危重患者护理常规

危重患者护理常规 一、 危重病人基础护理常规 二、 昏迷患者护理常规 三、 休克患者护理常规 四、 气管切开患者护理常规 五、 气管插管患者护理常规 六、 使用呼吸机患者护理常规 七、 深静脉置管患者护理常规 八、 腹部外伤性多脏器损伤护理常规 九、 上消化道大出血护理常规 十、 呼吸衰竭护理常规 十一、 心力衰竭护理常规 十二、 急性肾衰竭护理常规 一、危重病人基础护理常规 ? 热情接待病人，将病人安置于抢救室或重症病房，保持室内空气新鲜、温、湿度适宜;做好病人及家属的入院(科)宣教。 ? 及时评估: 包括基本情况、主要症状、皮肤情况，阳性辅助检查，各种管道，药物治疗情况等。 ? 急救护理措施:快速建立静脉通道，(视病情及药物性质调整滴速)，吸氧(视病情调整用氧流量)，心电监护，留置导尿，保暖， 1 做好各种标本采集，协助相应检查，必要时行积极术前准备等。 ? 卧位与安全 ?根据病情采取合适体位。 ?保持呼吸道通畅，对昏迷病人应及时吸出口鼻及气管内分泌物，予以氧气吸入。 ?牙关紧闭、抽搐的病人可用牙垫、开口器，防止舌咬伤、舌后缀。 ?高热、昏迷、谵妄、烦躁不安、年老体弱及婴幼儿应加用护栏，必要时给予约束带，防止坠床，确保病人安全。 ?备齐一切抢救用物、药品和器械，室内各种抢救设置备用状态。 ?严密观察病情，专人护理，对病人生命体征、神志、瞳孔、出血情况、SpO2、CVP、末梢循环及大小便等情况进行动态观察，配合医生积极进行抢救，做好护理记录。 ?遵医嘱给药，实行口头医嘱时，需复述无误方可使用。 ?保持各种管道通畅，妥善固定，安全放置，防止脱落、扭曲、堵塞，严格无菌技术，防止逆行感染。 ?保持大小便通畅:有尿潴留者采取诱导以助排尿，必要时导尿、便秘者视病情予以灌肠。 ?视病情予以饮食护理:保持水、电解质平衡及满足机体对营养的基本需求，禁食病人可予以外周静脉营养。 ?基础护理 ?做好三短九洁、五到床头(三短:头发、胡须、指甲短;九洁:头发、眼、身、口、鼻、手足、会阴、肛门、皮肤清洁;五到床头:医、 2 护、饭、药、水到病人床头)。 ?晨、晚间护理每日2 次;尿道口护理每日2 次;气管切开护理每日2 次;注意眼的保护。 ?保持肢体功能，加强肢体被动活动或协助主动活动。 ?做好呼吸咳嗽训练，每2h 协助病员翻身、拍背、指导作深呼吸，以助分泌物排出。 ?加强皮肤护理，预防压疮。 ?心理护理:及时巡视、关心病人，据情作好与家属沟通，建立良好护患关系，以取得病人信任、家属的配合和理解。 二、昏迷患者护理常规 ?观察要点 ?严密观察生命体征(T、P、R、B)、瞳孔大小、对光反应。 ?评估GLS 意识障碍指数及反应程度，了解昏迷程度，发现变化立即医生。 ?观察患者水、电解质的平衡，记录24h 出入量，为指导补液提供依据。 ?注意检查患者粪便，观察有无潜反应。 ?护理要点 ?呼唤患者:操作时，首先要呼唤其姓名，解释操作的目的及注意事项。 ?建立并保持呼吸道通畅:取侧卧位头偏向一侧，随时清除气管内分泌物，备好吸痰用物，随时吸痰。 3 ?保持静脉输液通畅:严格记录所用药物及量。 ?保持肢体功能位:定期给予肢体被动活动与按摩，预防手足挛缩、变形及神经麻痹。 ?促进脑功能恢复:抬高床头30-45 度或给予半卧位姿势，遵医嘱给予药物治疗和氧气吸入。 ?维持正常排泄功能:定时检查患者膀胱有无尿潴留，按时给予床上便器，协助按摩下腹部促进排尿，导尿者或更换尿袋时应注意无菌技术。 ?维持清洁与舒适:取出义齿、发卡，修剪指(趾)甲;每日进行口腔护理两次，保持口腔清洁湿润，可涂石蜡油，唇膏，防止唇裂，定时进行床上檫浴和会阴冲洗，更换清洁衣服。 ?注意安全:躁动者应加床档，若出现极度躁动不安者，适当给予约束，意识障碍伴高热抽搐、脑膜刺激征时，应给予有效降温并放置牙垫，防止咬伤舌颊部，固定各种管路避免滑脱。 ?预防肺部感染:定时翻身拍背，刺激患者咳嗽，及时吸痰，注意保暖，避免受凉,使用热水袋时水温不易超过50 度，不能直接接触皮肤，防止烫伤。 ?预防压疮:使用气垫床，骨突出部分加用海绵垫，保持床单位整洁、平整。每1-2h 翻身一次。 ?眼部护理:摘除隐形眼镜交家属保管。患者眼睑不能闭合时，定时用生理盐水檫洗眼部，用眼药膏或凡士林油纱保护角膜，预防角膜干燥及炎症。 4 ?健康教育 ?取得家属配合，指导家属对患者进行相应的意识恢复训练，帮助患者肢体被动活动与按摩。 ?心理护理:关心鼓励患者，使患者认识到自己在家庭和社会中存在价值，以增加战胜疾病信心。 三、休克患者护理常规 ?观察要点 ?严密观察生命体征(T、P、R、BP)、心率、氧饱和度的变化，观察有无呼吸浅快、脉搏细速、心率增快、脉压减小〈20mmHg、SBP 降至〈90mmHg 以下或较前下降20-30mmHg、氧饱和度下降等现。 ?严密观察患者意识状态，(意识状态反映大脑组织血液灌注情况)，瞳孔大小和对光反射，是否有兴奋、烦躁不安或神志淡漠、反应迟钝、昏迷等表现。 ?密切观察患者皮肤颜色、色泽，有无出汗、苍白、皮肤湿冷、花斑、紫绀等表现。 ?观察中心静脉压(CVP)的变化。 ?严密观察每小时尿量，是否?30 ml/h;同时注意尿比重的变化 ?注意观察电解质、血常规、血气、凝血功能及肝肾功能等检查结果的变化，以了解患者其他重要脏器的功能。 ?密切观察用药治疗后的效果及是否存在药物的不良反应。 ?护理要点 ?取平卧位或休克卧位，保持病房安静。 5 ?迅速建立静脉通道，保证及时用药。根据血压情况随时调整输液速度，给予扩容及血管活性药物后血压不升时作好配血、输血准备。 ?做好一切抢救准备，严密观察病情变化，行心电、呼吸、血压、血氧等监护。 ?需要时配合医生尽可能行深静脉穿刺术，以便抢救用药，随时监测CVP。若无条件做深静脉穿刺，应注意大剂量的血管活性药物对患者血管的影响，避免皮肤坏死。 ?保持呼吸道通畅:采用面罩或麻醉机给予较高流量的氧气吸入，以改善组织器官的缺氧、缺血及细胞代谢障碍。当呼吸衰竭发生时?应立即准备行气管插管?给予呼吸机辅助呼吸。对实施机械辅助治疗的按相关术后护理常规护理。 ?留置导尿，严密测量每小时尿量，准确记录24h 出入量，注意电解质情况，做好护理记录。 ?保持床单位清洁、干燥，注意保暖，做好口腔护理，加强皮肤护理?预防压疮。 ?做好各种管道的管理与护理，预防各种感染。 ?病因护理，积极配合医生治疗原发病，按其不同病因进行护理。 ?做好患者及家属的心理疏导。 ?严格交接班:交接班时要将患者的基础疾病、诊治经过、药物准备情况、患者目前情况、特殊医嘱和注意事项等详细进行交接班每班要详细记录护理记录。 ?指导要点 6 ?进行心理指导，使患者及家属克服对疾病的恐惧感。 ?指导患者及家属对诱发休克出现的疾病进行预防。 ?指导患者按时服药，定期随诊。 四、气管切开患者护理常规 ?观察要点 ?注意倾听患者主诉，严密观察患者生命体征、神志、瞳孔、SpO2 变化，特别是气管切开，术后三天的患者应重点加强巡视，床旁应备气管切开包。 ?观察气管分泌物的量及性状。 ?观察缺氧症状有无改善 ?严密监测有无并发症的发生，如出血、气胸、纵隔气肿、皮下气肿等。 ?护理要点 ?环境要求:病室空气新鲜，定时通风，保持室温22-24 度左右，相对湿度60%。 ?仪表要求，工作人员在护理患者时要严格无菌操作，洗手、带口罩、戴手套。 ?正确吸痰:防止感染? ?首先要掌握好恰当的吸痰时机:一般是在床旁听到患者咽喉部有痰鸣音，患者出现咳嗽或呼吸机气道压力升高有报警，发现氧饱和度突然下降等情况时给予吸痰。 ?先将吸痰管插入气道超过内套管1-2cm，再开启吸痰负压，左右旋 7 转边退边吸，切忌在同一部位长时间反复提插式吸痰，吸痰负压不能过大，以防损伤患者气道粘膜，吸引时间一次不超过15 秒。 ?吸痰前后应充分给氧:吸痰管吸一次换一根，顺序为气道、口腔、鼻腔。 ?遵医嘱配置气道湿化液:每24 小时更换一次，气管内滴入水份约200ml/日左右，平均每小时约10ml，可在每次吸痰前后给予。 ?手术创面的护理:在贴皮肤面以油纱布覆盖，常规每日在严格无菌操作下更换敷料两次并注意观察切口愈合情况，有无感染等征象及分泌物颜色，切口感染后分泌物多呈草绿色或铜绿色，一旦出现应及时进行分泌物培养，以便指导临床用药。 ?使用带气囊的气管导管时，要随时注意气囊压力，防止漏气。 ?每日检查套管固定是否牢靠，套管采用双带打手术结法固定，松紧以能容一指为度。随时调节呼吸机支架，妥善固定呼吸机管道，使气管套管承受最小牵拉，防止牵拉过度致导管脱出。 ?保持内套管通畅:(金属导管);是术后护理的关键。取出内套管的方法是，左手按住外套管，右手转开管上开关后取出，以防将气管套管全部拔出。 ?维持下呼吸道通畅:保持室内温度和湿度，有条件者可用蒸汽吸入疗法。 ?保持口腔清洁、无异味，口腔护理每日两次。 ?拔管:对于原发病以痊愈或减轻，喉梗已解除，作拔管准备工作——试行堵管，可先堵1/3-1/2，观察有无呼吸困难现象，观察24 小时 8 呼吸通畅，可行完全性堵管，观察24-48 小时后拔管。对于因非喉部疾病行气管切开者，如无气管插管等喉部可能损伤的病史者，可于呼吸功能衰竭纠正后直接全堵管进行观察，并于24 小时后拔管。拔管1-2天内应严密观察。 ?指导要点 ?吸痰前应与患者进行有效的沟通，减少患者的焦虑和紧张。 ?佩带气管套管出院者，应告之患者及家属? ?不可取出外套管，注意固定带是否固定牢固，以防套管滑出发生意外。 ?沐浴时防止水渗入气管套管内，教会患者及其家属清洁消毒内套管的方法，告诉患者气管切开术迟发性并发症的症状和体征。 五、气管插管患者护理常规 ?观察要点 ?严密观察患者生命体征、神志、瞳孔、SpO2 变化。 ?注意观察导管插入的深度。 ?观察气管分泌物的性质、颜色。 ?拔管后的观察??严密观察病情变化?监测心率、血压、血氧饱和度，观察呼吸道是否通畅，呼吸交换量是否足够，皮肤黏膜色泽是否红润，同时遵医嘱行血气分析;?观察有无喉头水肿、黏膜损伤等情况?发现异常及时通知医生处理。 ?护理要点 ?环境要求:病室空气新鲜，定时通风，保持室温22-24 度左右，相 9 对湿度60%。 ?仪表要求:工作人员在护理患者时要严格无菌操作，洗手、带口罩、戴手套。 ?无论是经鼻腔或口腔插管均应注意固定牢固，做好标记，防止口腔插管时牙垫脱落，注意导管插入的深度及插管与头颈部的角度。 ?气囊管理:定时监测气囊压力，在给气囊放气前或拔除导管前必须清除气囊上滞留物。 ?保持气管插管通畅:及时有效的进行气管内吸痰，吸痰管吸一次换一根，顺序为气道、口腔、鼻腔、吸痰前后应充分给氧，一次吸痰时间不超过15 秒，吸痰过程中出现气管痉挛、紫绀、躁动不安等情况应停止吸痰，立即通知医生处理。 ?根据患者的病情:遵医嘱给予适量的止疼药或镇静药。 ?气道湿化:人工气道建立后，上气道的湿化、温化功能缺失，易导致痰液潴留、结痂等并发症应加强气道湿化，遵医嘱配置气道湿化液，每24 小时更换一次，气管内滴入水份约200ml/日左右.平均每小时约10ml，可在每次吸痰前后给予。 ?保持气管插管局部清洁:固定气管插管的胶布如被污染应立即更换?每天做口腔护理两次。 ?经鼻或经口插管拔管方法:? ?原发病治愈应适时拔管，并向患者做好解释，取得患者合作? ?如无禁忌症，以床头抬高30 度以上为宜，以减少返流和误吸? ?吸引气管插管以上及经口腔排出堆积在套囊以上的分泌物，因其在 10 套囊放气后可被吸入到下呼吸道。? ?吸入高浓度氧数分钟，每分4~6L，将套管内气体放出? ?将吸痰管放入气管插管略超过其长度，边吸痰边拔管，以防积存在气管内套管周围的分泌物被误吸? ?拔管时在呼气相将导管拔除，以便拔管后第一次呼吸是呼出气体?以免咽部分泌物吸入? ?一旦导管拔除后，将患者头转向一侧，防止口腔内分泌物误吸入气道? ?拔管应尽量在白天进行，以便观察病情与及时处理拔管后发生的合并症。 ?拔管后的护理? ?以口鼻、面罩吸氧，以保证安全? ?4 小时内禁食，因为此时声门关闭功能及气道反射功能不健全? ?禁止使用镇静剂，因在拔管后如有烦躁可能是缺氧的表现? ?予定时翻身、排背、鼓励患者咳嗽、咯痰。 ?指导要点 ?做好患者及家属的心理护理，消除焦虑恐惧感。 ?吸痰前应与患者做好有效的沟通交流，减少患者的焦虑和紧张。 ?为减少气囊对气管壁的压力，在充气时可采用两种方法，最小漏气技术，(MLT)或最小闭合容积技术(MOV)。 ?拔除导管前必须使用气囊上滞留物清除技术。 ?拔管后鼓励患者主动咳嗽、咯痰。 11 * 最小漏气技术 ?套囊充气后吸气时容许不超过50 毫升的气体从套囊与气管壁间的空隙漏出。先把套囊注气至吸气时无气体漏出，然后以0.1 毫升/次进行套囊放气，直到吸气时有少量气体漏出为止。 * 最小闭合容积技术;套囊充气后刚好吸气时无气体漏出。先把套囊注气至吸气时无气体漏出，然后以0.1 毫升/次进行套囊放气，听到漏气声后向套囊内注气0.1 毫升/次，无漏气即可。 六、使用呼吸机患者护理常规 ?观察要点 ?观察神志、瞳孔、心率、血压、SpO2 变化? ?评估患者的面色，肢体活动，自主呼吸的力量;注意呼吸频率、节律、深浅度及自主呼吸与呼吸机辅助呼吸的配合情况。 ?观察呼吸机工作是否正常，了解呼吸机报警原因，及时通知医生处理。 ?每日行动脉血气分析，了解pH、PaO2、PaCO2 的变化，根据变化调整呼吸机参数。发现酸、碱中毒时，及时对症处理。 ?观察痰量及性状，了解有无肺部感染或肺水肿等。 ?护理要点 ?保持管道连接紧密，各种导线、传感线无松脱，确认呼吸机工作状态。预设潮气量(VT)6-8ml/kg，频率(RR)16-20 次/分，吸/呼比(I:E)1:1.5-2，吸入氧浓度(FiO2):40%-60%。 ?向清醒患者及家属解释使用呼吸机的目的，取得合作，消除恐惧心理。 12 ?保持气道通畅:及时吸痰，吸痰前后要予以3min 纯氧吸入，以防止吸痰造成的低氧血症，并妥善固定气管内插管或气管套管，严格无菌操作。 ?呼吸机通气过度可导致血压下降，未经医生同意护士不可任意调节呼吸机参数。 ?保持湿化罐内无菌蒸馏水或注射用水于正常刻度范围内。保持吸入气体温度在32-34?。 ?保持呼吸机管路中的集水杯方向向下，且处于最低点，以免集水阻塞管路或流入患者气道内或返流入湿化罐。勤倒集水杯内集水。 ?呼吸机管道一人一换，长期带机患者应每周更换。每周冲洗呼吸机上的过滤网。 ?呼吸机管道和人工气道加接螺纹管，以免牵拉刺激引起气道损伤和人工气道脱出。 ?注意患者体位的舒适度，避免人工气道与患者气管成角，避免人工气道扭曲、折迭、滑出或接头松脱。 ?有心血管功能不良、血容量不足、高龄、原有低血压、易导致低血压，应采取相应措施，维持循环稳定。 ?胸部物理治疗每4 小时一次。 ?遵医嘱使用镇静剂，并在护理记录上准确记录用法用量及患者用药后状况。 ?呼吸机旁备简易人工呼吸器，如遇呼吸机功能丧失或停电，先将氧气管与简易人工呼吸器相连，按操作程序先用气囊通气，直至问题解 13 决。 ?心理护理 ?呼吸机通气支持的患者:由于本身病情危重，加上环境的陌生及呼吸机带来的异常声响、交流障碍、舒适改变等，易出现焦虑、恐惧及不合作等心理问题，部分患者在呼吸机治疗过程中会出现呼吸机心理依赖问题。 ?重视患者的心理问题理解与疏导，让患者熟悉病房环境，了解呼吸机治疗的目的及配合方法，建立护患之间有效的沟通交流方式，可备纸笔或写字板等非语言交流形式，鼓励患者主动加强自主呼吸，争取早日脱机。 ?指导要点 ?患者发生缺氧和呼吸困难时，如不能马上找到原因，应立即脱开呼吸机，用简易人工呼吸器辅助通气。 ?注意保持湿化器中蒸馏水量，并及时清理呼吸机管道中的积水。 ?吸痰前应与患者进行有效的沟通，减少患者的焦虑和紧张。 七、深静脉置管患者护理常规 ?观察要点 ?观察置管的长度、时间。 ?观察局部皮肤有无红、肿、渗液、分泌物等感染征象。 ?观察患者生命体征变化，注意有无寒战高热等全身感染征象。 ?护理要点 ?保持穿刺点皮肤的清洁、干燥，每日换药一次，疑有污染随时更换。 14 ?妥善固定导管，导管各连接处用无菌纱布包裹，防止脱落。 ?深静脉测压通道连接专用延长管和三通，禁止连接头皮针、肝素帽。输液通路连接处尽量少用头皮针和肝素帽，一个肝素帽最多插头皮针2-3 根，肝素帽3-5 天更换一次，每次输液完毕，不需维持通道者用肝素液和生理盐水脉冲式正压封管。 ?及时更换液体，测压后及时打开输液通道，以避免血液回流引起导管堵塞。 ?血管活性药物应单通道泵入，连接专用微泵延长管在深静脉管近端防止速度过快或过慢，影响药物疗效，如需快速输液、输血应直接连接三通，TPN、血液制品、普通液体不能在同一静脉通道输入。 ?拔除导管后按压穿刺点5 分钟，防止出现局部血肿，用消毒液消毒局部，并用无菌敷料覆盖24 小时以上。 ?指导要点 若深静脉导管被血凝块堵塞不通或呈半通状态，立即用空针向外抽吸，切勿将血凝块冲入血管内，否则易导致血栓栓塞，若回抽不通，应拔除导管。 八、腹部外伤性多脏器损伤护理常规 ?观察要点 ?严密监测患者意识情况P、R、BP、CVP、尿量、肢体温度、颜色?注意有无休克的表现。 ?观察气道是否通畅，注意呼吸的形态及频率。 ?观察腹痛的特征、无腹膜刺激症，判断是实质脏器损伤还是空腔脏 15 器损伤。 ?观察患者的体位及局部软组织损伤、肢体活动情况。 ?护理要点 ?保持呼吸道通畅:清除呼吸道分泌物及异物，吸氧，必要时行气管插管或气管切开，予以人工呼吸。 ?迅速补充血容量:快速建立静脉通道2-3 条，以上肢静脉为宜1 路扩容输血输液、1路滴注或推注各种药物，必要时行深静脉置管。 ?体位:抬高下肢15?-20?，合并休克者，取休克卧位，抬高头胸部10?-20?抬高下肢20?-30??。 ?遵医嘱立即行备皮、皮试、合血、导尿、胃肠减压等，协助做好术前准备。 ?术后护理? ?体位:根据麻醉方式，采取必要的体位，6 小时后可取半卧位? ?遵医嘱准确给药、补液，维持水电解质平衡? ?严格记录24h 尿量，观察尿量颜色，并做好护理记录? ?切口护理:定时观察敷料，是否有出血及不正常分泌物，敷料被浸湿时注意其颜色、性质及量，并及时更换敷料保持干燥，并做好记录 ?疼痛护理:如采取合适体位、遵医嘱使用止痛剂、辅助疗法等? ?引流管的护理:明确各种引流管的位置及作用,妥善固定和保护引流管,保持引流管通畅,密切观察引流物的颜色、性质、量,并做好记录,定时更换引流袋。 ?评估肠蠕动恢复情况,据情况鼓励适当活动。 16 ?做好基础护理，预防感染? ?病室定期通风换气，进行空气消毒，留置氧气管、胃管、导尿管按相应常规护理。 ?口腔护理2 次/d，协助翻身、拍背、指导咳嗽咳痰，及时吸痰，防止肺部感染。 ?饮食护理:根据患者具体病情指导饮食。 ?心理护理:鼓励开导患者树立战胜疾病的信心。 ?指导要点 ?做好患者及家属的心理疏导，减轻焦虑情绪。 ?适当休息，注意锻炼，促进康复。 ?告知患者饮食注意事项。 ?告知患者若有不明原因的发热>38?，或腹痛腹胀、肛门停止排气排便等不适应及时就诊。 九、上消化道大出血护理常规 ?观察要点 ?严密监测患者生命体征、意识、瞳孔、CVP、SpO2 和心电图。 ?评估皮肤温度、湿度、色泽及有无淤斑。 ?定时监测血气分析、电解质和尿量、尿比重。 ?评估呕血与便血的量、次数、性状，估计出血量? ?大便潜血试验阳性，提示出血量5ml 以上。 ?出现黑便，提示出血量在50ml-70ml 甚至更多。 ?胃内出血量达250ml-300ml，可引起呕血。 17 ?柏油便提示出血量为500ml-1000ml。 ?注意观察腹部体征。 ?观察有无再出血先兆:如头晕、心悸、出汗、恶心、腹胀、肠鸣音活跃等。 ?观察有无窒息的先兆症状，及时采取措施。 ?护理措施 ?出血期的护理 ?保持呼吸道通畅:立即清除口腔、咽喉部呕吐物、分泌物和血液予以面罩吸氧，必要时床旁紧急行气管插管，呼吸机辅助呼吸。 ?体位:采用头抬高15-30?，下肢抬高30-45?卧位。 ?遵医嘱置入胃管，用温盐水洗胃后，在30-60min 内用1-4?冰盐水冲洗胃。 ?床旁合血:建立两根以上静脉通路，必要时协助医生进行深静脉置管和动脉插管，连接测压装置。 ?若患者出现失血性休克表现，立即予以快速、加压输血、输液?维持收缩压在100mmHg以上，脉率100 次/min 以下?CVP0.8?1.2kPa,尿量25ml/h。 ?遵医嘱定时向胃内注入去甲肾上腺素和冰盐水，注入硫糖铝等制酸剂，及时准确静脉应用止血药、制酸剂、抗菌素等。 ?做好护理记录，严格记录出入量，严密监测24h 尿量。 ?并发症期的护理 ?肝昏迷的护理? 18 ?肝昏迷先兆:主要是发现并及时报告病情。 ?中度和深度昏迷:主要是注意患者烦躁不安，以免造成意外伤害。 ?并发肝昏迷患者:反复性较大，所以必须延长观察时间。 ?防止褥疮的护理:长期卧床，必然有发生褥疮的可能，因此强调定时更换体位。 ?健康教育 ?保持良好的心境和乐观主义精神，正确对待疾病。 ?生活要规律，避免过饥、过饱、避免粗糙、酸辣刺激性食物，如醋、辣椒、蒜、浓茶等，避免食用过冷、过热食物。 ?戒烟、禁酒。 ?遵医嘱服药:避免服用阿司匹林、消炎痛、激素类药物。 ?定期复查:如出现呕血、黑便?立即到医院就诊。 十、呼吸衰竭护理常规 ?观察要点 ?观察患者神志、血压、呼吸、脉搏、体温、皮肤色泽等。 ?注意观察有无肺性脑病症状及休克。 ?监测动脉血气分析和各项化验指数变化。 ?观察用药情况:药物作用和副作用，尤其是呼吸兴奋剂。 ?护理措施 ?饮食护理:鼓励患者多进高蛋白、高维生素食物，不能自行进食者予以鼻饲饮食。 ?保持呼吸道通畅 19 ?鼓励患者咳嗽、咳痰、更换体位和多饮水。 ?危重患者每2-3h 翻身拍背一次，帮助排痰。如建立人工气道患者?应加强气道管理，必要时机械吸痰。 ?神志清醒者可做雾化吸入，每日2—3 次，每次10—20min。 ?合理用氧:对?型呼吸衰竭病人应给予低浓度25一29。流1~2L/min鼻导管持续吸氧。如何配合使用呼吸机和呼吸中枢兴奋剂，可稍提高给氧浓度。 ?危重患者或使用机械通气者应做好特护记录，并保持床单位平整、干燥，预防发生褥疮。 ?使用鼻罩或口鼻面罩加压辅助机械通气者，做好该项护理有关事项。 ?病情危重患者建立人工气道，气管插管或气管切开，应按人工气道护理要求。 ?建立人工气道接呼吸机进行机械通气时应按机械通气护理要求。 ?用药护理 ?遵医嘱选择使用有效的抗生素控制呼吸道感染。 ?遵医嘱使用呼吸兴奋剂，必须保持呼吸道通畅。注意观察用药后反应，以防药物过量，对烦躁不安、夜间失眠病人慎用镇静剂以防引起呼吸抑制。 ?健康教育 ?教会患者做缩唇腹式呼吸以改善通气。 ?鼓励患者适当家务活动，尽可能下床活动。 20 ?预防上呼吸道感染，保暖、季节交换和流感季节少外出，少去公共场所。 ?劝告戒烟:如有感冒尽量就医，控制感染加重。 ?严格控制陪客和家属探望。 十一、心力衰竭护理常规 心力衰竭的临床类型按其发展速度可分为急性和慢性两种。按其发生的部分可分为左心衰、右心衰和全心衰。左心衰时由于肺淤血而引起不同程度的呼吸困难，最早为劳力性呼吸困难，逐渐发展为夜间阵发性呼吸困难，端坐呼吸，右心衰由于体循环淤血而表现为腹胀、水肿、肝脏肿大、颈静脉怒张。 ?观察要点 ?严密观察患者的心律、心率、呼吸、BP、神志等的变化，尽早发现各类型的心律失常。 ?观察患者症状及体征:注意有无呼吸困难、心悸、晕厥等症状及有可能诱发严重后果的因素，如电解质紊乱、洋地黄中毒、心跳骤停等征兆，以便及时抢救。 ?观察用药后的效果及有无副作用的发生。 ?观察血气分析、电解质等与疾病相关的各种实验室指标。 ?护理措施 ?休息及体位:卧床休息，限制活动量，有心慌、气短、呼吸困难病人取半卧位或坐位，急性左心衰时取端坐位，双下肢下垂，以利于呼吸和减少静脉回心血量。 21 ?氧疗:持续吸氧3~4 升/分，急性左心衰时立即予鼻异管给氧，氧流量为6~8 升/分，病情特别严重可应用面罩呼吸机加压给氧，给氧的同时在氧气湿化瓶内加入50%的酒精，或给予消泡净(二甲基硅油)，吸入有助于消除肺泡内的泡沫。如患者不能耐受，可降低酒精浓度或给予间断吸入。必要时行气管插管或气管切开，兼行间歇正压呼吸(IPPB)或呼吸末正压呼吸(PEEP)。 ?严格控制输液量和补液速度，一般为每分钟20-30 滴，以防加重心衰及诱发肺水肿发生。 ?用药护理:遵医嘱给予利尿、强心剂和扩血管药物，并注意药物的不良反应，使用利尿剂者，应注意低钠、低钾症状的出现，如全身无力，反应差，神经反射减弱，腹胀，尿潴留等，应用洋地黄类药物时观察有无毒性反应，如恶心、呕吐、视力模糊，黄绿视及心律失常等使用血管扩张应密切注意血压变化。 ?遵医嘱准确测量并记录尿量，并注意嘱咐患者不能用力排便，保持大便通畅。 ?病情稳定后可鼓励患者做下肢自主活动或下床行走，避免深静脉血栓形成。 ?饮食护理:给予低热量、高维生素饮食，少量多餐，禁烟酒。水肿较重患者限制钠盐和液体入量。 ?皮肤护理:伴有水肿时应加强皮肤护理，以防感染及发生褥疮，可用温热水清洁和按摩局部皮肤。 ?心理护理:做好心理护理，协助患者克服各种不利于疾病治疗的生 22 活习惯和嗜好。 ?健康教育 ?予以饮食指导，戒烟、戒酒。 ?注意保暖:预防感冒，避免诱发因素，指导患者注意劳逸结合。 ?告知患者按时服药，定期复诊。 ?指导患者学会自行记录出入量及水肿的变化情况。 ?指导患者对疾病有正确认识，保持心情舒畅。 十二、急性肾衰竭护理常规 ?观察要点 ?观察患者尿量情况。 ?观察患者水肿情况、血压变化情况。 ?观察患者有无呼吸困难，烦躁不安、紫绀、大汗淋漓等左心衰表现。 ?观察患者有无高血钾症，如四肢乏力、神志淡漠和感觉异常、皮肤苍白发冷、心跳缓慢或心律不齐、血压低、甚至出现软瘫，呼吸肌麻痹，心跳骤停。 ?护理措施 ?绝对卧床休息。 ?监测患者生命体征，准确记录出入量，测每日体重。 ?少尿时，体内常发生水过多，应控制水及盐的摄入预防心衰。 ?给高热量、高维生素、低盐、低蛋白质、宜消化饮食，避免含钾高的食物，如香蕉、柑、橙、山楂、桃子、鲜桔汁、油菜、海带、韭菜、番茄、蘑菇、菠菜、榨菜、川冬菜、豆类及其制品等。 23 ?急性左心衰是急性肾衰的主要并发症，出现症状应立即给予纠正缺氧、镇静、利尿、行血液透析等措施。 ?注意皮肤及口腔护理。 ?有高钾血症时应积极控制感染，纠正酸中毒，输血选用新鲜血液，给予高糖，胰岛素静脉滴入或输入氯化钙?配合血液透析。 ?健康教育 ?向病人及家属介绍治疗的重要性，特别是限制液体及饮食的目的争取病人及家属对治疗、护理的配合。 ?指导病人合理饮食，少尿期对水、高钾、高钠及高蛋白食物摄入的限制，多尿期则注意水、含钠、钾的食物及适量蛋白的补充。 ?督促病人少尿期应绝对卧床休息，恢复期也要限制活动，避免过度劳累。 ?告之病人避免加重肾功能恶化的因素，如妊娠、创伤、及使用对肾有害的药物。 ?告知病人定期门诊复查的重要性，以便能据病情变化及时调整用药、饮食及体液限制。 24 (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen 25 party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations 26 repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth 27 Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political 28 Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision 29 of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and 30 to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on 31 a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a 32 total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > 33 real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years 34 implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, 35 exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should 36 be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective 37 convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts 38 of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application 39 of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation 40 made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give 41 expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental 42 organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post 43 processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in 44 the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in 45 the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management 46 of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, 47 around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one 48 size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are 49 relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < 50 new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform 51 comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation 52 of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 53 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily 54 blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres 55 should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection 56 with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace 57 with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of 58 the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline 59 must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be 60 held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations. 61