外科创伤患者的护理课件.ppt
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1、Nursing Care of Client Experiencing Trauma创伤病人的护理创伤病人的护理vDefinition of TraumavTrauma morbidity(发病率)(发病率)and mortality(死亡率)(死亡率)constitute a major health care challenge.创伤的发病率和死亡率构成了健康的最大挑战。创伤的发病率和死亡率构成了健康的最大挑战。vAlthough significant strides have been made in combating heart disease and selected cance
2、rs,traumatic injury continues to be the number-one killer of the young.Section 1 OverviewTraumatraumatic injuryheart diseasecancerThe number-one killer of the youngvIt is estimated that traumatic injury causes about 140,000 deaths per year.vAn additional 57 million people suffer nonfatal(不致命的)不致命的)i
3、njuries each year.当肯尼迪乘坐敞蓬轿车驶过德克萨斯州达拉斯的迪利广场(当肯尼迪乘坐敞蓬轿车驶过德克萨斯州达拉斯的迪利广场(Dealey Plaza)时,遭到枪击身亡)时,遭到枪击身亡。约翰约翰肯尼迪肯尼迪是美国历史上第四位遇刺身亡的总统,也是第八位在是美国历史上第四位遇刺身亡的总统,也是第八位在任期内去世的总统。任期内去世的总统。assassination 遇刺,暗杀遇刺,暗杀John Fitzgerald Kennedy 肯尼迪诅咒肯尼迪诅咒 curse v 1 119411941年,约瑟夫的残疾女儿死于失败的脑叶切除手术;年,约瑟夫的残疾女儿死于失败的脑叶切除手术;v 2
4、 219441944年,约瑟夫长子小约瑟夫年,约瑟夫长子小约瑟夫肯尼迪战时死于飞机失事;肯尼迪战时死于飞机失事;v 3 319481948年,约瑟夫二女儿凯瑟琳死于飞机失事;年,约瑟夫二女儿凯瑟琳死于飞机失事;v 4 419631963年,肯尼迪总统的第三个儿子出生两天后夭折;年,肯尼迪总统的第三个儿子出生两天后夭折;v 5 519631963年,约瑟夫二子肯尼迪总统遇刺身亡;年,约瑟夫二子肯尼迪总统遇刺身亡;v 6 619681968年,约瑟夫三子罗伯特遇刺身亡;年,约瑟夫三子罗伯特遇刺身亡;v 7 719831983年,罗伯特之子博比因吸毒被判刑;年,罗伯特之子博比因吸毒被判刑;v 8 8
5、19841984年,罗伯特之子戴维因过量吸服海洛因死亡;年,罗伯特之子戴维因过量吸服海洛因死亡;v 9 919971997年,罗伯特之子迈克尔死于滑雪事故;年,罗伯特之子迈克尔死于滑雪事故;v 101019991999年,约翰之子小约翰年,约翰之子小约翰肯尼迪死于飞机失事;肯尼迪死于飞机失事;v 111120092009年,约瑟夫四子爱德华死于脑癌;年,约瑟夫四子爱德华死于脑癌;vTraumatic injury usually occurs suddenly,leaving both the client and family with little time to prepare for
6、its consequences.v创伤发生得太突然,没有任何时间留给病人和创伤发生得太突然,没有任何时间留给病人和家庭来准备承受后果。家庭来准备承受后果。vNurse provide a vital link in both the physical(生理的)(生理的)and psychosocial(心理社会)(心理社会)care for the injured client and family.v护士要提供给护士伤员及家庭一个关健的护理护士要提供给护士伤员及家庭一个关健的护理不仅是生理上的还包括心理社会的。不仅是生理上的还包括心理社会的。traffic accidentvIn cari
7、ng for the client who has experienced trauma,nurses must consider not only the initial physical injury,but also its long-term consequences,including rehabilitation and the clients return to his or her previous way of life.v护士护理创伤人员时,不仅必须考虑最原先的护士护理创伤人员时,不仅必须考虑最原先的生理创伤,而且也要考虑长期的后序治疗,包生理创伤,而且也要考虑长期的后序治
8、疗,包括康复和伤员能回归原来的生活轨道。括康复和伤员能回归原来的生活轨道。Types of Trauma 创伤类型创伤类型Severity 严重程度分类严重程度分类vWhether intentional or accidental,trauma causes injury to one or more parts of the body.1 Minor trauma2 Major or multiple trauma1 Minor trauma 轻伤轻伤vMinor trauma causes injury to a single part or system of the body and
9、 is usually treated in the hospital or emergency department.v轻伤导致身体一个部分或一个系统的损伤,通轻伤导致身体一个部分或一个系统的损伤,通通都会在医院或急诊科被治疗。通都会在医院或急诊科被治疗。vA fracture of the collarbone,a small second-degree burn,and a cut requiring stitches are all considered minor trauma.v锁骨的骨折,二度烧伤和一个需要缝合的伤口锁骨的骨折,二度烧伤和一个需要缝合的伤口都被认为是轻伤。都被认为
10、是轻伤。2 Major or multiple trauma 重伤及多发伤重伤及多发伤vMajor or multiple trauma involves serious single-system injury(such as the traumatic amputation of a leg)or multiple-system injuries.vMultiple trauma requires immediate intervention(立即干预)(立即干预)that is specifically focused on ensuring the survival of the cl
11、ient.v多发伤需要立即干预,尤其重心是保证病人的多发伤需要立即干预,尤其重心是保证病人的生命。生命。vClients who suffer multiple trauma receive immediate emergency care and often require long periods of intensive nursing care.v多发创需要立即接受急救治疗,并且经常需要多发创需要立即接受急救治疗,并且经常需要常长时间的护理。常长时间的护理。Types of TraumaSkin Integrality 按皮肤的完整性来分按皮肤的完整性来分v1 Blunt trauma
12、 闭合性损伤闭合性损伤 Blunt trauma occurs when there is no communication from the damaged tissues to the outside environment.v2 Penetrating trauma 开放性损伤开放性损伤 Penetrating trauma occurs as the result of foreign objects set in motion.Penetration of tissues causes damage to body structures,most commonly the intes
13、tines(肠道)(肠道),liver(肝脏)(肝脏),spleen(脾脏)(脾脏),and vascular system(血管系统)(血管系统).Types of TraumaOrgan and location 创伤器官和部位分创伤器官和部位分vtrauma of abdomen 腹部创伤腹部创伤vtrauma of bladder 膀胱损伤膀胱损伤;膀胱外伤膀胱外伤vtrauma of limbs 四肢损伤四肢损伤vTrauma of chest 胸部损伤胸部损伤vtrauma of breast 乳腺外伤乳腺外伤vtrauma of gastrointestinal tract 胃肠
14、道创伤胃肠道创伤vtrauma of nose 鼻外伤鼻外伤vtrauma of brain 脑外伤脑外伤vtrauma of spinal cord 脊髓外伤脊髓外伤Effects of Traumatic Injury 创伤的影响创伤的影响v Causes and Initial Management 创伤原因和处理创伤原因和处理vAirway obstruction 气道阻塞气道阻塞vTension pneumothorax 张力性气胸张力性气胸v Hemorrhage 出血出血v Integumentary effects 皮肤损伤皮肤损伤v Hypovolemic shock 低血容
15、量性休克低血容量性休克v Neurologic effect 对神经系统的影响对神经系统的影响v Effect on the family 对家庭的影响对家庭的影响1 Causes and Initial Management 创伤原因创伤原因和处理和处理(1)Natural Disastersv Earthquake 地震地震v Mudslide;mudflow 泥石流泥石流v volcano 火山火山vlkeinuv lahar 火山泥流火山泥流l:h:v avalanche 雪崩雪崩v,lntv Blizzard 暴风雪暴风雪 blzdv Hurricane 飓风飓风v Typhoon
16、taifu:n台风台风v Flood 洪水洪水v ice storm 冰雹冰雹1 Causes and Initial Management 创伤原因创伤原因和处理和处理Man-made disastersDerail 火车出轨火车出轨Traffic crash;traffic accident 交通事故交通事故Plane crash 飞机失事飞机失事attack;slaughter;fight 袭击;屠杀;打架袭击;屠杀;打架terrorist attack 恐怖袭击恐怖袭击Shooting 枪击枪击War;battle 战争;战斗战争;战斗Sport activityInitial Man
17、agementvA mentioned as the opening of this chapter,death is a common result of serious traumatic injury.vDeath from trauma may be immediate,early,or late.创伤引起的死亡可以是立即的,早期的或创伤引起的死亡可以是立即的,早期的或是晚期的。是晚期的。vImmediate death is death is death at the scene from such injuries as a torn thoracic aorta(主动(主动脉撕裂
18、伤)脉撕裂伤).vEarly death is death occurring within several hours of the injury from,for example,shock(休(休克)克)or lack of treatment for unrecognized injuries(无法诊断的损伤)(无法诊断的损伤).vLate death generally occurs one or more days after the injury and results from multiple organ failure(器官衰竭)(器官衰竭).vBecause of the
19、 serious consequences of a traumatic injury,it is important to identify rapidly and take interventions appropriately.v因为创伤的严重后果,对于迅速确定并且适当因为创伤的严重后果,对于迅速确定并且适当地采取措施非常重要。地采取措施非常重要。EP 10 mins 急救白金十分钟急救白金十分钟emergency platinum 10 mins10platinumpltnmCRASH PLAN检查顺序检查顺序vC cardic 心脏心脏vR respiratory 呼吸呼吸vA ab
20、domen 腹部腹部vS spine 脊柱脊柱vH head 头颅头颅vP Pelvic 骨盆骨盆vL 1imb 四肢四肢 vA artery 血管血管vN nerve 神经神经2 Airway obstruction 气道阻塞气道阻塞vThe trauma clients airway may become obstructed by the presence of blood,teeth,the tongue,and vomitus(呕吐)(呕吐).Airway interventions may include:v1 Clearing the airway by suctioning(吸
21、引)。(吸引)。v2 Use of airway adjuncts,such as an oropharyngeal(口咽的)(口咽的)airwayv3 Intubation with an oral endotracheal airway(气管插管)(气管插管).v4 Needle or surgical circothyroidotomy.(气管(气管切开)切开)This procedure is performed only after other methods are ineffective in opening and maintaining an open airway.开放气道
22、开放气道 AirwayClearing the airway by suctioningan oropharyngeal airwayv口咽管口咽管Intubation with an oral endotracheal airwaycircothyroidotomy3 Tension pneumothorax 张力性气胸张力性气胸vA pneumothorax results from air in the pleural space from blunt and penetrating injuries to the chest.vWhen a one way valve(阀(阀门)门)i
23、s created so that air can enter the pleural space but not exit,a tension pneumothorax may develop.4 Hemorrhage 出血出血v1 External Hemorrhage(外出血)(外出血)vWhen the client has suffered an injury that causes external hemorrhage,such as severing of an artery,the bleeding must be controlled immediately methods
24、 to achieve this include:v(1)Applying direct pressure over the woundv(2)Applying pressure over arterial pressure points 压迫伤口上方动脉压迫伤口上方动脉 v(3)Elevating the injured limb 抬高抬高v(4)Clamping the bleeding vessel.(固定,夹紧)(固定,夹紧)v(5)Applying a tourniquet.(止血带止血带)压迫止血压迫止血Applying direct pressure over the wound
25、包扎止血包扎止血Clamping the bleeding vesselApplying pressure over arterial pressure points 压迫伤口上方动脉压迫伤口上方动脉 4 Hemorrhage 出血出血v2 Internal Hemorrhage 内出血内出血vInternal hemorrhage may result from either blunt or penetrating traumatic injury.Discovering the cause of,location of,and extent of blood loss related t
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