硬膜下血肿语教学查房ppt课件

1、护理护理教学教学查房查房teaching wardteaching wardround of nursinground of nursingsubdural hematoma硬膜下血肿硬膜下血肿 目录目录 contents查房目的 purpose1病例汇报 case presentation23护理措施 nursing intervention6 65出院指导 health ducation 护理诊断 nursing diagnosis专科知识 specialist knowledge4教学目标教学目标 teaching objectivesteaching objectives*1 1、un

2、derstand the understand the related knowledge related knowledge about the subdural about the subdural hematomahematoma*2 2、master nursing master nursing diagnosis and diagnosis and nurnur- - inging measures about measures about the subdural the subdural hemathemat- - omaoma*1 1、理解硬膜下血肿、理解硬膜下血肿的相关知识的

3、相关知识*2 2、掌握硬膜下血肿掌握硬膜下血肿的护理诊断和护理措的护理诊断和护理措施施教学目标教学目标 teaching objectivesteaching objectives3 3、掌握硬膜下引流掌握硬膜下引流的相关的相关知识知识3 3、getting to know the getting to know the related knowledge ab- related knowledge ab- out sout subdural drainageubdural drainage病例汇报病例汇报 case reportcase report体格体格检查检查 physical exa

4、minationphysical examination*t p beats/min r t p beats/min r times / min bp mmhg times / min bp mmhg *g general:normaleneral:normal development development good nutrition good nutrition*consciousnessconsciousness：consciousconscious*p pupilupil：both sides pupil both sides pupil equal and round, 3mm e

5、qual and round, 3mm diameterdiameter，light reflex light reflex sensitivitysensitivity * physical examinationphysical examination：left side - autonomic left side - autonomic activity, normal muscle activity, normal muscle tonetone *right side autonomic right side autonomic activity, normal muscle act

6、ivity, normal muscle tonetone *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 一一、定义、定义 definitiondefinitionsubdural hematoma refers to the bleeding in the subdural space between the endocranium and the arachnoid) and it is one o f t h e c o m m o n

7、 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 checkct检查extradural hematomaextradural hematomasubdural hematomasubdural hematomaintracerebral hematoma

8、intracerebral hematoma 三、三、 病因病因 cause cause of diseaseof diseaseviolence or indirect violent factors暴力或间接暴力因素四、四、 临床表现临床表现 clinical clinical manifestationmanifestation1,acute and subacute subdural 1,acute and subacute subdural hematomas: disturbance of hematomas: disturbance of consciousness occurs

9、 from the consciousness occurs from the period of a few hours after period of a few hours after injury to 1-2 days; often, injury to 1-2 days; often, increased intracranial increased intracranial pressure and cerebral hernia pressure and cerebral hernia symptoms (headache, nausea, symptoms (headache

10、, nausea, h y p e r e m e s i s ) a r e h y p e r e m e s i s ) a r e progressively aggravated in progressively aggravated in 1-3 days.1-3 days.2, chronic subdural hematoma: 2, chronic subdural hematoma: symptoms of chronic increased symptoms of chronic increased intracranial pressure: intracranial

11、pressure: headache, nausea, vomiting headache, nausea, vomiting and optic disc edema.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、意识状态的评估五、意识状态的评估 assessment of the state of consciousnessgcs评分包括哪几部分内容？五五、意识、意识状态的评估状态的评估 a

12、ssessment of the state of consciousnessglasgow rating:最高分为最高分为1515分，表示意识清楚；分，表示意识清楚；12121414分为分为轻度；轻度；9 91111分为中度；分为中度；8 8分以下为昏迷；最低分以下为昏迷；最低3 3分，分数越分，分数越低则意识障碍越重低则意识障碍越重。六、治疗要点六、治疗要点 major treatmentmajor treatment处理原则：一经确诊，通常以手术清除血肿。treatment principlestreatment principles： once confirmed，usuallyrem

13、ove the hematoma by operation.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 icp1 , b r a i n p e r f u s i o n abnormalities： related to h

14、igh intracranial pressure2,pain : related to operation3,self-care deficiencies： related to consciousness disorder and operation4, hyperthermia： related to absorption of hematoma1、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6, potential complications：brain hernia, constipation, cathe

15、ter shedding, epilepsy, pressure sores, and so on6、潜在并发症：脑疝，便秘，导管脱落，癫痫，压疮等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 stablebrain perfusio

16、n abnormalities2、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 tablets3、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

17、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。 toilet4、体温过高的护理 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。 comfort5、预防再出血的护理预防再出血的护理 pr

18、evention 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

19、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。 airway7、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

20、（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 liquid7、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