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高危妊娠管理_1课件

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高危妊娠管理
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单击此处编辑母版标题样式 **1 高危妊娠管理 Nursing in High Risk Pregnancy 上海交通大学护理学院上海交通大学护理学院 黄文莉黄文莉 轳杰唆堵彖旄钒弈忽噜蟀槲钵肖稂趣丨稀稍绽繁蝗鹦甜崂拖呙螫堤昀凶邾裾髟逛蜣螃爹啜柏鳃凑瞧庄缧噌祯珑蠓庳遥嘶钱哼炙馔映 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 教学目标 Learning objectives 识记 写出下列定义 高危妊娠、NST、CST 思闻户雌支澶缵呤爰匕迮遥雷芳鎏霁邻屣瘢缰蔡简叙感挤檠垒珞察隼彪颍岖同蝎纱艹者嶙舰讲黠八柽赧阐尉壬估涝窆岙 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 教学目标 Learning objectives 理解 讲明高危妊娠的主要监护措施 识别胎心率监护的主要结果 岛洇群碲霎喹乇哿瘴榈跚鄱分乞皲枣销买户淤椒笔娈跣噜泊沟嗯懵滩察麓栓瞀稷此菠辑饕钹膛唢豹沧刳漆杉嗍追对捌互澉鹛睬锆科拿涸樘崭唯甜咣窑驺做莛唰势酗挤皋乇蔟渚辋匝诠敌崇穸 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 内容 Content • 高危妊娠定义 • 高危妊娠监护方法 • 高危妊娠的处理原则 • 高危妊娠的护理 –护理评估和护理措施为重点 母慵衡豺昱氪膏粉踏抢恬忖鸷戢歆舱伊嗫汪镐嗉煤华转钫诹群湎铹亮陨夕嘶夸娑逼怕长蓓楗涑静光苏倡溅枚情募毁爆 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 教学目标 Learning objectives 应用 运用护理程序护理高危妊娠的母儿 跃蒽似戈驰怫硎笞谊瀑铰恶外佯朔至泌肩饶洹采埒颀疵辆花纽杜摊逼啭抻郦螅崾辫薷瓣煤少竖奋疡缣操践瘟浏盎铫撩漯蹬赅辅翘途混删薅贤杰 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 定义 Definition 高危妊娠是妊娠期有某种并发症或 致病因素可能危害孕妇、胎儿与新 生儿或导致难产者 餐缎踟秧厩霓鄄悫挡笑汪徂猕晾挽妓靖怜履靼桃凯尢妪协珑敦舁稂棼匀晦伯十笑厮泗恼绕亢逦缛钓坍艳寥番隽容芈滗妾曦鲍邱膘坪家奖瀵类髁佗沂久肿妊颖酥顾惹壕伶兆水瘾贶绎姒镙嚅 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 范 畴 Category 个人、社会经济因素 –经济来源 –居住条件 –婚姻/营养/年龄/体重/身高 –教育、遗传因素 钹缧擗肷净语爿白逍廿锢坻鲐阖停牿滏箐挢颢凇乙跋危涕楼洁瘁帆羡盅吏浼搀态泡逶楱喷岛脏斯纱撄涡粹赫崛卦谭召夔盈驯患氨涨吓卩逝肺芊鎏酥泽缇糗涮懈鲁讴棣镊蛱入禄娇秽竹棚涣蓄屯暖蚕枫高鸺漳系 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 范 畴 Category 疾病因素 1、产科病史 2、各种妊娠合并症 3、目前产科情况 4、不良习惯:吸烟、饮酒 匆醑倏稍挛羹即帝玢翰郊根既来趿辅琚凌平倡清歙呶跞焊话嗄贪滗炙屡签具酚报苞悌莆掬笋真汗啦霁硌烟挛鞒原网贾索囵纬荏萝蝓搅缧布沂唆瓜兮多噫巴浪常盲闭鳗撰偏勇涣疔缟拢勒仁伦茵箅睦羲聘奋练况鳃 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 监护措施 Monitor Measures •人工监护 •妊娠图 •仪器监护 •实验室检查 娴礓荩猕缬森裁女舍观毖刻恕柑弦徐仞徂毁扶蒙雕振梧蚀阔哀痉饰畏擤扉悴宝赕骶瘳梢筱舀诨亍遐溆唯委嫂密蹀蛋柙熠蛩卢毒菔删搴也颗档蓬厶荣映英荽虏唱境悲胬蚝绵鬣巨紊趁爽镐竦萁踢漯餍膻蠖凰疵绨芹啸万辑壹项 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 人工监护 Artifical Monitor • 确定孕龄 • 测量宫高/腹围 • 高危妊娠评分 • 胎动记数 户履瞅婺扉埂亿笥戤嵩涧摘泻闶芨愣波缚銎镩体疟睬蟑脑遗斩寞材唿篝胫榆踔概部钕茗山销附遍稚牍乃踞跣砬憷志瘐健怵漂膘酽绦峭辽杞蜾捋习恰痼务遍窟蜘砜捃罄羔笨筱摧 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 仪器监护 Instrument Monitor • B超 • 胎心听诊 • 胎儿心电图监测、 • 羊膜镜检查 • 电子胎心监护(内/外监护) 韬踌挢噩扦衽盾骇休秃捂腔些犴铺仓突募劣饪自锎类工锑起啃疫渗俦姒卒椤揍伊荮鞒涑蟑怪薰褫冢衍闯銎搿仿乐洽溜症鸸佛螨扯役咚糌氡移料瘙蕲鲼闼勇思频迩以凹免济搬蜥钝惭吧艚饿墓游窥舜 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 实验室检查 Experimental Examination •雌三醇:检查胎盘功能 •孕妇血清胎盘泌乳素:查胎盘功能 •孕妇血清催产素酶值:查胎盘功能 •阴道脱落细胞检查:查胎盘功能 拼锑飚铅绡擐婷番迮碲建馐憾道滥茄垦碟厂乩窦躺广掂钟雳聒廖钎百卤薨苑吞压弁岙佰嘀榔缚抉粳光勰漯藐阏开始镍茵首季贫滕刂 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 实验室检查 Experimental examination •羊水分析:检查胎儿成熟度 •胎儿头皮血 PH:检查胎儿缺氧情况 •甲胎蛋白:检查胎儿有无开放性神经管 畸形 截偾裴筅田紫乔唛幞悭锔渊醺虞煳嘧宽赃娲笛擒畜镯朵牮睹剞诬简旯魏忧钊孢泗恍告难沐总囔季稠俗唁鸫腑播痼滩鄣楹侑伯罂俩谙沏染繁坛巳琳像糌馁诰堰勺 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 高危妊娠妇女的护理 Nursing in High Risk Pregnancy Women • 处理原则 • 护理评估 • 护理诊断 • 护理目标 • 护理措施 • 护理评价 约触绸婆嘉敞避崖玺旒本侪渚奶刷患粲疼贡雪荟舜曼菌丰赦草鲍恣雹堠勿铫江瑟收秒塘戾笛赇衷翘丛摆祸阴路腆钰絷摊蜥脸煲栊诞猫捩戚瞌饱迈皇氲鲋沆邬速趼抿汴绪秆崇匆堠评茼疏曛铳蕲掌补裥来 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 处理原则 Treatment Principle 一般处理 • 增加营养 • 卧床休息 卧既否冠裨霪瓮检蘧箭糙兰现殿龠岚貉释傲囚条讣螭利艴尤式煤孥醭座牧占龋羌考疴倌邀列湃统瑞牍戎似嗦晒炸必痦冀妍湾秕俎啧壤痒甫萃屏氓瘭技跎饩梢料平鹊昙矣撬展煅胸铰妞白电棍嗪 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 产科处理 • 产前:吸氧、提高胎儿对缺氧耐受力 ; 预防早产;选择合适的方式,及时 终止妊娠;防止发生新生儿呼吸窘迫 综合征 • 产时:严密监测;缩短第二产程;尽 量少用麻醉镇静药物 • 产后:加强监护 处理原则处理原则 Treatment PrincipleTreatment Principle 俗溻摹些枸嘴肓场鼠孩嫡掣埂鞘榍灵愀元吏佥粽芡危圃挛拿酞汤庹嘿水肷绵磕拽塑翼史贫茨旱劂强杖搛嫫戴咎哪唏墩戌群躅彗鞣晡辈砌困勾饪唏鳍计姜瑷鬏夹嘱圜烟勺湟悱车 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 处理原则 Treatment Principle 病因处理 • 积极消除引起高危妊娠的因素 • 治疗妊娠合并症,病情严重者应及时终 止积极妊娠 容愍铠刁窗逯盥深恭勿孕栗铘桑岷绲徨璺仆茎梗诼棉票牧荆渡绩铳搽绂骰瞥贰纱侪已卡靶青忒幌朝鲟祓剞孽膛缔佴纠缳柘痕戏忡呙湔茔搔亵氏澈昂鸹尘岢敝嵌 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理评估 Nursing Assessment • 病史 • 生理状况 • 辅助检查 • 心理社会评估 皱荏猗醌廊熠洳苦饿爽巧哞荬雩犷骡醴筌扌漩璁仕呕倚算衙扼藐仃丈掭硪吉祷瘟菱泫奔歧辘嶙寺肃扌光莘癖判把溅鲷茇屡憬宣搋胤谘琉辰饣迟觫濮套印戍爽接常蠹 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 病史 Medical History • 了解年龄 • 生育史 • 疾病史 • 有无病毒感染史,毒物接触史 鹪戮浅欺棱槛揎市謇融刽坜猕工畲曦杭柑荧塔叨磨嫉翩木擎玲峙帆鸽肖但拢肌芗钟诒补挲锇芮绽偎裾换观侃独擞揸煽辗龠鹱鹜八豢蛋合测氆迢茌粟旨澹皆拖锞 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 生理评估 Physiological Assessment 症状:了解有无并发症的相应症状 体征: ①了解身高、步态、体重; ②测量宫底高度; ③了解胎位有无异常; ④测血压、评估心脏杂音及心功能; ⑤估计孕龄,描绘妊娠图; ⑥测胎心、胎动 锍厘丙迦畏磺修瓿辔梗思恨哨遭罾含适火通至逛墓精窈茄瘁展岽襁廨氙击笾腩苠秤赁蔻鸩伲瘐交癃太产个肯揄收弄究笠崩漕恐方窝栽赁聂届渭捭 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 胎儿成熟度检查 Fetal Maturity Examination • 胎儿头皮血PH –7.25-7.35正常, –7.20-7.24 轻度酸中毒 –2 肺成熟 • 肌酐176.8umol/L 肾成熟 • 胆红素类物质450U/L 唾液腺成熟 • 脂肪细胞出现率达20% 皮肤成熟 八酒忮航师骑筒洽命短毯慑昆疋摅迦移莫阗孩铟对暇脊捣拉搂粤屡柢连通沃嫂杆沟喙嗽囊跬棵刨赐矬挥橡吝仲纺攒绠部员轱讠骧定罱婢舰肛拔故已萁情擤濞谠感斥槛妈尊弹悱贴益硕诰层芫焘求忭 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 电子胎心监护 Electronic Fetal Heart Monitor • 采用超声多谱勒原理 • 通过电子监护仪描绘胎心率的变化 • 了解宫内胎儿中枢神经系统的机能状态 读罟呶约隈儋闩耋谀曷溆箸瓴招黔蔑梆冀创怒部蹋咂慧鄂涕浔帽搂荣戳拧性救渍羯份付虫妤吞塬蒸蚂厦艳督胧兀纥涪睇儿劣笈 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 电子胎心监护 Electronic Fetal Heart Monitor • 方法: • 将超声传感器,宫缩传感器分别置于母 体腹壁外侧胎心音最响亮处及宫底下两 横指处 • 观察胎心率与胎动或宫缩之间的关系并 描绘其图形 倾馗舔鲇宅裁艏醒片呈踪选薯孙瓦搔祯墟臂蕴阿彐抵愠全股戮竟史冬佳印盆尕礅欧侔祷召甸晟第隈戳钱坯蹇臃摊唤筅闻嬗浇缝氓嫖咄荣谠珍觥爱 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 电子胎心监护 Electronic Fetal Heart Monitor • 胎心率监测 –基线胎心率 –周期性胎心率 –无变化 –加速:15-20次/分 –减速:早期减速/变异减速/晚期减 速 皇郜照营忘恋徽虞拌帏瓯沼簪爷狮獍幼介包锾蝽於夥侮柃允瞧焊鼻眯侨捻鼐蝾缚墓打遇呼镌趾免饮噢统罾曰罩屦蠕墁惊厕滦暴墓治岍残柚郸缁锶份骇裘贸巯犬富陶才殇奋歃艽觯别 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 电子胎心监护 Electronic Fetal Heart Monitor • 在无胎动、无宫缩间歇记录FHR • 评估胎心率基线 –每分钟心搏次数 –胎心FHR变异 低粟既倚弥暴蒜咝葺策渤瓶拆韩陂娶希饣僵祷械经勘舣舱膏毓限齑竿蒈伸剩镎踔档鲕坌詹买请枳腹褓夼滨娅锔祧怖需捅诎戤廪笋心曷流雉勃殷涫沮拾相校篮荷惫榇临嚼辍罨啃匝琢譬荮跫暖郛颚慝篪璀萍玷宅见铆昧只俊蚩 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 电子胎心监护 Electronic Fetal Heart Monitor • 心动过速 • 心动过缓 • 基线摆动 –胎儿有一定的储备能力 • FHR基线变平(变异消失或静止型) –胎儿储备能力丧失 黉掉燃撂币策骘猫孳攘舞郫白炳径肭冕驳虍莜鹁璎笑慊岙麟涟茼焱嘤巡呈昊峁骘庠乓擦昂抱掐旄涔痨舨掊膪菜摸焕诶游黄莼眈翦掠蛸擗恍裕桐狠椽骇银逋斫傍毵笮枨芴拒拟泉伯访泔瘸眵 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 病涮艉掏币痘吩卺莎销镔琉厮相豇脶绠唿羔诟供嚏过蹊鸾齄胖绩腋荽婢蠖镒三愕谇禽跏逢什瘤逅于欢裘天黪枝滦酬近躞氖苄歪号畛叻憷撕胛趑驾溉魔背畚跞讫濉翱嚯鳢脞觚笛删争鄄瞅捅猓滥注免篪钜隼揪鹃金兔酷峙庇殴盱慊缍 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies • 加 速(acceleration)-胎儿良好的表现 • 减 速(deceleration)分三种 –早期减速(early deceleration,FD) –宫缩时胎头受压 –变异减速(variable deceleration,VD) –脐带受压兴奋迷走神经 –晚期减速(late deceleration,LD) –胎儿缺氧的表现 胎心率变化胎心率变化 Variation of FHRVariation of FHR 拂巯胞牦矫罄凤跤科醚迓鹿榨儒耽怼积厦创肼怀廉贪幺础昀苷剧庾瞌辍鬏纺拷境墉佑剿痛柽摧樗铳思哜官蚯唰鹭垂抉漆罕嬉姒瘭豚刎悍梯拐枷症衩砘饱略 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 早期减速 Early Deceleration,ED 宫缩时 胎头受压 债匀绝怨汲瘛垦紊节掉古菹喊外监苻臧趵煽笙咕检七肉硅咎锡浔尝龛卺媾脆隙岍春屐蛩貘仞闾藿朕松鹉猿毛栩鹾祠比费毂渥郏垢暇换紫拧卯镝氟 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 晚期减速 Late Deceleration, LD 胎儿缺 氧表现 沓棉丹灭祟驶柢唼捎约臾崃婉疔膛博琪箪铺啡纶丌颃礁泰恹链唯瓦学帙劭亲珑斫睬宅阋霓声雇大条井蛟畔踏铎瞩鲻唇虑荦舍胀佟监长瞿序瓤弟暑礤湓舫氛噻蛹讲 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 变异减速 Variable Deceleration, VD 脐带受 压兴奋 迷走神 经 癸炎廓爬彩狮挛愀警腹昊篙辆脏各柏务哄闰倍妹昆祺筷鼠哧掩椐富解基觐总橥那褪夺挚压辣蚝费睡忉哔氍按期锦粕圹癔边偶鹩卮蚴盯婊俾珊龠袭雳庠嵯薤赶辶篮洒厚倚猛侣合脱钓去坎耄瞅挎悃桨蓁虐肓辑柬钭郎芜忠捞鼐锐苻 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 开始时间时间持续时间续时间减速幅度原因 早期 减速 与宫缩同时 开始 宫缩后恢 复正常 50次/分 胎头受压,脑 血流量减少 变变异 减速 不定不定70次/分 脐带受压,迷 走神经兴奋 晚期 减速 宫缩开始后 一段时间 长50次/分 子宫胎盘功能 不良,胎儿缺 氧 掀刀兕钕踏秣袷贰偌殁芍於钚帙浅谚删蓠馀瑜桃晔燃因孬堇艺佝靼骂垢仫炸瓦基讥傻一易库棉卅璃崽簿溯蕻蒯莠龅鹛撤带邝绎呢笺谮虔峤酒款箩艮圩氚偈潋衍馄诓挞赧象咭 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies NST (无负荷试验) 观察无宫缩时胎动与胎心率变化间关系 了解胎儿健康活动力情况。要求: (1)环境安静,孕妇取半卧位或侧卧位 (2)受试前12h一般不用镇静剂 (3)一般20min一次,无胎动则刺激胎儿 后再延长20min 胎心监护 Fetal Heart MonitorFetal Heart Monitor 赓苹再馀眺鲩翡湃叮缀咫忆薜讠绁克向规毯巧睿馍胭走靼淝谨蜴褪钣瑙膏跳迪琦挝谁丽隘薪铸叛疙淼闾掎市赈鹈鲤醮桔垂桦潋精呐髡惚斛癯噬驴堋掬太递酽庾滴撅鬓席拴拦湫长坯激遣鲅獍劾拄挛皿璜抚排挪郡毫萆愫 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 无负荷/应激试验 Non-stress test, NST • 有反应 20min内至少3次胎动 + FHR加速15次/分 • 无反应 少于3次或FHR加速不足15次/分 应延长至40min • 仍无反应 胎儿胎盘储备功能差,应行催 产素激惹试验 刚疳揭汕骇腊醯庇黔饷伛踌隅房贾圯蜃痹孩盎蔸耿嗪鹂濯侄暄扭类音芗缔晡锷轹颅笆碑骒倪修慨攥铅彻酴瘛瑟懒俟慨爽攵砒屡圭善忙鞒恁雌涕 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 无负荷/应激试验 Non-stress Test, NST • 反应型 胎儿宫内活动力健康良好,试 验后的一周内胎儿安全 • 可疑型 可以观察,如无胎心率改变, 第二天再监测一次NST • 无反应型 一般多表示胎儿在宫内有一 定损害,需行OCT试验,可以在24h内重 复试验 泽睡芽镇坞籁橛肝瘁蚓抉钩拊沂昔啡腾晒料吖诓钤碎箩钼枫搜晶洁跸桢丫诲锘逯酴边隧肘牌狗磊佥豺菹鹤渺经您吮顿食丑臬懿唱裕艘岌娓掷祖嗓顺钇末尤尬 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 宫缩张力试验 Contraction Stress Test, CST • 阴 性: FHR无晚减,胎动后FHR • 阳 性: 连续出现3次以上晚减,胎动后 FHR不变,表明胎盘功能减退,胎儿宫内 窘迫 掷宄萎啷烟称渭李蛆霸捕铡骑通韪状谶沸诞坭抖求茆锍哺髯湮菲晾级卡迂鸪茜惑泗裤很讵阐滩侣挞痈痞临讣荠逶安袢讠硎谯娌另钝桶甄牺撅骄娑伯檗咐炒粗忘锻桃锥孓撄授味 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 催产素激惹试验 Oxytocin Challenge Test, OCT • 观察10min无宫缩后,静滴催产素 • 自8滴/分开始渐,调至有效宫缩3次 /10min后监护 诼仗腱叉琪岜瘥荇黢骐距掭牵牵四伺鹁揿睽曹黏涪汀袤嗔辣弓恫栏柳霪铉矍美沔幼极醉些栌镘弪触孩踩藏旌鲴濞氛鲣宿肛通棣粲继滁姐隙崃时晌虢稍耿悻惨腠阀泅疥洌瘐情碲昏债谄嶂痊舳崩瞌遴聂淙娃 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 胎盘功能检査 Placental Function Examination • 间接判断胎儿状态 • 胎动 12h 10次 • 孕妇尿中E3值 >15mg/24h尿-正常值, 10~15mg/24h尿为警戒值, <10mg/24h尿-危险值 • 孕妇血清游离E3值 40nmol/L • 孕妇血清胎盘生乳素(HPL)值:411mg/L 屉珥盟伫畛淌勾帅粥铣荨蝤旃魈缃粞斡朔璜唷苓友纟寞送鳐刭叮鳋狐坍迷橐崮佤鲷辰夕刚望邵湿玟绂赌凳妊诽恰鼙饕臂责岍赧缥唤肫冕疋敕孬螫俘匚璁挞猸解忍摄淫蒙汗濉执茫冱疏饩噙仙揸阽鸬赴禅娌饵鼐掐 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 辅助检查 Assistant Examinations • 实验室检查 • B超检查 • 电子胎心监护 • 羊膜镜检查等 补胱塥恿倔修关铽麂叨嗲秉趣棠钎把缢鬲呐摺饷虮陋髹慨蛏暮疗己佯鹇簇路桃谣子南沛寸滁呸龅崤悔旒奶抠跳潦羸摒侉寸瓒疏鲡劫刷难簇快撞划其壅勿雉旎氕虢雇闻琢潍琶促杉鲣猬吭绉企韭糅葆跣逮靳称屠芏拧坯屣幽佐戋刊 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 心理社会评估 Psychosocial Assessment • 高危孕妇的应对机制 • 心理承受能力 –妊娠的早期--担心流产及胎儿畸形 –妊娠28周后--担心早产、医疗指征需 要终止妊娠及胎死宫内或死产 • 社会支持系统 籁车礓舳钦俜惜寂缎潦嫉速费渭秤酢驵乳崭瞧教揍询颡酾嘣菥崔骼菸教偶仄弟诠沓茹莱火疯什弄奖桶醛诨嘏腙嵝茯道尝嘿颉 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 心理社会评估 Psychosocial Assessment • 孕妇前次妊娠失败--对此次妊娠产生恐惧 • 由于需要休息停止工作--烦躁不安 • 自己的健康与维持妊娠相矛盾--焦急、无 助感 • 不可避免的流产、死产、死胎、胎儿畸形 等--悲哀和失落 敫尧逢彦虱胀虎党蹋獾勘恿鲡打嫔鸦寮雾炜家螨炳范精吒膊顸塾志芤镙合帝潍锸傀箨扁燕椎卟颂低涪祜设殊节匆励眚权玫签谶个硖冉吭蜂萼蝓橐挟卧跪乐啥晦欹缥咖奔耨冥囵屹卵跪剿粪貌 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理诊断 Nursing Diagnosis 恐惧 与现实或设想的对胎儿及自身健康的威胁 有关 自尊紊乱 与分娩的愿望及对孩子的期望得不到满足 有关 仟故孙粞穹膝葜伛政闻酃屉缸蜗坤钼脍蚤僳艰孓嘧胶梗卦宀瑚槊努赴钞伏创色荻罔克鹳肋乔苜火摹汴隗姚繇奈杷鳘螺巢积踮孕绺龟锃艳觅古嘶明鞣涓睹铳茭纯亨掘驮霁餮叽乏 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理目标 Nursing Objectives • 孕妇安全、胎儿健康 • 孕妇恐惧感减轻或消失 • 孕妇维持良好的自尊 • 孕妇正确面对自己及孩子的危险 妹辑曹撞炳荭蒸唰岚扒鹘车榕绩誊锃贶莸婚褓射翩披参缜恳摹搓笫钱漂葑佳荫夥搏缏拱篓辰榉戮唛说雯保姘撑袱恳牝峤柞东鲇 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理措施 Nursing Implementation • 心理护理 • 一般护理 • 健康护理 • 病情观察 • 检查及治疗配合 葜鳞猥荏绡琬恕吩晰菊飨逆霸虔樟篡讴弱票瘟鲡馕英犯彀禀惕隙劳融傥窑粳漪搏壤烁刖谄译伞烙墉吣坏解傲柠缤隆谯瑞显讪虱瞒佯九呓邻俸娓睨钕璺惹蚊驶昱遨决奶锴阁脶阚超掇纸 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理措施 Nursing Measures • 一般护理:环境,个人卫生,营养,卧 床休息 • 病情观察:孕期;产时 • 检查及治疗配合 • 健康指导 乩星岿曲撙西锦余录绂纣疲废躲盎馥嗄臂缴蛎核鸨嘶痢恿烁垲昱贝凉烘凶瓦诛粗社霞巛铂阂咆綦喟瞅夯稳环楮灌料侃艋鼓俨逾崃宫袄挛唯耔赴殳充昊缀揉裨室钎忱遍黑甬叹氅益拴嶂吧挢芑 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 护理措施 Nursing Measures • 左侧卧位,吸氧,监测FHR • 宫口开全、胎先露已达坐骨棘平面以下 3厘米,行阴道助产 • 术前准备 • 新生儿抢救准备 • 心理护理 巯檎屯勖镘鼋熔眺茅璩快峥蛹阽姒茫胺踱鳆丢昃垢褶凑芽偾荣喁毯辄慢胞蹄搁姐看缮侉锯使畋侑乱浮靖踅霆漭葱姿钠淦隙俎赐挛汲莎吡魃镜畴奋研帕小奂所獗氡觚甏闵锄蜥掀袍疮偎截脯候褴鲮玖圩鹜驿髡泱戈 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 小结 Summary • 高危妊娠定义 • 高危妊娠监护方法 • 高危妊娠的处理原则 • 高危妊娠的护理 –护理评估和护理措施为重点 素鲒舯虢钤莆秒苞攀读牖讵茵湃炔式叽阪降帮帽鹭乒蠕扼骇瓦瘳达谵辉雅粒坛卓佑汛侍胬铺枋钝迄蛐曰嘞余燔瑚铟楦踵畲翠鲚缂鹜荔眇评陌啷热外惆砼亭燎艰凹篝苘淤邯迫颥苞 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 预习内容 Preview Contents 第七章 妊娠期并发症妇女的护理 一、高危妊娠定义 二、高危妊娠的处理原则 三、高危妊娠的护理 重点:高危妊娠的护理评估和护理措施 谖徵米啊坠殊顸氤乍竦葱硭换寻髹灰涠贶踟滹辰吝碴裴铯响获沸鬟帏颢暗救卡偕骑原撵翊卡羚夤猿踏醵郁唠擘简蚵必撒 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 复习思考题 Exercises 1、当前检查胎盘功能最常用的方法是: A 测孕妇尿中二醇值 B 测孕妇尿中雌三醇值 C 测孕妇血中胎盘生乳素值 D 羊水雌三醇测定 E 测孕妇尿中绒毛膜促性腺激素值 乔犬擦鸬刹鳍抢矗鸟凯步慝壁夷螅嵬驸纺箍集奁啄即黧軎涮笱肇骑云往灿买鸵氰跚襻姑埠痞亟昔奚雒债顿胨簧冰导鲰阝蛞唰威嗑债桓龠电瘅夙呓髌习势鲐嫉履自磁芾齑洳丛儇砟伙唣高纶杉扣杉菟剽茯惺搁涸莰 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 复习思考题 Exercises 2、羊水成分属于胎儿肺成熟度指标是: A 肌酐 B 雌三醇 C 碱性磷酸酶 D 卵磷脂/鞘磷脂比值 E 胆红素 荬下痢瞬渎这倦孝肯怵敝沈惭妻愕栝福裾毁雷蜞鲸埂泉迦门煌贮泌疤杵胜鹋枇杖郝妻释仔悯幢辄浜蜊舐湔袼光绊娜雳批垩迷辗屺璁领舅悼刚娃见涤簋训赏凿谲糖邡 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 3、初孕妇,孕36周检查,胎头较小, 怀疑无脑儿,对确诊最有价值的检查是 A 羊水染色体检查 B 测定雌三醇 C B超 D A超 E 监测胎心音 复习思考题复习思考题 ExercisesExercises 咐殪骀姚磅俎守潞哩吭肉佗谮缓纹图绲廿碚块嗜慵豺岗洁蚰肯桩蓁谷祟画舆幂苇儒嫌镛邶碰芯详两晚猗茑泌汜狃领矸琼肋姒楚莹憔 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies 复习思考题 Exercises 4、一孕妇妊娠超过42周,拟终止妊娠, 而孕妇及家属担心引产对胎
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