肺癌患者的护理查房课件.pptx

1、Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process肺癌患者的护理查房Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process目录DIRECTORY相关知识01病史

2、汇报02护理诊断及措施03护理难点04Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process相关知识Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process 原发性支

3、气管肺癌，简称肺癌，发生于支气管 黏膜上皮，近50年来肺癌的发病率显著增高，在欧美工业发达国家和我国的一。些工业大城市中，肺癌发病率在男性恶性肿瘤中已居首位，在女性发病率也迅速增高，占女性常见恶性肿瘤的第2位或第3位。肺癌成为危害生命健康的一种主要疾病概述Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process肺的解剖Asymptomatic ulcerative colitis

4、patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process解剖学部位组织病理学非小细 胞癌小细胞癌中央型周围型病理和分类Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process 吸烟环境和职业电离辐射电离辐射遗传大气污染肺部慢性感染病

5、因病因Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process由原发肿瘤引起的症状肿瘤局部扩展引起的症状由肿瘤远转移引起的症状肺外表现1234临床表现临床表现Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Be

6、nchmarks Angoff Process实验室及检查细胞学检查影像学检查 支气管镜检查 其他 痰脱落细胞检查X线检查 CT检查 磁共振穿刺活检纤维支气管镜Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process治疗要点4.其他3.放射治疗2.化学治疗1.手术治疗Asymptomatic ulcerative colitis patients on an ProDepressi

7、on A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process病史汇报Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process一般资料：姓名:性别:年龄:职业:入院日期:入院诊断：1、2、3、4、病例介绍Asymptomatic ulcerative colitis patients on

8、 an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process主诉现病史2014年3月:2014年4月-10月:2015年1-3月:2017-03-23：病例介绍Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process病例介绍平素体健，否认吸烟史，工作环境特殊

9、接触史:否认。既往史入院查体体温:37 脉搏:80次/分 呼吸:20次/分血压:120/65mmHg KPS评分60，双侧颈部及耳后可触及肿大淋巴结，右侧额顶部可见术后瘢痕。左下侧胸壁压痛，左侧语颤减弱，左肺叩诊浊音，右肺叩诊清音，左肺未闻及呼吸音，余肺呼吸音粗，未闻及干湿性罗音。心腹等未见明显阳性体征。Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process实验室及器械检查结果2

10、017年03月21日：胸部CT示左肺中央型CA,左肺全叶不张，左侧胸腔大量积液，右肺多发转移瘤，肝内多发低密度影，考虑多发转移瘤。病例介绍Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process。2017-03-242017-04-062017-04-21病程介绍Asymptomatic ulcerative colitis patients on an ProDepression

11、 A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process病程介绍患者胸闷气紧，肺部闻及干湿性啰音，予地塞米松、茶碱解痉平喘、吸氧对症支持治疗，必要时复查胸部CT，继续引流胸水，并予营养支持治疗。晚期肺癌姑息性治疗患者，左侧胸部及左上腹针刺样疼痛给予硫酸吗啡缓释片镇痛、奥美拉唑及胃苏颗粒护胃及营养支持等对症治疗。患者诉近日夜间反复左侧胸部及左上腹针刺样疼痛不适，给予引流胸水，辅以硫酸吗啡镇痛，氨基酸、葡萄糖营养支持对症治疗。2017-05-032017-05-212017-06-30Asymptoma

12、tic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process 病程介绍Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process护理诊断及措施Asymptomatic ulcerative c

13、olitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process0102030405疼痛：与晚期癌症有关气体交换受损:肺癌晚期，与大量胸水压迫，使肺不能充分扩张，使气体交换面积减少有关活动无耐力：与肿瘤机体的消耗营养低于机体需要量：与癌症高消耗，长期胸腔引流有关导管脱落风险：与PICC置管及左侧胸腔管固定有关护理诊断Asymptomatic ulcerative colitis patients on an ProDepression A

14、 Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process0607080910便秘：与长期口服吗啡止痛药有关睡眠形态紊乱：与晚期肿瘤引起的疼痛有关预感性悲哀:疾病晚期，与疾病治疗上丧失信心有关知识缺乏：与患者文化程度及接受能力有关潜在并发症：呼吸衰竭，窒息，大咯血护理诊断Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmar

15、ks Angoff Process疼痛主诉疼痛消除或减轻护理目标护理措施护理评价1.评估疼痛：疼痛的部位、性质、程度及止痛效果2.用药护理：口服止痛药物或静脉注射及肌肉注射止痛药物,给药时遵循WHO推荐的：按阶梯给药,遵医嘱予20%甘露醇快速静点降颅压治疗,按时按量使用止痛药。3.心理护理：精神安慰和心理疏导，指导病人应用松弛疗法患者疼痛症状得以控制Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks An

16、goff Process气体交换受损改善患者呼吸困难护理目标护理措施护理评价1、严格卧床休息，取半坐卧位。2、保持室内空气新鲜，开窗通风，注意保暖，避免劳累3、给予床旁氧气吸入2L/min。4、遵医嘱给予适当的放胸腔积液，给予平喘药等。病人呼吸功能有所改善，但仍有气促、发绀等缺氧征象。Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process活动无耐力患者能自行下床活动1、控制好胸腔

17、积液，减轻肺部的压迫。2、鼓励患者床边活动，促进肠蠕动，增进食欲。3、纠正低蛋白血症及贫血症状。4、保证充足的睡眠时间。患者能自行下床活动护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process营养失调获得充足的营养和能量，满足机体的需要量1.指导进食高蛋白、低盐、低脂、低糖、低热量的清淡饮食2.多吃新鲜蔬菜，优质蛋白食物（鸡、鱼和豆类）3.遵医嘱，静脉补充

18、营养液等基本满足机体需要量护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process有导管脱落的危险导管固定妥善1、牢固固定picc导管及胸腔引流管，使导管个部 位链接紧密（使用思乐扣固定翼固定）。2、定期更换敷料，观察穿刺点周围皮肤做好皮肤护理.3、严格交接班，每班评估导管。4、患者翻身时先妥善固定导管，以防牵拉时使导管脱出。导管固定良好护理目标护理措施护理

19、评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process便秘患者大便通畅1、饮食指导:多食含膳食纤维多的食物，如水果蔬菜。2、养成良好的排便习惯，定时排便能防止粪便堆积 3、药物治疗：指导病人正确使用缓泻剂，如：开塞露，乳果糖。必要时给予灌肠。患者便秘情况得以改善。护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on a

20、n ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process睡眠形态紊乱患者能适应环境，有较好的睡眠质量1.建立良好的休息环境，及时熄灯，避免噪音。2.夜间查房时，除不必要操作，尽量不要干扰患者睡眠。3.减少探视，限制陪护，督促患者早点入睡。4.必要时使用药物治疗，如止痛针镇痛，舒乐安定改善睡眠。患者能够安静入睡护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Fa

21、ctor for Infant Mental HealthMammography Benchmarks Angoff Process预感性悲哀增强患者治疗信心1.与病人和家属建立融洽的关系，倾听并鼓励病人表达悲哀。2.经常与病人交谈，以了解病人的想法，给予心理疏导3.多讲解肺癌治疗案例，及时为病人提供有利于治疗的信息，增强患者治疗的信心。患者情绪稳定，能配合治疗护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammogr

22、aphy Benchmarks Angoff Process知识缺乏患者能知晓疾病方面的知识1、评估患者知识缺乏的程度。2、向其讲解各项辅助检查的必要性，使其理解并配合。3、讲解疾病的相关知识及注意事项。4、告之患者如有异常情况，应及早报告医护人员。5、与病人一同制定护理计划，以便顺利实施。患者能了解疾病知识护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Proc

23、ess潜在并发症病人并发症得到及时发现、控制或未发生并发症1.密切观察患者呼吸形态，指导有效咳嗽咳痰2.遵医嘱给予雾长期氧气吸入3.观察患者痰液性质4.监测血氧饱和度或动脉血气分析。患者未出现并发症护理目标护理措施护理评价Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process护理难点怎么有效的控制疼痛?Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff ProcessPPT模板下载： 谢谢聆听Asymptomatic ulcerative colitis patients on an ProDepression A Risk Factor for Infant Mental HealthMammography Benchmarks Angoff Process