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脑血管支架置入术围手术期护理绿色韩国春天漂亮模板课件_1

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脑血管 支架 置入 手术 护理 绿色 韩国 春天 漂亮 模板 课件 _1
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L O G O Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 全脑血管造影术围手术期护理 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 脑血管造影检查是将含 碘造影剂通过导管注 入到血管内 使血管 显影 通过dsa机快速 连续摄片和相片处理 清晰显示脑血管的形 态以诊断脑血管疾病 的方法 这是现代最 先进的脑血管诊疗方 法 是脑血管疾病诊 断的金标准 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 内 容 脑血管疾病是由各种血 管源性病因引起的脑部 疾病的总称 是临床神 经内科最常见的疾病 包括短暂性脑缺血发作 脑 卒中 颅内动脉瘤 颅内血 管畸形 脑动脉炎等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 脑血管造影检查 利用导管操作技术 在计算机控制的数 字减影血管造影 DSA系统 的支持下 对累及神经系统血 管内的病变进行诊断 和治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 适应 症 邻近血管关系 某些肿瘤定性 蛛网膜下腔出血病因检查 观察颅内占位性病变的血供 颅内外血管性病变 例如动脉狭窄 动 脉瘤 动静脉畸形 颅内静脉系统血栓 形成等 自发性脑内血肿 3 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 禁忌 症 脑疝晚期 脑干功能衰竭者 有严重出血倾向或出血性疾病者 严重心 肝或肾功能不全者 碘过敏者 3 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 正常脑血管造影正位像 侧位像 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 治疗方法 患者平卧 用利多卡 因局麻腹股沟区动脉搏 动最明显区域 用穿刺 针扎进股动脉 插入导 丝及插入血管鞘 然后 用4F或5F的造影管 先 后进入左右两侧颈总动 脉或颈内动脉 颈外动 脉和椎动脉 在DSA监视 下行全脑血管造影 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 1 评估患者心理状况 向病人及家属介绍脑血 管造影方法和意义 手 术的必要性和安全性 以解除思想顾虑和精神 紧张 必要时手术前夜口服安 定5mg 保证充足的睡 眠 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 2 了解病人既往史 有 无高血压 糖尿病 溃 疡等以及神经功能缺失 及日常生活活动能力情 况 掌握患者病变部位 手术方式 常见并发 症 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 3 查看有关实验室检查 血常规 肝肾功能 凝血四项 乙肝六项 心电图 全胸片等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 4 执行术前医嘱 为双 侧腹股沟及会阴部进行 备皮 清洗皮肤 指导 患者练习床上大小便 避免术后由于排便习惯 改变发生便秘 必要时 给予导尿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 5 术前做碘过敏试验 术中使用离子或非离造 影剂 以显示脑动脉狭 窄情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 6 术前禁食6h 禁饮4h 防止术中出现呕吐 有假牙者取出 防止脱 落滑入气管引起窒息 建立静脉通道 在插管 的对侧肢体建立留置针 通道 左手 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 7 术前肌注苯巴比妥 0 1g 以镇静催眠 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 8 测量双足背动脉搏动 情况 如强中弱 标记 足背动脉搏动点 做好 护理记录以便术后对照 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术前护理 9 遵医嘱口服药物 阿司匹林0 3g qd d 波立维 75mg qd d 尼莫同30mg bid d 连服3d Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 1 物品和药品准备 1 1物品准备 心电监护仪 氧气 负 压吸引器 各种型号的 动脉鞘 导丝 导引导 管 支架 球囊 保护 伞 压力泵等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 1 物品和药品准备 1 2药品准备 尼莫地平 罂粟碱 地 塞米松 阿托品 硝 普钠 盐酸多巴胺等 急救药品 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 2 体位 协助患者平卧于工作台 上 充分暴露经皮穿刺 部位 调整头部放置位 置 交待患者不宜挪动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 3 制动 术中制动非常重要 有 些患者不能控制自己 躁动不安而影响手术进 行 此时可遵医嘱适量 使用镇静剂 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 4 密切观察病情变化 予心电监护 密切观察生命体征 神志 瞳孔变化 以及肌力和语言情况尤其当支架放置成功后因血流 灌注改变而使血压升高 血管痉挛而致头痛等情况 及时汇报医生 对症处理 并做好记录 特别是 注射造影剂时 如出现面色苍白 呼吸急促 血压 下降 呕吐等提示药物过敏 应立即停止注射 配 合医生抢救 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 5 准备及时给药 术中需要全身血液肝素化 掌握时间及静脉给药 剂量要准确 患者发生病情变化时 按医嘱给药 术中需要生理盐水加压动脉鞘内持续滴入 观察压 力袋压力情况 压力低时及时加压 压力维持在 500 设立术中护理记录单 及时进行记录 尤其是记录 好肝素静脉推注时间 动脉鞘穿刺成功置入时间 以便提醒医师适时追加肝素及确定拔动脉鞘时间 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后护理 1 密切观察病情变化 持续心电监护24h左右 密切观察意识状态 生命体 征 神经功能的改变 支架 置入术患者带导管鞘回病房 观察鞘管固定是否良好 取仰卧位 头部不可过高 不可过度用力扭转 前屈 防止支架脱落 鼓励患者多 饮水 以利造影剂排泄 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后护理 2 注意穿刺口出血 穿刺部位血肿是血管内穿刺插 管最常见的合并症 出血量大 时 可引起压迫症状 术后应 严密观察穿刺部位有无渗血和 血肿 密切观察下肢末梢血运 情况是及早发现股动脉栓塞及 明确栓塞程度的重要依据 每 30 60分钟巡视病房1次 由于 术肢制动 保持平伸位 不能 屈髋 屈膝 患者可产生腰酸 劳累等改变 可进行按摩受压 部位 以缓解其不适 24h后撤 除绷带 穿刺局部换药一次 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 3 注意穿刺肢体动脉搏动 及色泽 由于术后病人需平 卧24h 拔管后穿刺局部加 压包扎12h 穿刺肢体伸直 禁止屈曲 故术后需严密观 察术侧足背动脉搏动及皮肤 色泽情况 测足背动脉半小 时一次 连续6次 经常询 问病人有无下肢疼痛现象 若术后足背动脉搏动较对侧 明显减弱和下肢疼痛明显 皮肤色泽发绀 提示下肢栓 塞可能 期间密切观察穿刺 部位有无淤血 周围皮肤有 无瘀斑及皮下血肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术中护理 4 饮食护理 术后即可进易消化清淡 饮食 但避免过饱 少食牛奶 鸡蛋等产气 食物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 并发症 1 脑出血 当病人发生头痛 呕吐 视神经乳头水肿 两慢 一高 即 脉搏缓慢洪 大 呼吸慢而深 血压 升高 言语不清 肢体 活动障碍等 提示并发 脑出血可能 应急查头 颅CT Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 并发症 2 急性血栓形成 斑块破裂后继发血栓形 成 如果是放支架的患 者支架在动脉中滞留 血小板沉积 纤维蛋白 的包裹很容易形成血栓 临床主要表现为意识 障碍 偏瘫 言语不清 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 并发症 3 过度灌注综合征 因动脉狭窄的解除 脑 血流动力学突然改变而 引起 主要表现为剧烈 头痛 呕吐 血压增高 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 并发症 4 穿刺部位出血 血肿 因拔管手法不当 压迫 时间过短 过早肢体活 动均可能导致穿刺部位 血肿或出血 一旦发现 血肿 应立即给予重新 包扎 止血治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 出院健康教育 1 生活规律 保证睡 眠 保持情绪稳定 合 理饮食 戒烟戒酒 告 知脑血管病发病征兆 若有不适 及时就诊 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 出院健康教育 2 注意饮食健康 低 盐饮食 每日盐量不超过 5g 多食蔬菜 水果 少食含胆固醇较高的食物 如蛋黄 动物内脏 猪油 等 食用含蛋白质丰富的 食物如瘦肉 鱼肉 豆制 品等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 出院健康教育 3 坚持服用医生所 开出的出院带药 定期监测 血压变 化 定期来院复诊 如出现头 痛 眩晕 偏瘫应 及时来院 就诊 L O G O Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 谢 谢
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本文标题:脑血管支架置入术围手术期护理绿色韩国春天漂亮模板课件_1
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