外科護(hù)理技能實(shí)訓(xùn) 課件 項(xiàng)目一 腸鏡

外科護(hù)理護(hù)理技能實(shí)訓(xùn)系列教材十二指腸鏡下膽總管取石術(shù)的護(hù)理目錄CONTENTS目的01準(zhǔn)備02實(shí)施03問題探究04........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【目的】1.減輕病人痛苦，減輕和避免各種并發(fā)癥。2.促進(jìn)病情康復(fù)。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【準(zhǔn)備】1.護(hù)士準(zhǔn)備衣帽整潔，七部洗手，戴無菌口罩。2.病人準(zhǔn)備向病人解釋、取得配合；安置舒適體位。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【準(zhǔn)備】3.用物準(zhǔn)備電子十二指腸鏡、X線機(jī)（C臂機(jī)）、造影管、乳頭切開刀、導(dǎo)絲、三腔取石氣囊、導(dǎo)絲引導(dǎo)式擴(kuò)張球囊、高頻電治療儀、取石網(wǎng)籃、鼻膽管及引流袋、吸氧裝置、吸痰管及負(fù)壓吸引器、監(jiān)護(hù)儀、搶救藥品及儀器、應(yīng)急碎石器等。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【準(zhǔn)備】4.環(huán)境準(zhǔn)備室內(nèi)空氣清潔，光線明亮，溫度適宜，符合無菌要求，有消毒隔離措施。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(1)心理評估(2)體位準(zhǔn)備(3)胃腸道準(zhǔn)備(4)呼吸道準(zhǔn)備(5)術(shù)前檢查(6)術(shù)前用藥(7)其他........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(1)心理評估全面評估病人的心理狀態(tài)，與病人進(jìn)行交流，建立融洽的關(guān)系，并向病人講解該治療的目的、優(yōu)勢、基本方法及安全性、注意事項(xiàng)及術(shù)后并發(fā)癥，消除病人顧慮，使病人能更好地配合治療，增強(qiáng)治療過程中自我應(yīng)付能力。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(2)體位準(zhǔn)備指導(dǎo)病人練習(xí)左側(cè)臥位和吞咽動作。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(3)胃腸道準(zhǔn)備術(shù)前1～2天開始流質(zhì)飲食，術(shù)前6～8小時禁飲禁食。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(4)呼吸道準(zhǔn)備術(shù)前戒煙至少2周，進(jìn)行深呼吸鍛煉。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(5)術(shù)前檢查評估心肺功能、凝血酶原時間、血小板計(jì)數(shù)和肝功能。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(6)術(shù)前用藥治療開始前指導(dǎo)病人口服咽部局麻藥，治療前半小時遵醫(yī)囑給予病人解痙、鎮(zhèn)痛和鎮(zhèn)靜藥物，以減少胃腸蠕動，松弛乳頭括約肌，聯(lián)合使用鎮(zhèn)痛藥，保持病人的耐受性。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】1.術(shù)前護(hù)理(7)其他?建立靜脈通道，于臀部或下肢貼好負(fù)極板?密切觀察病人生命體征變化?準(zhǔn)備造影劑備用（用藥前詢問過敏史、做碘過敏試驗(yàn)）?準(zhǔn)備好急救藥物。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】2.術(shù)中護(hù)理(1)再次核對，協(xié)助病人安置左側(cè)臥位(2)監(jiān)測心電圖、血壓、血氧飽和度等(3)給予持續(xù)鼻導(dǎo)管吸氧。(4)配合醫(yī)師準(zhǔn)確有效快速取出結(jié)石(5)留置了鼻膽引流管、胃腸減壓(6)術(shù)畢整理........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】2.術(shù)中護(hù)理(1)體位護(hù)理再次核對，協(xié)助病人安置左側(cè)臥位。(2)病情監(jiān)測監(jiān)測心電圖、血壓、血氧飽和度和全身情況。(3)吸氧給予持續(xù)鼻導(dǎo)管吸氧(2～4L/min)，以避免病人檢查時發(fā)生低氧血癥，減少呼吸和循環(huán)意外的發(fā)生。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】2.術(shù)中護(hù)理(4)操作配合?手術(shù)中配合醫(yī)師準(zhǔn)確有效快速地取出結(jié)石。?留置了鼻膽引流管、胃腸減壓。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】2.術(shù)中護(hù)理(5)術(shù)畢整理........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(1)術(shù)后觀察及護(hù)理(2)吸氧(3)活動與休息(4)飲食護(hù)理(5)鼻膽管護(hù)理(6)其他........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(1)術(shù)后觀察及護(hù)理觀察病人生命體征、腹部體征，有無黃疸、發(fā)熱，有無惡心、嘔吐、嘔血、黑便等消化道出血的癥狀，如出現(xiàn)不適應(yīng)密切觀察，并做相應(yīng)的處理。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(2)吸氧手術(shù)后吸氧2～3小時。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(3)活動與休息手術(shù)后需臥床休息2～3天，注意保暖，避免著涼。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(4)飲食護(hù)理?手術(shù)后需禁食，排氣后可進(jìn)少量流質(zhì)，胃腸道功能恢復(fù)后逐漸恢復(fù)流食，6～8日后恢復(fù)普通飲食。?禁食和少量飲食期間應(yīng)從靜脈供給水、電解質(zhì)和營養(yǎng)物質(zhì)。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(5)鼻膽管護(hù)理?觀察引流液的顏色、性狀及量。?術(shù)后病人放置鼻膽管后應(yīng)于體外妥善固定導(dǎo)管，以防意外脫出，固定在鼻翼側(cè)、頰部和床旁，避免逆行感染。?保持管道有效的引流，動態(tài)觀察引流量，若引流量減少或無膽汁引出，應(yīng)疑為導(dǎo)管堵塞、脫出或扭曲打折，經(jīng)X線透視證實(shí)，予以沖洗確保通暢或重新置管。?置管期間注意維持水電解質(zhì)和酸堿的平衡，做好口腔護(hù)理。........................................................................................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理01【實(shí)施】3.術(shù)后護(hù)理(7)其他根據(jù)病情應(yīng)用抗生素及止血藥。..............................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理05【問題探究】1.如何警惕手術(shù)后胰腺炎發(fā)作？2.手術(shù)后何時拔除鼻膽管？..............................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理05【問題探究】1.如何警惕手術(shù)后胰腺炎發(fā)作？答：手術(shù)后24小時內(nèi)要進(jìn)行血、尿淀粉酶及脂肪酶檢查，警惕手術(shù)后胰腺炎發(fā)作，給予禁食、胃腸減壓，抑制胰液分泌治療。..............................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理05【問題探究】2.手術(shù)后何時拔除鼻膽管？答：取石術(shù)后置鼻膽引流管，臨床癥狀改善，各種指標(biāo)恢復(fù)正常3天后，給病人進(jìn)行鼻膽管造影，若未見明顯結(jié)石影即可拔除引流管，若有殘余結(jié)石，可以通過十二指腸鏡再次取出膽總管結(jié)石。..............................................................................十二指腸鏡下膽總管取石術(shù)的護(hù)理05【問題探究】3.如何做好術(shù)中護(hù)理？答：護(hù)士要熟悉手術(shù)的每一個步驟和手術(shù)者的操作習(xí)慣，密切配合，盡量縮短操作時間，減輕病人痛苦；術(shù)中應(yīng)及時吸凈病人口腔分泌物，避免引起窒息、吸入性肺炎等。若術(shù)中出現(xiàn)呼吸抑制、血壓下降、嗆咳、嘔吐、躁動等特殊情況，要及時終止操作并做相應(yīng)處理。感謝您的聆聽THANKYOUFORLISTENING外科護(hù)理護(hù)理技能實(shí)訓(xùn)系列教材B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理目錄CONTENTS目的01準(zhǔn)備02實(shí)施03問題探究04............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【目的】1.觀察病情變化及傷口愈合情況。2.減輕病人痛苦，減輕和避免各種并發(fā)癥。3.促進(jìn)傷口愈合。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【準(zhǔn)備】

1.護(hù)士準(zhǔn)備衣帽整潔，七部洗手，戴無菌口罩。

2.病人準(zhǔn)備向病人解釋、取得配合；安置舒適體位；必要時遵醫(yī)囑用鎮(zhèn)靜劑或止痛劑。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【準(zhǔn)備】

3.用物準(zhǔn)備組織活檢穿刺針（針芯內(nèi)有一“活塞”，可防止組織被吸入注射器內(nèi)發(fā)生破碎），針上另有一套可以控制穿刺深度的套管、10%福爾馬林液1小瓶（5ml）、無菌洞巾、75％乙醇或碘伏棉球、無菌敷料、膠布、快速手消毒液、按醫(yī)囑準(zhǔn)備局麻、鎮(zhèn)靜、鎮(zhèn)痛、解痙藥物。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【準(zhǔn)備】

4.環(huán)境準(zhǔn)備室內(nèi)空氣清潔，光線明亮，溫度適宜，符合無菌要求，有消毒隔離措施。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(1)心理評估(2)術(shù)前訓(xùn)練(3)飲食護(hù)理(4)術(shù)前檢查(5)術(shù)前備血............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(1)心理評估全面評估病人的心理狀態(tài)，與病人進(jìn)行交流，建立融洽的關(guān)系，并向病人講解該治療的目的、優(yōu)勢、基本方法及安全性、注意事項(xiàng)及術(shù)后并發(fā)癥，消除病人顧慮，使病人能更好地配合治療，增強(qiáng)治療過程中自我應(yīng)付能力。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(2)術(shù)前訓(xùn)練?術(shù)前指導(dǎo)病人進(jìn)行屏氣動作訓(xùn)練，以配合操作。?術(shù)前指導(dǎo)病人練習(xí)床上使用便盆和尿壺，保證術(shù)后能絕對臥床休息。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(3)飲食護(hù)理術(shù)前一天進(jìn)食低脂食物，術(shù)前4～6小時禁食。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(4)術(shù)前檢查?評估心肺功能、凝血酶原時間、血小板計(jì)數(shù)和肝功能。?有出血傾向者遵醫(yī)囑給予維生素K1注射3天，待出血傾向糾正后再行手術(shù)。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】1.術(shù)前護(hù)理(5)術(shù)前備血遵醫(yī)囑術(shù)前備血。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(1)體位護(hù)理(2)心理護(hù)理(3)操作配合(4)術(shù)畢整理............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(1)體位護(hù)理再次核對，協(xié)助病人安置相應(yīng)的體位，一般取仰臥位或稍向左側(cè)臥位，雙手或右手置于枕后或頭頂。暴露穿刺部位。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(2)心理護(hù)理守候在病人身旁，隨時了解病人有無不適，注意分散病人的注意力，同時要給予心理安慰和支持。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(3)操作配合?指導(dǎo)病人保持平穩(wěn)呼吸，避免深呼吸，遵醫(yī)囑屏氣?配合醫(yī)生通過B超檢查，確定穿刺點(diǎn)、穿刺方向和深度。一般選在腋前線或腋中線第8～9肋間............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(3)操作配合?配合醫(yī)生進(jìn)行穿刺點(diǎn)常規(guī)消毒、鋪巾?配合醫(yī)生行穿刺點(diǎn)局部浸潤麻醉............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(3)操作配合?將標(biāo)本放入固定液后送檢?穿刺部位覆蓋無菌敷料，腹帶加壓包扎至少6小時............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】2.術(shù)中護(hù)理(4)術(shù)畢整理?及時整理病人衣物，注意保暖?床單位整理，病人轉(zhuǎn)運(yùn)?用物整理............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】3.術(shù)后護(hù)理(1)術(shù)后觀察(2)飲食護(hù)理(3)穿刺部位護(hù)理(4)其他............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】3.術(shù)后護(hù)理(1)術(shù)后觀察平臥4～6小時，臥床休息24小時，避免增加腹壓。嚴(yán)密觀察生命體征和腹部體征，及早發(fā)現(xiàn)和處理出血、膽汁腹膜炎等并發(fā)癥。............................................................................................................................B超引導(dǎo)下肝穿刺活檢術(shù)的護(hù)理02【實(shí)施】3.術(shù)后護(hù)理(2)飲食護(hù)理術(shù)后禁食禁飲2小時。指病人進(jìn)食低脂食物，宜少量多餐，食物應(yīng)富含維生素及優(yōu)質(zhì)蛋白，避免高脂飲食。................................................................................................