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混合痔护理查房精要课件

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混合痔护理查房 护理查房课件 护理查房课件ppt课件 护理查房ppt课件 护理查房混合痔 混合痔护理查房课件 混合痔护理查房ppt课件 护理查房ppt
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理查房 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 病史介绍 患者以“发现外阴包块10年疼痛5天”为主诉入妇产科。查体:T 36.4℃ P 80次/分 R 19次/分 BP 130/80mmHg,心肺未见异常,腹软肝脾无肿大,双下 肢无浮肿,入院后完善有关检查,诊断考虑 1.混合痔 2.肛瘘 3.老年性阴道 炎,给予抗炎,阴道冲洗,放药治疗,为进一步确诊请普外科确诊后与12月2 号转入我科。转入时情况:患者一般情况可心肺腹未见异常肛门外形正常, 肛门口可见皮赘11点距肛门5厘米处可见一瘘口,挤压时有脓性分泌物流出, 肛门指检:肛门括约肌略松弛,未触及占位性病变,直肠粘膜松弛。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 混合痔  混合痔是指处在同一部位的直肠齿线上下静脉丛同时曲 张、扩大、充血,相互沟通吻合,括约肌间沟消失。齿线 上方的痔核表面为直肠粘膜,齿线下方的痔表面为肛管皮 肤覆盖,也即俗称的内痔部分与外痔部分所形成的一个整 体,则称为混合痔。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 症状 混合痔的主要症状为:①便血:大便时带血或射血,血色 鲜红,不与粪便相混。②肿胀疼痛:肛门有下坠或异物感 ,大便时用力内痔部分极易脱出。③脱垂:由于内痔经常 脱垂于肛门外,粘膜受到刺激,粘液分泌大量增加,可致 肛周皮肤潮湿不清、瘙痒发炎或湿疹。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society (1)以外痔性质来分 ①炎性混合痔;②血栓性 混合痔;③结缔组织性混合痔;④静脉曲张性混 合痔。临床上以后两者居多。 (2)以数目来分 ①单纯性混合痔;②多发性混 合痔;③环状混合痔;④复杂性混合痔。 分类 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 肛瘘是肛门直肠周围脓肿破溃后形 成的疾病,其一端通于肛管内的原 发感染病灶—肛窦,即内口,另一 端通到肛门周围皮肤,即外口,多 由肛周脓肿破溃后形成,可不止一 个,内、外口之间相通的管道称为 瘘管,瘘管壁由脓腔纤维化后形成 。也有仅具内口或外口者,即内盲 瘘或外盲瘘。 肛瘘 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2013年12月2号给予外科常规护理,二级 护理,流质饮食 经过完善检查后定于12月3号在腰麻下行 1.肛周脓肿切开引流术 2.内痔套扎术。 术后给予心电监测指脉氧检测中心供氧6 小时,二级护理流质饮食。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理诊断 {疼痛:与疾病的类型有关 {便秘 : 与肛周疼痛惧怕解便有关 {知识缺乏:缺少有关疾病的治疗术 后预防复发的康复知识 护理诊断 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 术后当日禁食6小时或进 少许流质饮食,次日进半 流质或普食,但应避免刺激 性食物。如稀饭、 粥等。鼓励患者多饮水、多 食新鲜蔬菜和水果,以保 持大便通畅。 饮食护理 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 排尿排便护理 排便的护理:手术当日不宜排便,以免 引起创口出血或痣核脱出。术后一 般24小时后方可解第1次大便,嘱 患者每日排便1次,尽可能在每日 早餐后排便,因早餐后易引起胃- 结肠反射,时间为2~3分钟为宜, 坐式排便为好,这样方可建立定时 排便的习惯。排便时注意力要集中 ,不要看书报、抽烟。 排尿的护理:行混合痔外包内扎术后一 般都能自行排尿,但有少数患者因 精神过度紧张或腰麻后引起排尿反 射障碍出现尿潴留,此时应做好患 者的思想工作,使患者消除顾虑, 安定情绪,诱导排尿 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 缓解疼痛 对于剧烈疼痛者,给以止痛剂处理,肛管内纳入消炎止痛栓,肛门部位冷敷 。 坐浴:每次排便后应坐浴,清洁溃疡面或创面,减少污染,促进创面愈合,水温40- 46℃,每日2-3次,每次20-30分钟。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 Ø舒适的改变:头晕 ™卧床休息,加强基础护理。 ™保持病室安静,提供充足的休息时间, ™病人主诉头晕时应立即关心和安慰病人。 ™指导病人采取放松技术,做深呼吸、听轻音乐等,达到缓解头晕的 目的。 ™遵医嘱用扩张血管药,改善循环,达到治疗目的。观察药物的疗效 和副作用。 ™密切观察病人头晕发作持续的时间及次数。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 护理措施 Ø知识缺乏:缺乏本病的防治知识 ™疾病指导:向病人解释本病的病因、症状、预防、自我护 理方法。 ™用药指导: 指导病人按医嘱正确服药,告知药物的作用及 注意事项,和不良反应的观察。不能随意更改、终止或自行 购药服用。 并发症的观察和护理:因术后肛门疼痛,反射性引起膀胱括约 肌痉挛,麻醉抑制剂作用使膀胱逼尿肌松弛,易发生急性尿 储留,通过诱导等 促进排尿,必要时行导尿处理。排便困 难大便变细者,术后5-10日内扩肛。肛门括约肌松弛者, 术后3日指导病人进行肛门肌收缩舒张运动。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ①养成良好的排便习惯 ②保持肛门卫生,建议使用柔软,白色,无刺激手纸,避 免在肛门周围使用肥皂或用毛巾用力擦洗。 ③多饮水,多吃蔬菜水果,少吃辛辣刺激食物,不饮酒。 ④避免长时间久坐和久站。 ⑤如有便秘者,多食纤维食物,服用适量植物油或蜂蜜, 促进肠蠕动,防止便秘发生。 ⑥每日晨起或晚睡前作10分钟腹部按摩,即用手掌轻柔自 右下→右上→左上→左下反复按摩腹壁。 ⑦鼓励病人进行肛门括约肌收缩舒张运动。 健康指导 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 1.混合痔的概念是什么? 2.混合痔的临床症状? With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
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