常見(jiàn)癥狀皮膚黏膜出血課件

匯報(bào)人：xxx20xx-03-15常見(jiàn)癥狀皮膚黏膜出血ppt課件目錄皮膚黏膜出血概述皮膚黏膜出血相關(guān)疾病皮膚黏膜出血的鑒別診斷皮膚黏膜出血的治療與預(yù)防皮膚黏膜出血的并發(fā)癥及處理皮膚黏膜出血的病例分享與討論01皮膚黏膜出血概述皮膚黏膜出血是因機(jī)體止血或凝血功能障礙所引起，導(dǎo)致全身性或局限性皮膚黏膜自發(fā)性出血或損傷后難以止血。定義根據(jù)出血范圍和嚴(yán)重程度，可分為瘀點(diǎn)、紫癜、瘀斑和血腫等類(lèi)型。分類(lèi)定義與分類(lèi)如遺傳性出血性毛細(xì)血管擴(kuò)張癥、過(guò)敏性紫癜等，導(dǎo)致血管壁通透性增加或脆性增高。血管壁異常血小板異常凝血功能障礙如血小板減少性紫癜、血小板無(wú)力癥等，影響血小板的數(shù)量或功能，導(dǎo)致止血功能障礙。如血友病、維生素K缺乏癥等，導(dǎo)致凝血因子缺乏或活性降低，影響凝血過(guò)程。030201發(fā)病原因及機(jī)制以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書(shū)書(shū)寫(xiě)制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.臨床表現(xiàn)瘀點(diǎn)、紫癜、瘀斑等皮膚黏膜出血表現(xiàn)，嚴(yán)重者可出現(xiàn)血腫、關(guān)節(jié)腔出血等。診斷依據(jù)結(jié)合病史、體格檢查和實(shí)驗(yàn)室檢查，如血常規(guī)、凝血功能檢查等，綜合分析判斷。同時(shí)，需排除其他可能導(dǎo)致皮膚黏膜出血的疾病，如肝病、腎病等。臨床表現(xiàn)與診斷依據(jù)02皮膚黏膜出血相關(guān)疾病病因癥狀診斷治療血小板減少性紫癜血小板生成減少、破壞過(guò)多或分布異常導(dǎo)致皮膚、黏膜出血血常規(guī)檢查血小板減少，骨髓檢查可確診皮膚瘀點(diǎn)、瘀斑，鼻出血，牙齦出血等糖皮質(zhì)激素、免疫抑制劑、脾切除等機(jī)體對(duì)某些致敏物質(zhì)產(chǎn)生變態(tài)反應(yīng)，導(dǎo)致毛細(xì)血管脆性及通透性增加病因皮膚紫癜、關(guān)節(jié)腫痛、腹痛、便血等癥狀根據(jù)典型癥狀及過(guò)敏原檢測(cè)可確診診斷抗過(guò)敏藥物、糖皮質(zhì)激素、免疫抑制劑等治療過(guò)敏性紫癜常染色體顯性遺傳，血管壁結(jié)構(gòu)異常導(dǎo)致皮膚、黏膜出血病因癥狀診斷治療皮膚、黏膜多發(fā)性毛細(xì)血管擴(kuò)張，反復(fù)鼻出血等根據(jù)家族史、典型癥狀及實(shí)驗(yàn)室檢查可確診對(duì)癥治療，如止血、補(bǔ)充鐵劑等，嚴(yán)重者可考慮手術(shù)治療遺傳性出血性毛細(xì)血管擴(kuò)張癥遺傳性凝血因子缺乏導(dǎo)致的出血性疾病，表現(xiàn)為關(guān)節(jié)、肌肉、內(nèi)臟等深部zu織出血血友病多種疾病導(dǎo)致的凝血功能障礙綜合征，表現(xiàn)為全身多部位出血、休克等彌散性血管內(nèi)凝血（DIC）血管性血友病因子缺乏或異常導(dǎo)致的出血性疾病，表現(xiàn)為皮膚、黏膜出血傾向增加血管性血友病某些藥物導(dǎo)致的皮膚、黏膜出血，如抗凝藥物、抗血小板藥物等。藥物性紫癜其他相關(guān)疾病03皮膚黏膜出血的鑒別診斷與類(lèi)似癥狀的鑒別瘀點(diǎn)、瘀斑與皮膚黏膜出血類(lèi)似，但瘀點(diǎn)和瘀斑一般不高出皮面，壓之不褪色，多發(fā)生于下肢及軀干部位的皮膚黏膜。皮疹皮疹也可表現(xiàn)為皮膚黏膜的出血點(diǎn)或瘀斑，但皮疹常伴有瘙癢、疼痛等癥狀，且壓之可褪色。血管痣血管痣也可表現(xiàn)為皮膚黏膜的小紅點(diǎn)，但其形態(tài)較為規(guī)則，壓之可褪色，且一般不會(huì)自行消失。ABCD實(shí)驗(yàn)室檢查與輔助檢查血常規(guī)通過(guò)血常規(guī)檢查可以了解血小板數(shù)量及功能、凝血因子等情況，有助于判斷出血原因。骨髓檢查對(duì)于懷疑有造血系統(tǒng)疾病的患者，可以進(jìn)行骨髓檢查以明確診斷。尿常規(guī)尿常規(guī)檢查可以了解有無(wú)泌尿系統(tǒng)出血的情況。影像學(xué)檢查如B超、CT、MRI等影像學(xué)檢查，有助于了解出血部位及原因。診斷標(biāo)準(zhǔn)根據(jù)患者的病史、癥狀、體征及實(shí)驗(yàn)室檢查結(jié)果，綜合判斷患者是否符合皮膚黏膜出血的診斷標(biāo)準(zhǔn)。診斷流程首先詢(xún)問(wèn)病史并觀察癥狀，然后進(jìn)行體格檢查和實(shí)驗(yàn)室檢查，最后根據(jù)檢查結(jié)果綜合分析并作出診斷。在診斷過(guò)程中，需要與類(lèi)似癥狀進(jìn)行鑒別診斷，以排除其他疾病的可能性。診斷標(biāo)準(zhǔn)及流程04皮膚黏膜出血的治療與預(yù)防03遺傳性出血性毛細(xì)血管擴(kuò)張癥加強(qiáng)ju部護(hù)理，避免創(chuàng)傷和感染，可考慮激光治療。01血小板減少性紫癜首選糖皮質(zhì)激素治療，無(wú)效者可考慮脾切除或免疫抑制劑治療。02過(guò)敏性紫癜避免接觸過(guò)敏原，應(yīng)用抗過(guò)敏藥物，必要時(shí)使用糖皮質(zhì)激素。針對(duì)不同病因的治療方案包括促進(jìn)凝血因子活性藥物、抑制纖維蛋白溶解藥物、血管收縮藥物等。止血藥物應(yīng)在醫(yī)生指導(dǎo)下使用，注意藥物劑量和使用時(shí)間，避免濫用和不良反應(yīng)。止血藥物的應(yīng)用及注意事項(xiàng)注意事項(xiàng)止血藥物種類(lèi)加強(qiáng)鍛煉，提高身體素質(zhì)和免疫力。均衡飲食，增加富含維生素C和K的食物攝入。避免接觸過(guò)敏原和創(chuàng)傷，注意個(gè)人衛(wèi)生。保持良好心態(tài)，避免過(guò)度勞累和情緒波動(dòng)。預(yù)防措施與生活習(xí)慣調(diào)整05皮膚黏膜出血的并發(fā)癥及處理皮膚黏膜出血可能導(dǎo)致ju部破損，增加細(xì)菌、病毒等病原體侵入的風(fēng)險(xiǎn)，從而引發(fā)感染。感染風(fēng)險(xiǎn)保持皮膚清潔干燥，避免破損部位接觸污染物；如有感染跡象，及時(shí)使用抗生素等藥物治療。預(yù)防措施感染風(fēng)險(xiǎn)及預(yù)防措施貧血原因皮膚黏膜長(zhǎng)期或大量出血可能導(dǎo)致失血性貧血，影響患者健康。糾正與治療根據(jù)貧血程度，給予患者補(bǔ)充鐵劑、葉酸、維生素B12等造血原料；嚴(yán)重貧血者，可考慮輸血治療。貧血的糾正與治療心理壓力的緩解與支持心理壓力皮膚黏膜出血可能影響患者外觀，導(dǎo)致焦慮、抑郁等心理問(wèn)題。緩解與支持給予患者心理安慰和支持，幫助其建立積極心態(tài)；如心理問(wèn)題