www.melanexjou.fora.pl

[px231858]

Mirror laparoscopic bile duct common bile duct exploration via the cystic duct stone Nursing


Big 85 and the youngest 8 years old. Of which 37 cases of severe head injury, 15 cases of severe combined injury, chronic obstructive pulmonary disease (COPD) with respiratory failure in 8 cases. Mechanical ventilation in this group is 4h-60d, where 37 cases of tracheostomy, endotracheal intubation in 21 cases, 2 cases of oxygen masks. 2 patients with mechanical ventilation results in 60 patients cured, 50 cases were discharged in 6 cases, 4 deaths, the cure rate of 83.3%. Use of mechanical ventilation 4h-60d. 3 3.1 The guardianship of monitoring the use of multi-function monitor clinical monitoring,[link widoczny dla zalogowanych], close observation and record patient temperature, pulse, respiration, blood pressure, consciousness, pupil, urine output, fluid input and output. According to respiratory rate, oxygen saturation, select the appropriate mental state means of mechanical ventilation, properly regulate the ventilator parameters, waves of gas 8-12ml/kg; respiratory ratio (I: E) 1:1.5-3.0; respiratory rate 14-18 times / min, inhaled oxygen concentration: 30% to 40%. After 30min on the monitoring of blood gas analysis machine, according to the results of blood gas analysis and respiratory conditions, timely adjustment. Parameter setting and adjustment of mechanical ventilation should be run through the whole process 【l1. Ventilator alarm occurs when a timely manner. 3.2 wet suction airway humidification are: ① the steam humidifier: Drager ventilator temperature on the electric steam generator, timing distilled water, adjust the proximal airway temperature 3235 ℃, the inhaled gas humidity 60% to 70% of ciliary activity to maintain the physiological requirements. ② direct intratracheal instillation: We give each patient the daily preparation of mechanical ventilation in normal saline 250ml + gentamicin 160 000 u + Mi protein 10mg, sputum viscosity in patients with intermittent injection every 30min ~ 60min 2-3ml, 24h total does not generally more than 250ml. The attraction of respiratory secretions, should be strictly aseptic operation, given the high concentration of oxygen before and after suction, home to the deepest human suction tube, 1cm on the mentioned negative side to open side of rotating side to attract exit gentle suction action should attract negative pressure of not more than 0.01MPa,[link widoczny dla zalogowanych], attracted no more than 15s. Closely observed during suction changes in condition, if the heart rate, blood pressure,[link widoczny dla zalogowanych], oxygen saturation was significantly changed, have to immediately stop the suction. Nutrition support in mechanically ventilated patients 3-3 energy consumption, prone to malnutrition, the difficulties caused by off-line, ventilator dependency. Nutritional support is extremely important,[link widoczny dla zalogowanych], the preferred flow of juice through a nasogastric tube nasogastric enteral nutrition line. So that patients can adapt to start tube feeding should be small when the amount of nutrient solution, such as tube feeding each about 50 ~ 100ml, then gradually incremental, low density of the liquid should also be gradually increased to avoid the start of the liquid to cause significant high permeability state. Tube feeding should be strictly physical cleaning and disinfection. Should be checked before each tube feeding and determine the gastric tube in the stomach can be carried out. Long-term nasal feeding by a week to re-set nasal gastric tube replacement of 1. Nasal tube every drop 1 drop of liquid paraffin oil to reduce friction tube to prevent drying of nasal mucosa erosion. The event of adverse reactions, should disease treatment, adjusted according to blood tests nutrition formula. 3.4 respiratory tract infections and ventilator-free treatment of airway physiological defense barrier, coupled with high catabolic patients, lower the resistance, prevention of respiratory tract infection is very important. Enforcing aseptic suction, suction tube once a change, a suction tube with suction airway secretions should be suction mouth and nose cavity discharge, the inlet must not be repeated. Bacterial culture can be done on a regular basis in order to symptomatic treatment. Suction catheter and drainage bottles, threaded pipe ventilator daily disinfection. Condensate collection bottle placed in the lowest position piping, condensate disposal in time, strengthen the indoor air purification, regular ventilation. 3.5 Psychological care of patients with mechanical ventilation can not be sober language, coupled with the intensive care unit, no family members to accompany, prone to fear, depression, despair and other psychological. Particularly low in elderly patients ability to respond to treatment and care of the lack of proper understanding and cooperation [21. Therefore, spiritual, psychological support is very important. So that patients understand the use of breathing machine to help tide them over difficulties, to avoid danger,[link widoczny dla zalogowanych], allowed to adapt, with mechanical ventilation. Church of patients with simple sign language, such as the thumbs that there stool, urine expressed little finger extended, fist that thirst and so on. For patients with high educational level, may be given a tablet, allowed to write their feelings and demands. 3.6 to strengthen basic care in mechanically ventilated patients can not arbitrarily change position, prone to bed sores, should be given air bed to keep sheets clean of debris. 1h-2h turn over every 1, side 90. Who have difficulty, can be left lying supine for a 45. One of a supine right lateral decubitus 45. Turn over alternately, with the cushion to maintain position, while leaving it with the palm Medical Forum 2008 in late August l2 Journal Volume
More articles related to topics：


new balance outlet Small dose of local anesthetic

timberland portugal Hepatic artery chemoembolizati

keen shoes sale Methylcobalamin treatment of diabe