修正药业集团药品目录

修正药业集团药品目录 护理业务查房 目:妊娠合并梅毒 主持人:黄银微 记录者:黄银微 时间:2013-1-16 地点:示教室 参加人员: 姓名 签到 姓名 签到 姓名 签到 姓名 签到 黄丁 陈海棠 林丹 黄银微 钱秋芳 陈春 林红 戴岑芳 彭小娜 涂小乐 谢灵娜 方玉凤 沈小燕 董素贤 曾佳佳 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 护理业务查房 查房题目:妊娠合并梅毒 职称 护师 时间:2013-1-16 查房对象:黄森森 住院号:0636982 查房目标:妊娠合并梅毒的定义及病因，临床现，护理诊断及预防，护理 重点内容:妊娠合并梅毒的定义及病因，临床表现，护理诊断及预防，护理措施 拟题的问题:1妊娠合并梅毒的传播途径有哪些? 2 妊娠合并梅毒的临床表现是什么, 3 妊娠合并梅毒的处理原则是什么? 4 妊娠合并梅毒的护理措施, 5 妊娠合并梅毒的心理护理, 黄银微:大家好，今天疾病查房的内容是妊娠合并梅毒，希望通过这次学习，让大家对妊娠 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 合并梅毒当然护理有更深刻的认识。 下面由戴岑芳进行病史汇报:黄森森，女，37岁，于孕13周时发现“梅毒抗体弱阳性，查血清梅毒滴度试验阴性”，1月前复查“梅毒滴度试验阳性(1:2)”予“青霉素针肌注治疗4次”，余无异常。3小时前无明显诱因下出现阴道流水样液，量少，色清，无阴道见红，无下腹坠痛，于2013年1月69:21拟“G3P1孕38+3W LOA待产，胎膜早破，妊娠合并梅毒”入院。入院时，生命体征正常，产科检查:骨盆外测量正常，宫高33cm，腹围95cm，胎方位LOA，头先露，已入盆，胎心140次/分，规则，宫缩无。胎儿估计体重3772g，宫缩偶有，肛查宫颈未容受，宫口未扩张，先露-3，胎膜已破，羊水色清。辅助检查:NST呈反应型，B超检查示单胎妊娠，头位，胎儿存活，胎儿脐带绕躯干一周可能。医嘱予产护II级，软食，左侧卧位，自数胎动，予缩宫素静滴引产，11月27号予普贝生引产治疗，17:50胎儿娩出，新生儿男，体重4200g，查宫颈9点方向可见一约2cm裂伤，肛门括约肌可见断裂，予外缝6针，宫颈裂伤修补术，予禁食，肠外营养支持，予抗炎治疗，留置导尿。新生儿因呻吟不安予转新生儿科继续治疗。11月29号诉创口疼痛3-4分，予大黄芒硝外敷会阴创口，11月30号予改流质，12月1号予停留置导尿，12月3号予会阴拆线，发现会阴创口部分裂开，宽约2cm，深1.2cm，未与阴道相通，并见坏死组织及脓苔，予清创换药，予改半流，乳果糖促排便，查血常规示白细胞8.1x10^9/L，中性粒细胞80.2%，血红蛋白84g/l。12月4予创口换药，查创口分泌物培养，烧伤科会诊，产妇解大便一次。12月5予改软食，创口分泌物培养示大肠埃希菌阳性，与舒普深针抗炎治疗。12月7予多西环素抗炎治疗，力蜚能补血治疗。12月8查血常规示血红蛋白90g/l，余基本正常，12月11产妇会阴创口肉芽组织，未见感染性分泌物，医嘱予出院。 下面由请彭小娜会阴?度裂伤定义及病因:定义，或称会阴完全裂伤，包括阴道口裂伤、会阴裂伤及肛门括约肌的裂伤，严重者破裂可伸展到直肠壁，引起大便及气体失禁。发生原因多由于分娩过程处理不当，偶有外伤致成。由于新法接生的大力推行，接生员恰当地保护会阴，使会阴?度裂伤的发生率大大降低。在城市的大医院中也偶有发生。 病因，分娩时不注意保护;或宫缩过强,产妇用力过猛造成胎儿娩出过快,可使未来得及充分扩张的会阴发生裂伤; ?度裂伤,有时伴直肠前壁破裂,如不能及时正确缝补,将会导致会阴陈旧性裂伤,甚至大便失禁. 戴岑芳临床表现 会阴?度裂伤发生在第二产程，在胎头着冠时，助产者可能察觉到会阴部有撕裂感。分娩后即时发现?度裂伤而缝合。由于破裂程度不同，症状亦有轻重，如括约肌只有部分撕裂，则只当大便稀时不能控制，虚恭不能控制。在这种情况下患者尽量设法使自己大便干燥。控制大便主要依靠肛门括约肌，在腹压增高时不致使大便突然溢出，但自主管制大便反应不仅依靠括约肌，还要依靠提肛肌。严重者即使干燥大便也不能自控，外阴经常被大便污染。我们有一患者，年龄已43岁，干大便一直能控制，来院的主诉是二年来大便有鲜血，这是由于直肠粘膜损伤所致。检查时可见会阴部消失，阴道和直肠的末端相通。肛门后面皮肤呈放射状皱纹，括约肌断端退缩处在肛门两侧形成小凹陷。肛查时嘱患者向内缩，可试验其括约肌的管制功能。如直肠也有撕裂，直肠粘膜呈红色，向外翻出. 下面由黄银微护师讲下会阴?度裂伤诊断及预防 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check (一)分娩时撕裂 会阴?度裂伤发生在第二产程，在胎头着冠时，助产者可能察觉到会阴部有撕裂感。分娩后即时发现?度裂伤而缝合，伤口愈合一般良好。 (二)陈旧性裂伤 在检查时一指伸入肛门，嘱患者用憋住大便的方式用力向内缩，这时肛指不感到有括约肌的收缩感，并由于撕裂肌肉断端回缩，在肛门侧方可见到小凹陷，在撕裂处可找到环形的肌肉断端。 1 预防 (1)认为正确的接产技术和发生裂伤时，如及时缝合并积极抗感染治疗多可降低患病率。(2)采用正确的助产方法，做好预防工作。(3)严密观察产程，应于妊娠早期了解软产道有无异常。(4)会阴水肿，弹性差，第一胎会阴部紧的产妇分娩时应作预防性会阴后侧切开，产后即刻修补会阴撕裂，避免伤口感染，影响愈合。(5)第二胎会阴陈旧性裂伤可放宽剖宫产指征。 术后护理(涂小乐) 1 临床护理 (1)术后卧床休息，术后进食3天后给予流质饮食。 (2)保持会阴清洁，每天会阴消毒2次，并观察会阴伤口有无红肿及脓性分泌物，有无诉局部疼痛,不做下蹲动作及下肢跨度过大的动作; (3)抗感染，补充营养治疗; (4)服复易蒙停，以防术后3日内排大便; (5)第五天未解大便，可用乳果糖口服液15ml tid导泄剂。 (6)尿管的护理，需保留尿管5天，在保留尿管期间，鼓励患者多饮水，保持尿道通畅,观察尿道颜色和性状,拔管前一天,给予夹放,拔管后不可憋尿. 2 心理护理 (1)听取病人叙述，给予心理支持; (2)传授产妇一些放松疗法参与照料婴儿，多与产妇沟通，分散注意力; (3)医护人员为产妇诊疗护理过程中，以精湛的技术水平，高度的责任心和同情心及良好的服务态度，赢得产妇及家属的信任感，增强其战胜疾病信心，预防感染的护理; (4)保持环境清洁通风，保持床单清洁。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 护理业务查房 查房题目: 主查人: 记录者: 职称: 时间: application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check