完整版昏迷病人的护理

临武县中医医院ICU

朱洁娜昏迷患者的护理

学习内容1、昏迷的概念及意识的分类。2、了解引起昏迷的原因。3、了解GCS评分。4、昏迷病人的护理措施。一、昏迷的概念昏迷是因脑功能严重障碍引起，以意识丧失、运动感觉障碍和反射消失为主的一系列临床表现，是大脑皮质和网状结构发生高度抑制的一种状态，其病情特点是重而复杂，变化快，随时有危及生命的可能，因此必须予以严密全面观察和护理。二、意识的概念意识是大脑的功能，是人类反映客观显示的最高形式，它通过人的语言、躯体运动和行为表达出来。意识是机体对自身和周围环境的感知，是机体处以觉醒状态，并能正确认识自己和周围环境。三、意识障碍概念

意识障碍系指人们对自身和环境的感知发生障碍，或人们赖以感知环境的精神活动发生障碍的一种状态。四、引起昏迷的原因一个是由于大脑病变引起的昏迷，这包括脑血管疾病（如脑出血、脑梗塞等）、脑外伤、脑肿瘤、脑炎、中毒性脑病等；。

另一个是由于全身疾患引起的昏迷，这包括酒精中毒、糖尿病酸中毒、尿毒症、肝昏迷、一氧化碳中毒等。五、意识的分类

清醒：正常。

嗜睡：是程度最浅的一种意识障碍，患者经常病理性倦睡，处于持续的、延长的睡眠状态，给予较轻微的刺激即可被唤醒，唤醒后能作简单对答和活动，无刺激时，迅即入睡。

昏睡：较嗜睡更深的意识障碍，表现为意识范围明显缩小，精神活动极迟钝，对较强刺激有反应。不易唤醒，醒时睁眼，但缺乏表情，对反复问话仅能作简单回答，回答时含混不清，常答非所问，各种反射活动存在。五、意识的分类五、意识的分类

浅昏迷：意识不清晰，对外界刺激无任何主动反应。随意活动消失，在强烈刺激下，如压迫眶上神经时可见痛苦表情和肢体轻微的防御反应除腹壁与提睾反射常消失外，其他各种生理反射（吞咽、咳嗽、角膜反射、瞳孔对光反应等）存在；体温、脉搏、呼吸多无明显改变，可伴谵妄或躁动。五、意识的分类

昏迷：即意识活动丧失，是严重的意识障碍。对外界各种刺激或自身内部的需要不能感知。可有无意识的活动，任何刺激均不能被唤醒。五、意识的分类

深昏迷：是最严重的意识障碍。随意活动完全消失，对各种刺激皆无反应，各种生理反射消失，可有呼吸不规则、血压下降、大小便失禁全身肌肉松驰（肌张力低下）、去大脑强直等。仅维持呼吸与循环等生命最基本的生理功能。五、意识的分类意识模糊：表现为注意力减退，情感反应淡漠，定向力障碍，活动减少，语言缺乏连贯性，对外界刺激可有反应，但低于正常水平。五、意识的分类谵妄：在意识模糊的同时，伴有明显的精神运动兴奋，如躁动不安、喃喃自语、抗拒喊叫等。有丰富的视幻觉和错觉。甚至有冲动及攻击行为。夜间加重，白天减轻。六、GCS评分

用格拉斯哥昏迷评分法来判断病人的意识情况，比较客观。评分标准：15分：表示意识清楚。12分～14分：为轻度意识障碍，

9分～11分：中度意识障碍，8分以下：为昏迷，分数越低则意识障碍越重

睁眼反应

4-自动睁眼3-呼之睁眼2-疼痛刺激睁眼1-不睁眼言语反应

5-正常交谈

4-应答错误

3-言语错乱

2-言语难辨

1-不语运动反应

6-按吩咐动作

5-对疼痛刺激定位反应

4-对疼痛刺激回缩反应3-刺痛肢体有屈曲反应2-刺痛肢体有伸直反应1-无动作七、护理措施日常生活中，我们经常遇到二种情况。一种是我们身边突然出现病人昏迷；另一种是病人因脑血管病或颅脑外伤等已昏迷一定时期，病情稳定后需回家中恢复和修养。

当我们身边突然出现疑似昏迷的病人时，鉴别病人是否昏迷最简单的办法是用棉芯轻触一下病人的角膜，正常人或轻症病人都会出现眨眼动作，而昏迷，特别是深昏迷病人毫无反应。当确定病人昏迷时，应尽快送病人到医院抢救。突然昏迷病的人

（1）要使病人平卧，头侧向一侧，以保持呼吸道通顺。（2）病人有活动性假牙,应立即取出，以防误入气管。

（3）注意给病人保暖，防止受凉。（4）密切观察病情变化，经常呼唤病人，以了解意识情况。对躁动不安的病人，要加强保护，防止意外损伤。长期昏迷的病人，应做好以下护理：（1）饮食护理。应给予病人高热量、易消化流质食物；不能吞咽者给予鼻饲。鼻饲食物可为牛奶、米汤、菜汤、肉汤和果汁水及肠内营养等。另外，也可将牛奶、鸡蛋、淀粉、菜汁等调配在一起，制成稀粥状的混合奶，鼻饲给病人。每次鼻饲量不超过200毫升，每次间隔时间不少于2小时。鼻饲时，应加强病人所用餐具的清洗、消毒。长期昏迷者每月更换鼻饲管一次。同时根据不同疾病引起的昏迷，营养要求不一样选择食物，应根据医嘱而定。吃多少，既要根据疾病不同而异，又要根据各人情况而定，以维持昏迷前情况为原则。开始时小量试喂，逐步增加。切忌急于求成。要注意观察其消化功能，根据情况及时调整。在每次鼻饲时一定要抽吸胃液，观察有无呃逆、腹部饱胀、胃液呈咖啡色或解黑色便，应立即通知医生给予止血药物。保持呼吸道通畅（2）防止感冒。长期昏迷的病人机体抵抗力较低，要注意给病人保暖，防止受凉、感冒。病人无论取何种卧位都要使其面部转向一侧，以利于呼吸道分泌物的引流；当病人有痰或口中有分泌物和呕吐物时，要及时吸出或抠出；每次翻身变换病人体位时，轻扣病人背部等，以防吸入性或坠积性肺炎的发生。预防压疮（3）昏迷病人预防压疮最根本的办法是定时翻身，一般每2小时翻身一次，予以卧气垫床，另外还要及时更换潮湿的床单、被褥和衣服。预防烫伤（4）长期昏迷的病人末梢循环不好，冬季时手、脚越发冰凉。在给病人使用热水带等取暖时，一定要注意温度不可过高，以免发生烫伤。防止便秘（5）长期卧床的病人容易便秘，为了防止便秘，每天可给病人喂蜂蜜水和含纤维素多的食物，每日早晚给病人顺时针方向按摩腹部。3天未大便者，应服用麻仁丸或大黄苏打片等缓泻药，必要时可用开塞露帮助排便。防止泌尿系感染(6)病人如能自行排尿，要及时更换尿湿的衣服、床单、被褥。如病人需用导尿管帮助排尿，每次清理病人尿袋时要注意无菌操作，导尿管要定期更换。帮助病人翻身时，不可将尿袋抬至高于病人卧位水平，以免尿液返流造成泌尿系感染。防止坠床（7）躁动不安的病人应安装床挡，必要时使用约束带，防止病人坠床、摔伤。预防结膜、角膜炎（8）对眼睛不能闭合者，可给病人涂用抗生素眼膏并加盖湿纱布，以防结、角膜炎的发生。一般护理（9）每天早晚给病人用生理盐水清洗口腔，每日床上擦浴1次，每日会阴擦洗2次。做好三短六洁。准确的记录病人的出入量。管路的护理

1、严格无菌操作原则。

2、保持引流通畅，避免扭曲折叠，妥善固定，注意观察引流液的色和量。

3、按各类引流管护理常规进行护理。管道标识和腕带的使用

1、各种管道均应按规定贴有标识。

2、昏迷病人都要佩戴腕带，并注明床号姓名、性别、年龄、诊断等信息。功能锻炼昏迷病人的挛缩畸形出现较早，尤其是小肌肉、小关节。开始就应每日2-3次做四肢被动活动，保留关节功能。防止关节强直，以免发生肌肉萎缩。并及时进行语言等各类训练。有肢体瘫痪者，应防止病人足下垂，并按瘫痪病人进行护理。病情稳定后，即可开始床上肢体活动。鼓励患者加强肢体的功能锻炼、按摩、针灸或被动运动。从发音器官开始到发单音节、单词，认人、物、字，数数等。说一些简单的日常用语，让患者跟着说，或让患者反复听日常用语的磁带，以强化语言刺激，逐渐恢复语言功能。康复期护理帮助病人家属树立战胜疾病的信心，积极配合。对植物人应加强基础护理和支持疗法的治疗护理。防止各种并发症，注意饮食营养卫生，坚持运动由小到大，由弱到强，循序渐进，并配合理疗、针灸等措施，促进功能恢复，直到康复。脑血管患者常因肢体瘫痪、语言障碍、大小便失禁等而产生痛苦、绝望、焦虑、自卑等心理，对治疗缺乏信心，应尊重患者的人格，态度和蔼、语言亲切，耐心地做好患者及家属的解释工作，帮助患者调整心理情绪，维持患者家庭和谐、社会融洽，让患者体会到相互信任所带来的愉快情绪，使患者保持积极乐观的情绪，树立战胜疾病的信心。谢谢聆听4242赠送2套亮丽色表格可一键删除折线图/表格/数据关系Trending

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