸等。distraction（4）密切观察疼痛程度，必要时遵医嘱使用止痛剂（如氨基比林咖啡因片等）Amidopyrine caffeine tablets,八、护理措施 Nursing intervention,3、自理能力缺陷的护理 Self-care deficiencies吸氧：持续吸氧，可提高血氧含量。 Oxygen基础护理：晨、晚间护理每日一次。 Life care皮肤护理：定时翻身，按摩受压部位皮肤。 Skin care保持肢体功能位，避免受压，维持关节韧带的活动度，防止肌肉萎缩。 Orthostatic保持二便通常：鼻饲新鲜的蔬菜和水果。按摩腹部，促进肠蠕动，注意做好肛周护理。 Toilet,八、护理措施 Nursing intervention,4、体温过高的护理 Hyperthermia降低体温：患者住院期间体温最高为38.3，可采用物理降温，如温水擦浴。 Lower the temperature加强监护：观察生命体征，定时测体温. Monitor Monitor补偿营养和水分：鼻饲充足的温开水，予高热量、高蛋白、高维生素、易消化的流质或半流质饮食。 Nutrition促进患者舒适：嘱患者多休息。 Comfort,八、护理措施 Nursing intervention,5、预防再出血的护理 Prevention of further hemorrhage严密控制血压，避免血压过高； Control BP密切观察生命体征、意识、瞳孔的变化，如有异常立即报告医生。 Monitor避免搬动：病情危重者发病初24-48小时内避免搬动，12小时内大幅度翻身。 Avoid moving保持大便通畅，避免屏气用力，剧烈咳嗽、打喷嚏等。Avoid hard,八、护理措施 Nursing intervention,6、预防脑疝的护理To prevent herniation观察有无剧烈头痛：伴恶心、呕吐。 Headache观察瞳孔变化：两侧瞳孔是否等大等圆，对光反射的灵敏度。 Pupil观察意识状态：通过交流、疼痛刺激及肢体活动情况来判断意识障碍程度。 Consciousness观察生命体征：血压升高、脉搏变慢、呼吸深慢，是颅内压增高的早期症状。 Vital Signs保持呼吸道通畅，按需吸痰，及时清除口鼻分泌物和呕吐物，持续吸氧。 Airway,八、护理措施 Nursing intervention,八、护理措施 Nursing intervention,7、硬膜下引流管的护理（1）、严格无菌操作，妥善固定引流管并保持通畅，每日更换引流袋。（2）、引流高度1015cm，并根据引流液的颜色、速度遵医嘱调节高度。每日引流量应小于300ml。观察并记录引流液的性状和量,7、Subdural drainage tube（1）,Strict aseptic operation,Properly fixed drainage tube and maintain patency, daily change drainage bag（2）, Drainage height 10 15 cm, and according to the color, drainage of liquid, speed adjustable height in accordance with the doctors advice. The daily traffic should be less than 300 ml. Observe and write down the quantity and the volume on the properties of liquid,八、护理措施 Nursing intervention,7、Subdural drainage tube care（3）, Drainage time, 3 4 days after craniotomy, 5 7 days after surgery（4） After extubation watch consciousness, pupil, blood pressure . Dressing clean and dry。,7、硬膜下引流管的护理（3）、引流时间，开颅术后34天，引流术后57天（4）、拔管后注意观察神志、瞳孔，血压变化。敷料清洁干燥与否,避免情绪激动，去除不安、恐惧、愤怒，保持心情舒畅。 Mood饮食清淡，多吃含水分、纤维素的食物,忌刺激性强的食物。 Diet生活要有规律，养成定时排便的习惯，切忌大便时用力过度和憋气。 Daily life 避免重体力劳动，注意劳逸结合。 Work and rest 积极进行心理疏导，讲解有关脑出血的有关知识，让病人及家属了解病因，按时服药，配合治疗护理。 Knowledge定期测量血液，复查病情，及时治疗可能并存在的动脉粥样硬化、高脂血症、冠心病等。 Referral 康复训练过程艰苦而漫长，需要有信心、耐心、恒心，应在康复医师指导下循序渐进，持之以恒。 Rehabilitation exercises,出院指导Discharge guidance,总结 Summary,1，The concept of a subdural hematoma, clinical manifestation and n