急性有机磷农药中毒的护理查房课件

急性有机磷农药中毒的护理查房

Acuteorganophosphatepesticidepoisoning（AOPP）carerounds2011/8/18.急性有机磷农药中毒的护理查房Acuteorganopho1病例介绍伍南臻患者，周桂云，女性，46岁入院时间：2011-08-07主诉：呕吐、口吐白沫、神志不清、大小便失禁4小时

Patients,guiyunZhou,female,46yearsoldAdmissiontime：2011-08-07ChiefComplaint:vomiting,foamingatthemouth,confusion,incontinence4hours基本资料1.病例介绍2病例介绍现病史：患者于4小时前因争吵后自服农药（半硫磷）约100ML，服用后出现神志改变。Historyofpresentillness,Forfourhoursafteranargumentwithhisfamilybefore,Shetakethepesticideabout100Milliliters,Pesticidesconsideredforthehalfsulphurphosphoric.Aftertakeappearmindchange.

.病例介绍现病史：患者于4小时前因争吵后自服农药（半硫磷）约13病例介绍家人行紧急救治后送入当地医院行洗胃治疗，于2011-08-0712:20急诊平车转入我院肾病内科Patientsaftermedicationwithvomiting,aftertheemergencysalvage,shewassendtothelocalhospitalforgastriclavageforherfamliy.Inaugust7,201112:20,Shewastransferredtoourhospitalnephropathyinternalmedicinewithemergencyflatcar..病例介绍家人行紧急救治后送入当地医院行洗胃治疗，于2011-4病例介绍转运途中出现呕吐，大小便失禁症状。门诊以“急性有机磷农药中毒”收治。起病以来，精神差，体重无明显变化。Intransit,PatientshadrepeatedvomitingandEliminationofurineandfecesarenotcontrolledbyherself,ClinicdiagnosisisAOPP,Afterthepatientisadmittedtohospital,herSpiritwassobadandweightdidnothavesignificantlychange..病例介绍转运途中出现呕吐，大小便失禁症状。门诊以“急性有机磷5病例介绍既往有肺脓肿病史，已行部分肺叶切除术，术中有输血，有青霉素过敏史。shehadlungabscessbefore,andwasdoneapartiallobectomy,inthatoperation,Shehadabloodtransfusion.ThemostimportantisshehadthePenicillinallergy..病例介绍既往有肺脓肿病史，已行部分肺叶切除术，术中有输血，有6病例介绍全凤春体格检查：T35.8℃P126次/分R20次/分BP109/69mmHgPhysicalexamination:Temperature：35.8℃,Pulse:126BeatPerMinute,respiration:20BeatPerMinute,BloodPress109/69mmHg.病例介绍全凤7病例介绍神志浅昏迷，双侧瞳孔等大等圆3mm,对光反射迟钝，口唇发绀，皮肤湿冷，双肺呼吸音粗，可闻及大量湿性啰音。

Comaconsciousness,Pupilsareequalroundnessandsamesizewith3mm,reactiontolightshowsdelay,whilethelipsiscyanotic,BreathsoundshowsCoarsewhileitCanbeheardandalotofwetrales..病例介绍神志浅昏迷，双侧瞳孔等大等圆3mm,对光反射迟钝，口8病例介绍心率

126次/分，肠鸣音活跃，四肢肌张力稍高，无自主活动，病理反射未引出。Heartrateis126BeatPerMinute,borhorygmusshowsincreased,Limbmuscletoneisslightlyhigher,thereisnoindependentactivity,Pathologicalreflexisnotelicited..病例介绍心率126次/分，肠鸣音活跃，四肢肌张力稍高，无自9病例介绍刘伟明入院诊断:1、急性重症农药中毒（半硫磷）

2、中毒性心肌炎

3、吸入性肺炎Admissiondiagnosis:1、severeacutepesticidepoisoning(halfsulphurphosphorous)2、toxicmyocarditis3、aspirationpneumonia.病例介绍刘伟10主要病情变化马志群8-801:40T39.1摄氏度，予温水擦浴

05：20患者开始出现躁动，予丙泊酚5毫升IV效果不明显，予地西泮镇静

Onefortyonaugust8th,thepatient’sbodytemperaturerisestothirty-onepointonedegreescelsius,wegivehimawarmwaterbath.Fivetwenty,thepatientbegintoappearrestless,propofulfivemilliliterintravenensinjection,theeffectisnotobvious,tothediazepamsedation..主要病情变化马志群8-811病例介绍12:30患者躁动不安，血氧饱和度波动在70%-80%请麻醉科及ICU会诊后考虑气管插管脱出予重新插管14：50患者转入ICUTwelvethirty,thepatientisrestless,fluctuationsofoxygensatturationinseventypercenttoeightypercent.thenpleaseanesthesiaandintensivecareunitconsulation,consideringtheendotrachealtobeextrusion,toreintubationforhim.Fourteenfifty,thepatientistransforredtotheintensivecareunit.病例介绍12:30患者躁动不安，血氧饱和度波动在70%-812病例介绍贺舒转入ICU时情况：体温37.3℃，脉搏140次/分，呼吸35次/分，血压116/87mmHg，血氧饱和度95%

WhentransferredtoICUconditions:temperature37.3,pulse140beats/min,breathing35times/min,bloodpressure116/87mmHg,oxygensaturation95%..病例介绍贺13病例介绍神志镇静中，躁动不安，两侧瞳孔等大等圆4mm，对光反射迟钝，气管插管，呼吸机辅助呼吸，气道内少量痰液，皮肤干燥。conscioussedation,irritability,Pupilsareequalroundnessandsamesizewith4mm,reactiontolightshowsdelay,endotrachealintubation,mechanicalventilation,Withinafewairwaysputum,dryskin..病例介绍神志镇静中，躁动不安，两侧瞳孔等大等圆4mm，对光反14病例介绍双肺可闻及中等量湿性啰音，腹部叩诊呈鼓音，诊断为：1.急性有机磷农药中毒；2.吸入性肺炎、1型呼吸衰竭；3.中毒性心肌炎。double-lungcanbeheardandmoderatemoistrales,Thedrumsoundabdominalsound

Thediagnosisis:1:acuteorganophosphoruspesticidepoisoning;2:aspirationpneumonia,type

1respiratoryfailure;3:toxicmyocarditis..病例介绍双肺可闻及中等量湿性啰音，腹部叩诊呈鼓音，诊断为：115病例介绍予以呼吸机辅助呼吸，留置胃管，胃肠减压，留置深静脉导管，遵医嘱予抗感染、护胃、护心、解毒、导泻等对症支持治疗。

Tomechanicalventilation,indwellingstomachtube,decompression,indwellingvenouscatheters,prescribedtofightinfection,protectstomachmucosa,protectionofheartfunction,detoxification,catharsis,symptomaticandsupportivetreatment.

.病例介绍予以呼吸机辅助呼吸，留置胃管，胃肠减压，留置深静脉导16病例介绍苏敏现患者的情况：神志模糊，躁动不安，双侧瞳孔等大瞪圆3mm,对光反射迟钝，皮肤干燥。Thecurrentsituationofpatients:mindfuzzy,restless,Pupilsareequalroundnessandsamesizewith4mm,reactiontolightshowsdelay,theskinisdry..病例介绍17病例介绍有发热，最高体温39℃，予物理降温。血压稳定，仍给予阿托品间断静推。withfever,themaximumtemperatureabout39℃,tothephysicalcooling.Bloodpressurestability,intermittentintravenousinjectionofatropine,.病例介绍有发热，最高体温39℃，予物理降温。血压稳定，仍给予18病例介绍气道内有少量的黄色痰液，双肺未闻及湿啰音，四肢有自主活动。

therewereafewoftheairwayyellowsputum,doublelungnotsmellandwetgosound,limbshaveindependentactivities..病例介绍气道内有少量的黄色痰液，双肺未闻及湿啰音，四肢有自主19病例介绍主要的实验室检查

8-7WBC27.3*109/L，CHE23KU/L,8-8尿常规RBC2-4/HP,K+3.38mmol/L,钙离子1.73mmol/L，CHE10KU/L，心肌酶、肝功能基本正常

ThemainlaboratorytestsOn8-7Thepatient’sWBCis27.3*109/LandCHEis23KU/L.On8-8FormtheRoutineExaminationofUrineonhighpowerlenswecansee2to4redbloodcells,Thepatient’sPotassiumis3.38mmol/L,calciumis1.73mmol/LandCardiacenzymeandliverfunctionarenormal.CHE10.0KU/L.病例介绍主要的实验室检查Themainlaborato20病例介绍8-9CHE8.0KU/L,。胸片提示：肺部感染及双侧胸膜炎。8-12血常规正常，CHE32KU/L

On8-9,CHE8.0KU/L;ChestXraytip：lunginfectionandbilateralpleurisy.On8-12Bloodroutineisnormal，andCHEis32KU/L.病例介绍8-9CHE8.0KU/L,。胸片提示：肺部感21病因与发病机制谢妹娜病因生产及使用过程的不当：如生产设备密封不严导致化学毒物泄漏；喷洒杀虫药过程中经皮肤和呼吸道吸收EtiologyImproperproductionanduse:Forexample,productionequipmentsealedpoorlyresultinleakageofchemicaltoxicant;intheprocessofsprayingpesticide,absorbedthroughskinandairway..病因与发病机制谢妹娜病因Eti22病因与发病机制生活性中毒：主要由于自服、误服或摄入被污染的水源和实物水果等。Livingpoisoning:Mainlyduetodrinkingoreatingcontaminatedwaterandfruitvoluntarilyorbymistakeetc..病因与发病机制生活性中毒：主要由于自服、误服或摄入被污染的水23病因与发病机制有机磷农药中毒机制主要是抑制体内胆碱酯酶的活性。正常情况下，胆碱能神经兴奋所释放的递质——乙酰胆碱被胆碱酯酶水解为乙酸及胆碱而失去活性。MechanismofpoisoningThePrimarymechanismoforganophosphatepesticidepoisoningisinhibitionoftheactionofcholinesteraseinbody.Ingeneral,excitementofcholinergicnervereleasesneurotransmitter----acetylcholinewhichcanbehydrolyzedtocholineandaceticacidbycholinesteraseandloseitsactivity..病因与发病机制有机磷农药中毒机制主要是抑制体内胆碱酯酶的24病因与发病机制有机磷农药进入人体后与体内胆碱酯酶迅速结合形成磷酰化胆碱酯酶，使胆碱酯酶失去水解乙酰胆碱的能力。Onceorganophosphatepesticidesenterintobody,itwillbindrapidlytocholinesteraseandformphosphorylatedcholinesterase,thusmakecholinesteraselosetheabilitytohydrolyzeacetylcholine..病因与发病机制有机磷农药进入人体后与体内胆碱酯酶迅速结合形成25病因与发病机制导致组织中的乙酰胆碱过量蓄积，产生胆碱能神经功能紊乱，先表现为兴奋，然后出现抑制。bringoutexcessiveaccumulationofacetycholineintissue,WhichresultindisfunctionofCholinergicNerve.Itmanifestatesexcitementatfirstandtheninhibition..病因与发病机制导致组织中的乙酰胆碱过量蓄积，产生胆碱能神经功26护理评估Nursingassessment袁清红临床表现胆碱能危象

急性有机磷农药中毒的典型表现

ClinicalSituationCholinergic

crisisTypicalperformanceofAOPP

..护理评估Nursingassessment27护理评估Nursingassessment毒蕈碱样症状主要是副交感神经兴奋所致,

临床表现有恶心,呕吐,腹痛,多汗,流涎,瞳孔

缩小,支气管痉挛,分泌物增多,心率减慢,气急,严重者出现肺水肿Muscarinic

symptoms

Mainly

causedby

the

parasympathetic

nervous

excitement,

Clinical

manifestations

have

nausea,vomiting,

abdominal

pain,

sweating,salivation,

miosis,

bronchospasm

and

Increased

secretionsheartratedecreased,dyspnea,theseriouscasesappearpulmonaryedema.

.护理评估Nursingassessment毒蕈碱样症状28护理评估Nursingassessment

烟碱样症状患者常有肌束颤动,肌肉强直性痉挛,心率加快,甚至全身抽搐,最后出现肌麻痹,呼吸肌麻痹引起周围性呼吸衰竭Nicotine-like

symptoms

Patients

often

have

muscle

bundle

oftrembling,

tetanicspasm,heart

rate

increased,Eventhewholebodytwitching,

finally,

myoplegiahappen,breathmyoparalysis

causeperipheral

respiratory

failure

.护理评估Nursingassessment烟碱样症状29护理评估Nursingassessment

中枢神经系统症状表现为头晕,头痛,疲乏无力,共济失调,烦躁不安,意识模糊,抽搐及昏迷

Central

nervous

system

symptoms

Manifested

as

dizziness,

headache,

fatigue,

ataxia,

irritability,

confusion,

convulsions

and

coma

.护理评估Nursingassessment中枢神经系30护理评估Nursingassessment

莫思慧急性有机磷中毒分为轻、中、重三级：轻度中毒：头晕、头痛、恶心、呕吐、多汗、流涎、视力模糊、瞳孔缩小、全血胆碱脂酶活力一般在70％－50％。

AOPPcanbedividedinto3grades:mild,moderate,severeMildpoisoning：dizziness,headache,nausea,vomiting,sweating,salivation,blurredvision,miosis,andthewholebloodcholinesteraseactivitywasinthe50~70%.护理评估Nursingassessment莫思31护理评估Nursingassessment

中度中毒：除上述症状外，还出现肌纤维颤动、瞳孔明显缩小、轻度呼吸困难、大汗、腹痛、腹泻、意识清楚或轻度障碍、步态蹒跚。全血胆碱脂酶活力降至50％－30％。Moderatepoisoning：Inadditiontotheseabove,symptomsalsoincludemuscularfibrillation,milddyspnea,sweat,abdominalpain,diarrhea,clearormilddisordersofconsciousness,andstaggeringgait.Wholebloodcholinesteraseactivitydeclinedto50%-30%.

.护理评估Nursingassessment中度中毒：32护理评估Nursingassessment

重度中毒：除上述症状外，发生肺水肿、惊厥、昏迷及呼吸麻痹。全血胆碱脂酶活力降至30％以下。

Severepoisoning：Inadditiontotheseabove,symptomsalsoincludepulmonaryedema,convulsions,comaandrespiratoryparalysis.Wholebloodcholinesteraseactivitydeclinedtobelow30%.

.护理评估Nursingassessment重度中毒：33护理评估Nursingassessment

王丽炜有机磷农药中毒后，经急救临床症状好转，可在数日到一周内突然再次发生昏迷，甚至发生肺水肿或突然死亡，此为中毒后反跳现象。

Organophosphoruspesticidepoisoningwerethefirstaidclinicalsymptom,canbeinafewdaystogetbetterwithinaweek,evenhappenagainsuddenlyapulmonaryedemaorsuddendeath,says"bounce"phenomenon..护理评估Nursingassessment34护理评估Nursingassessment

这与残留在皮肤、毛发和胃肠道的有机磷农药重吸收或解毒药停用过早或减量过快等原因有关。Thisandremainintheskin,hairandthegastrointestinaltractisabsorbedbyheavyorantidotetocreditdoseorreasonssuchastooearlyon..护理评估Nursingassessment这与残留在35护理评估Nursingassessment

在急性中毒症状缓解后迟发性神经病变发病前，一般在中毒后24~96小时突然发生以呼吸肌麻痹为主的症状群，称“中间型综合征”。

Inpatientswithacutepoisoningsymptomsafterthelate-occurredneuropathy,generallyinthepoisoningbefore24to96hoursafterhappensuddenlybyrespiratorymuscularparalysisprimarilythesymptoms,says"middletypesyndrome".

.护理评估Nursingassessment在急性中毒36护理评估Nursingassessment

发病机制可能与胆碱酯酶长期受到抑制，影响神经肌肉接头突触后功能有关。Themechanismmayandcholinesteraselong-termeffectisrestrained,neuromuscularpostsynapticfunctioning.

.护理评估Nursingassessment发病机制可37治疗原则严超治疗原则我们都知道，中毒后，我们要迅速清除毒物，一般来说越快洗胃效果越好TreatmentprincipleAsweknow,themostimportantofallisremovingtoxicasquicklyaswecanwhensomeonepoisoned.Generallyspeaking,thefasterlavagethebettereffectweget.

.治疗原则严超治38治疗原则幸运的是，这个病人中毒后4小时就在当地医院洗胃。另外，导泻也是一个好办法。Fortunately,thatpatientlavagedinlocalhospitalafterdrinkingtoxic4hours.Inaddition,guidingdiarrheaisaneffectivemeasure..治疗原则幸运的是，这个病人中毒后4小时就在当地医院洗胃。另外39治疗原则第二，促进毒物进一步排除也十分重要，在此，我们应用的是血流灌注。Secondly,promotingdischargepoisonisnecessary,weusedbloodperfusionforher..治疗原则第二，促进毒物进一步排除也十分重要，在此，我们应用的40治疗原则第三，特殊解毒剂的应用，如阿托品、碘解磷定，这取得不错的效果。Thirdly,theapplicationofthespecialeffectsantidotesuchasatropineandpralidoximeiodide.Thus,thedoctorsachievedgoodresultsintheprocessofthattreatmeat..治疗原则第三，特殊解毒剂的应用，如阿托品、碘解磷定，这取得41治疗原则最后也是非常重要的一点，对症支持治疗。抗感染，促进炎症消散；护胃，保护胃黏膜；护心，治疗中毒性心肌炎；Thelastbutnotleast,SymptomaticsupporttreatmentincludingFightinginfectiontopromoteinflammationdissolve;Protectingstomachtocaregastricmucosa；Heartcare,itispositivefortoxicmyocarditis..治疗原则最后也是非常重要的一点，对症支持治疗。Thela42治疗原则升压、降温，维持生命体征平稳很重要镇静，细心照顾他，安慰情绪尽快纠酸和纠正电解质紊乱，以稳定内环境Elevatingbloodpressureanddecreasingtemperatureareofimportancetomaintainvitalsignssmoothly;weshouldbettercalmdownheremotionandtakecareoftenderly.

Asquicklyaspossibletocorrectacidosisandelectrolytesdisturbancetostableinnercondition..治疗原则升压、降温，维持生命体征平稳很重要Elevatin43护理诊断

Nursingdiagnosis彭瑜气体交换受损与肺水肿有关清理呼吸道无效与呼吸道炎症、气道分泌物增多有关急性神志改变与胆碱能神经功能紊乱有关ImpairedgasexchangeRelatingtopulmonaryedemaAcuteconsciousnesschangingRelatingtocholinergicdisturbancesIneffectiveairwayclearanceRelatingtoairwaysinflammationandairwaysecretionsincreasing.

.护理诊断Nursingdiagnosis彭瑜气体44护理诊断

Nursingdiagnosis有效血容量不足与大量呕吐、感染等有关体温过高与肺部感染、应用阿托品等有关有受伤的危险与躁动不安有关有猝死的危险与毒物的重吸收和阿托品使用不当有关RiskforSuddenDeathRelatingtopoisonabsorbingandthewronglyusingofatropineHyperthermiaRelatingtoLungInfectionandapplicationatropineetcRiskforinjuryRelatingtorestlessnessInsufficientofblooddecreaseRelatingtoprofusevomiting,infectionandsoon.

.护理诊断Nursingdiagnosis有效血容量不足45护理措施

刘萍迅速清除毒物清除胃内毒物催吐：神志清楚、能合作的服毒者，可行催吐。让患者饮温水300～500毫升，然后用压舌板或患者手指刺激咽后壁或舌根部引起呕吐。

QuicklyremovetoxicremovaloftheundigestedpoisonsEmetic:Thisonlyappliestothepationswhocancooperatewith,Letthepatientdrinkwarmwater300to500ml,andthenwithaspatulaorfingerstimulatepatients,posteriorpharyngealwallorthebaseofthetonguecausedvomiting,

.护理措施刘萍迅46护理措施

洗胃：一般在服药后6小时内洗胃有效，但如果超过6小时，仍有洗胃的必要。导泻：洗胃后灌入泻药以清除进入肠道的毒物，常用硫酸钠或硫酸镁。清除皮肤上的毒物脱去污染的衣服，用肥皂水或大量清水冲洗皮肤和毛发。Gastriclavage:generallywithin6hours.ifmorethan6hours,itisalsonecessaryforgastriclavage.Catharsis:aftergastriclavagewecanfilllaxativestocleartheintestinalpoison,commonlyusedsodiumsulfateormagnesiumsulfate.Cleartheskin.Removecontaminatedclothing,washtheskinandhairwithsoapwater..护理措施洗胃：一般在服药后6小时内洗胃有效，但如果超过6小47护理措施

促进已吸收毒物排出利尿绝大多数毒物由肾脏排泄人工透析PromotionhasbeenabsorbingpoisonoutDiuresis:Thevastmajorityofpoisonexcretedbythekidneys,Artificialdialysis

.护理措施促进已吸收毒物排出Promotionhas48护理措施

龙丽娟应用阿托品的观察与护理抢救治疗中使用阿托品的原则：早期，足量，快速，反复给药，直到阿托品化后再逐渐减量或延长间隔时间。ApplicationofatropineobservationandnursingTherescueoftheprincipleoftreatmentusingatropine:early,enough,fast,repeateddose,untiltheatropineagainafterreducinggraduallyorextendthetimeinterval.

.护理措施龙丽娟应49护理措施

阿托品化和阿托品中毒的剂量接近，后者可引起抽搐、昏迷等。因此使用过程中应严密观察病情变化，注意区别“阿托品化”与阿托品中毒。Thecauseatropineandatropinetoxicdosageisclose,thelattercancauseconvulsions,coma,etc.Thereforewhenusingatropineweshouldmonitortheconditionchanges,andpayattentiontothedistinctionbetweentheatropineandatropinepoisoning..护理措施阿托品化和阿托品中毒的剂量接近，后者可引起抽搐、昏50护理措施

阿托品化的表现包括：①意识清楚或模糊②颜面潮红、干燥③瞳孔由小扩大后不再缩小④体温正常或轻度升高⑤心率≦120次／分，脉搏快而有力。Theperformanceofatropineinclude:(1)clearconsciousnessorfuzzy(2)redanddryface(3)thepupilbecomebigandnotsmallanymore(4)andthetemperatureisnormalorlittleraise(5)theheartrateismorethan120timeseveryminute,andthepulsefastandpowerful.护理措施阿托品化的表现包括：Theperformance51护理措施

阿托品化的表现包括：①意识清楚或模糊②颜面潮红、干燥③瞳孔由小扩大后不再缩小④体温正常或轻度升高⑤心率≦120次／分，脉搏快而有力。Theperformanceofatropineinclude:(1)clearconsciousnessorfuzzy(2)redanddryface(3)thepupilbecomebigandnotsmallanymore(4)andthetemperatureisnormalorlittleraise(5)theheartrateismorethan120timeseveryminute,andthepulsefastandpowerful.护理措施阿托品化的表现包括：Theperformance52护理措施

阿托品中毒的表现包括：①谵妄、躁动、幻觉、双手抓空、抽搐、昏迷②皮肤紫红、干燥③瞳孔极度散大④高热，T＞40℃⑤心动过速，甚至有室颤发生Atropinepoisoningperformanceincluding:(1)thedelirium,agitated,illusion,convulsions,coma(2)amaranthineanddryskin(3)thepupilsextremelyenlarge(4)highfever,thetemperature>40centigrade(5)tachycardiaandevenaventricularfibrillationhappen..护理措施阿托品中毒的表现包括：Atropinepoiso53护理措施

王洁应用胆碱酯酶复能药的观察和护理首先,你必须尽早用药。第二,轻度中毒,你可以单独使用这个药物,但是中度以上中毒,你必须和阿托品一起使用。Theclinicalobservationandnursingoftheapplicationofacetylcholinesterase：First，youmustusethemedicineearly.Second,lightpoisoningyoucanusethemedicine,butifbadpoisoning,youcanusetheatropinetogether..护理措施王洁应用胆碱54护理措施

第三,很高的浓度或快速注射能引起中毒，所以你必须稀释后使用，注意给药速度。第四,不可皮下注射，确定针头在血管内方可用药。Third,Muchhighconcentrationorfastinjectioncancausepoisoning.soyoumustdilutethemedicine.Payattentiontothemedicinespeed.Fourth,youcannotuseanintramuscularinjection.Whenyouwanttoinjectit,youmustdefinethepininthevein..护理措施第三,很高的浓度或快速注射能引起中毒，所以你必须稀55护理措施丁广湘

气管插管和呼吸机的护理体位：患者卧床休息，予抬高床头30~40°固定：导管固定要牢靠，确定导管已准确插入气管后，用长胶布将导管和牙垫一起捆扎固定；Trachealintubationandbreathingmachinecare.BodyPosition:bedrestforthepatientwithbedraising30~40°Fix:Thecathetershouldbefirmlyfixedtomakesurethatitisinsertedintotracheaandbetiedtogetherwithteethcushionthroughadhesiveplaster;.护理措施丁广湘56护理措施

气道护理气道的湿化保持气道通畅—吸痰Periodicallycheckthedepthoftracheaandcatheter,auscultationbreathsoundsfromlungs.Bereadyforbedsideshift.AirfluecareAirwayhumidificationMaintainairwayunobstructedSuctionphlegm..护理措施气道护理Periodicallycheckth57护理措施

密切观察生命体征、spo2、神志、皮肤面色、出入量、观察人机是否同步，并做好记录。心理护理。Closeobservationofvitalsigns、spo2、consciousnessandskincomplexion.Observewhethermanandmachinearesynchronization.PsychologicalCare..护理措施密切观察生命体征、spo2、神志、皮肤面色、出入58护理措施

刘斌患者机械通气病程长，机体抵抗力低下,口腔自净作用和黏膜抵抗力减弱，使大量细菌在口腔里繁殖，容易造成口腔感染。Oralcavitynurse.Theprocesswithmachineryventilationofpatientislong,herorganismresistibilityislow,oralcavity'sautomaticdepurationfunctionandthemucousmembraneresistibilityareweaken,somassivebacteriareproduceinsidetheoralcavityanditiseasytobeinfected.

.护理措施刘斌患者机械59护理措施

有机磷农药中毒的病人的口中会有大蒜样臭味,并且口腔黏膜干燥、唾液分泌减少，因此应做好口腔护理、保持口腔的清洁和湿润,每日高质量的口腔护理是预防口腔并发症和肺部感染的重要方法之一.ThepatientwhoispoisoningbyAOPPwillhavethegarlicstink,theiroralcavitymucousmembranedryandsalivareducesatthesametime,thereforetheyshouldcompleteoralcavitynursing,maintainoralcavitycleanandthemoistness,everydayhighgradeoralcavitynursingisoneoftheimportantmethodsinpreventingoralcavitycomplicationandlungsinfection..护理措施有机磷农药中毒的病人的口中会有大蒜样臭味,并且口腔60护理措施

中毒后肌肉震颤导致产热增加，大量阿托品应用后出现散热障碍，均可致体温上升。Afterthepoisoning,themuscletremblescausestoproduceincreaseshotlyandheatdissipationbarrierwillappearaftermassiveatropineapplication,bothofthemmayleadtobodytemperaturerising..护理措施中毒后肌肉震61护理措施

一般低度或中度发热不需处理，如出现高热，可以采取物理降温，同时可以给病人补充液体以达到降温，一般不用药物降温。Normallyormoderatefeverheatneedn’ttodealwith.Butifitpresentsthehighfever,wemayadoptthephysicalcooling.Simultaneouslywemaysupplementtheliquidforpatienttodecreasethebodytemperature,generallywedon’tneedthemedicineforcooling..护理措施一般低度或中度发热不需处理，如出现高热，可以采取物62护理措施

罗富群饮食重度中毒一般需禁食3-5天，待病情稳定，意识清醒后可以口服蛋清以保护胃粘膜，禁食刺激性及含油脂多的食物。DietSeverepoisoning,whichnormallytakes1-3daysoffasting,beinstablecondition,consciousandaliveafteroraltemperatureofliquideggwhitetoprotectthegastricmucosa,Prohibittheconsumptionofirritatingandgreasyfastfoodandmore..护理措施罗富群饮食Die63护理措施

昏迷3-5天患者鼻饲饮食，注意补充维生素和无机盐，供给足够的优质蛋白。Comainpatientswithnasalfeedingdietfor3-5days,payattentiontovitaminandmineral,thesupplyofadequatequalityprotein..护理措施昏迷3-5天患者鼻饲饮食，注意补充维生素和无机盐，64护理措施

何蓉安全护理患者昏迷，躁动不安，应派专人护理，防止意外发生。必要时对其用约束带限制其四肢活动，但应防止约束过紧，定时放松，以免造成局部末梢循环障碍和皮肤损伤。必要时使用镇静药。SafeComapatientswithrestless,shouldsendsomeonetocare,topreventaccidents.Whenitisnecessarytouseconstraintstolimittheirlimbswithactivities,butshouldpreventbindingtight,timetorelax,toavoidlocalperipheralcirculationdisordersandskinlesions.Usesedativewhennecessary.

.护理措施何蓉安65护理措施

刘芳心理护理待患者病情稳定后转入单间病房，保持室内清洁安静。防止围观，注意保护隐私。建立良好的护患关系，予以心理支持；良好的护患关系可使患者产生信任感和安全感。用心理解患者苦恼，允许患者发泄，鼓励其哭诉，让不良情绪充分释放出来。PsychologicalNursingTobetransferredtoasinglepatientinstableconditionafterward,tokeeptheroomcleanquiet.Preventonlookers,toprotectprivacy.Establishagoodnurse-patientrelationship,toheartsupport;goodnurse-patientrelationshipallowspatientsasenseoftrustandsecurity.Hardtounderstanddistressinpatients,allowingpatientstovent,toencouragetheirtears,sofullofnegativeemotionsreleased..护理措施刘芳Psyc66护理措施

医护人员及家属尽量不在患者面前谈论病情和预后，及时将良性信息反馈给患者，并尽快取得患者家属的配合,帮助患者寻求有效支持；实施心里护理除了直接面对患者外，同时还需给予患者家属心里疏导。使其更体恤患者处境，主动深入患者的内心世界，为患者赢得跟多的支持。Healthcareworkersandtheirfamiliesbeforethepatientisnotasmuchaspossibleabouttheconditionandprognosis,andtimelypositivefeedbacktopatients,andpatientsassoonaspossiblewiththefamilies,relativesandfriendstotemporarilytakecareoffamilyresponsibilities,torelievethepatient'sworries,assoonaspossiblesothatpatientsunderstandingoftheirattendingdoctorsandnurses..护理措施医护人员及家属尽量不在患者面前谈论病情67护理措施

找到有效的支持,以帮助病人;实施心理护理除了直接面对病人,家庭成员也很重要，让它们更加同情病人的现状,积极深入病人内在的世界。Tohelppatientsfindeffectivesupport;implementationofheartcareinadditiontodirectlyfacethepatient,thefamilymembersofpatientsalsoneedtogivemyheartease.Makeitmoresympathetictothesituationofpatients,activein-depthpatient‘sinnerworld.

.护理措施Tohelppatientsfindeff68相关知识

Hemoperfusionisamedicalprocedurewhichisusedtocleansethebloodoftoxins.Duringthisprocessthebloodispassedthroughanadsorbentmaterialwhichattractstoxicsubstances.血液灌流是指将血液通过体外循环．经过具有广谱解毒作用的吸附装置，以清除血中外源性或内源性毒物，从而达到血液净化的一种医疗治疗方法。

WhatIsHemoperfusion?什么是血液灌流?.相关知识Hemoperfusionisam69护理措施

血液灌流的实质是血液吸附，即溶解在血中的物质被吸附到具有较大表面积的固形物质上去，从而清除血中有毒物质。目前常用的吸附剂有两种：一类是活性炭，一类是合成树脂。

Theadsorbentmaterialisusuallycharcoaloractivatedcarbonfixedtoasolidsurfaceinsideacolumn.Duringtreatment,thepatient’sbloodispassedthroughthecolumnandtoxinsbindtotheadsorbentmaterial,allowingcleansedbloodtoflowoutofthecolumn.Thisprocesscontinuesuntilasmuchtoxicmaterialaspossiblehasbeenremovedfromtheblood..护理措施血液灌流的实质是血液吸附，即溶解在血中70护理措施

HemoperfusionisusuallycarriedoutforSeveralreasons.进行血液灌洗通常有几种原因。whenitisused?适应症.护理措施whenitisused?.71护理措施

首先,血液灌流主要用于急性药物或毒物中毒，特别是胎溶性毒物或与蛋白结合的毒物。血液灌洗等能成功地排除毒素和代谢废物.First,theprocedureisusedasanemergencymedicaltreatmentincaseswhereapatienthasingestedalargeamountofasubstancewhichistoxictothekidneys。Hemoperfusioncansuccessfullyremovetoxinsorwasteproductswhicharepresentinapatient’sblood.

.护理措施First,theprocedureisu72护理措施

其次，血液灌流对于那些接受脏器移植（如肝脏，肾脏移植）是一种辅助治疗，移植患者在此之前和之后接受血液灌流，这样受体脏器就不会负担过重。Second.,thisprocessisusedasasupportivetreatmentforpeoplewhoareundergoingalivertransplant,Beforeandafterthetransplantitself,patientsundergobloodcleansingsothatthenewly-transplantedliverisnotoverburdened.

.护理措施Second.,thisprocessis73护理措施

最后，血液灌洗等也是一种辅助治疗患者肾功能衰竭的透析治疗方法。

Finally.Hemoperfusionisalsoatypeofdialysis,itisusedasasupportivetreatmentforpeoplewithkidneyfailure..护理措施Finally.Hemoperfusionis74护理措施

最后，血液灌洗等也是一种辅助治疗患者肾功能衰竭的透析治疗方法。

Finally.Hemoperfusionisalsoatypeofdialysis,itisusedasasupportivetreatmentforpeoplewithkidneyfailure..护理措施Finally.Hemoperfusionis75护理措施

洗胃时间一般认为，洗胃的时间应该在6小时内。超过6小时就没有洗胃的必要。但事实证明：有些患者服毒超过6小时，其胃液和呕吐物仍有蒜臭味，表明毒物存在。因此，首次洗胃后，应该保留胃管24小时，每隔4小时重复洗胃一次，直到症状好转。GastriclavagetimeGenerallythought，Thegastriclavagetimeshouldin6hours.It’sunnecessarywhenthetimelongerthan6hours.Somesuffererscommitbypoisonlongerthan6hours,it’sstomachliquidandvomitsathingtostillhavegarlicbadsmell,expresspoisonexistence.Therefore,fortheveryfirsttimeafterwashingstomach,shouldreservestomachandtakecareoffor24hours,againwashstomachevery4houronce,untilsymptomamendment..护理措施Gastriclavagetime.76护理措施

胃管长度有研究证明：将胃管长度由45—55cm延长到55—70cm，使胃管侧孔全部在胃内，可使患者不论取何种体位，均达到洗胃液流出快、通畅，洗胃时间短，洗胃彻底的目的，为抢救赢得了宝贵的时间。GastrictubelengthResearchproves:willthetubelengthby45-55cmextendto55-70cm,makegastrictubesideholesinthestomach,allwithincanmakepatientstakenomatterwhatposition,achieveswashoutfast,unobstructed,gastriclavagetimeisshort,lavagecompletely,forthepurposeoftherescuetowintheprecioustime..护理措施Gastrictubelength.77护理措施

导泻有研究认为：在早期充分洗胃的基础上给予有效导泻处置，可充分地清除已进入患者体内但尚未吸收人血的有机磷成分，减轻中毒症状。即使中毒已超过6小时，3天内未予导泻处理者，仍应给予有效的导泻。CatharsisAstudyfoundthatintheearlydaysonthebasisoffullylavageprovideeffectiveguide,anditcanfullydiarrheadisposaltoremovehasenteredintothepatients'bodiesbutnotyetabsorbbloodcomposition.Evenmorethansixhourspoisoninghaswithinthreedays,stillshouldgiveeffectivecatharsis..护理措施Catharsis.78护理措施

阿托品化有学者认为，在AOPP患者中有30％始终不出现瞳孔散大，心率增快的速度变慢。这是因为他们对抗胆碱剂的耐受性增加。为此，提出把心率维持在80—100次／分，口腔、皮肤干燥，是判断阿托品化较为可靠，而且是相对稳定的指标，称为“简化阿托品化”。

AtropinizationSomescholarsthink，AOPPin30%ofpatientsnotalwaysappearinallpupil,heartrateincreasespeedslowbecausetheyfightchorineagent'stoleranceincreases，Forthis,putforwardtheheartratein80-100,oralcavity,dryskin,isthemorereliablejudgmentatropinization,andarerelati