Nursing Analysis of Severe Influenza A Pneumonia Gao Tianxia Zheng Yang Li Hongmei Hongye's knowledge, but also take the initiative to understand the patient's thoughts, try every means to eliminate bad psychological factors, adjust the patient's mood, let patients face the disease correctly, and establish the courage to overcome the disease. This is of great significance to the rehabilitation of CAC. Refer to [1] Lin Xian. Snake Journal of Psychological Care for Patients with Chronic Gastritis, 2007, 19 (1): 74. [2] Wang Yufei. The role of psychological nursing in chronic gastritis and depression. Miscellaneous Notes on Misdiagnosis of China, 2005,5 (3): 585. Methods From June 2009 to February 2009, 13 patients with severe pneumonia caused by influenza A in our hospital were analyzed retrospectively, and the best nursing measures to promote the recovery of the disease were summarized. Results 13 cases of severe pneumonia, 12 cases were cured and discharged, 1 case was obviously improved. He was still hospitalized on the fourth day after tracheotomy and extubation. Average length of stay: (221) D. Conclusion Reasonable nursing measures are effective methods to shorten the course of severe pneumonia caused by influenza A and improve the cure rate. Severe pneumonia; Nursing care of patients with severe pneumonia caused by influenza A is characterized by severe illness, rapid change, many complications, high mortality and involvement of various organs? . Especially in severe pneumonia at the peak of swine flu, this feature is more obvious. Therefore, in the process of treating severe pneumonia caused by influenza A, it is the fundamental guarantee to cooperate with doctors to formulate a perfect nursing plan and implement effective nursing measures. The nursing experience is analyzed as follows. 1clinical data in 2009, H 1N 1 epidemic in 1 1. Since the establishment of the fever ward in our hospital, 13 cases of severe pneumonia A/H 1N 1 have been treated, including 5 males with an average age of 47 years. There are 8 women, the youngest is only 24 years old, and the average age is 50 years old. Among l3 patients with severe pneumonia, 12 cases were cured and discharged, and 1 case was obviously improved. He was still hospitalized on the 4th day after tracheotomy and extubation. Average length of stay: (22 1) d. 2 Nursing analysis 2. 1 Suitable rest environment and comfortable lying position. Control the room temperature at 18oC~25~C 25 ~ C and the relative humidity at 60% ~ 65%. According to the weather conditions, ventilation 1 time and ultraviolet disinfection 1 ~ 2 times every day to keep the air fresh. The ward is cleaned with disinfectant twice a day to prevent cross infection. In order to make the patients have a full rest, we focus on treatment, nursing and other operations, and regularly guide patients to change their positions to reduce pulmonary congestion, which is conducive to the discharge of sputum. 2.2 closely observe the changes of the disease. According to the doctor's advice, monitor ECG blood pressure and blood oxygen saturation. Nurses should patrol the ward in time and closely observe the changes of respiration, pulse, blood pressure, body temperature, consciousness, pupil and urine volume. Observe whether the patients have any adverse reactions after taking the medicine. Pay attention to the fluctuation of blood oxygen saturation, the amount, color and quality of sputum when sucking sputum. In case of dyspnea, aggravated cough, shortness of breath, oxygen saturation below 90%, blood pressure fluctuation and other abnormal conditions, large-flow oxygen inhalation should be given immediately. Author: Longnan Hospital of Daqing General Hospital Group, Heilongjiang Province (Fifth Affiliated Hospital of Qiqihar Medical College) 163000 should know the doctor and deal with it in time. 2.3 Improve respiratory function 2.3. 1 Patients with dyspnea and continuous decrease of blood oxygen saturation can be assisted by breathing with a hectopascal ventilator (non-invasive). There are two female patients in our department who don't cooperate with the use of hectopascal respirator to assist breathing, and the patients are agitated. We give oxygen to the mask of oxygen storage bag, and the oxygen flow rate is 6 ~ 10 L/min. After the condition was stabilized, the oxygen flow rate was changed to 4 ~ 6 L/min, and satisfactory oxygen therapy effect was achieved. The patient's oxygen saturation can be maintained above 90%-95%. 2.3.2 According to the needs of illness, tracheal intubation and ventilator assisted breathing are given when necessary. Nurses should strictly change shifts at bedside, pay attention to the position of tracheal intubation, set ventilator parameters, handle all kinds of alarms in time, and manage ventilator pipes well. The airbag deflates every 4 ~ 6 hours 1 time. Avoid excessive swinging of the patient's head and neck. In addition, oral care and skin care should be done to prevent complications. In the process of using the ventilator, we should closely observe the respiratory and circulatory indexes of patients, regularly check the blood gas analysis, control the PaCO of patients at 30 ~ 35 mm Hg, and remove the secretions in trachea, mouth and nose in time, so as to strengthen airway humidification, reduce sputum scab formation, keep the airway unobstructed, and prevent complications such as atelectasis caused by blocking trachea and bronchioles. 2.3.3 Sputum is sticky and difficult to be sucked out, which seriously affects lung ventilation and can be treated by tracheotomy and expectoration machine. The nursing of tracheotomy should be paid attention to: first, humidifying airway: 20 ml normal saline plus gentamicin 80 thousand u and chymotrypsin 4000U, or 20 ml normal saline plus mucosolvan 30 mg can be given oxygen atomization inhalation twice a day; Before sputum aspiration, ambroxol hydrochloride injection was dropped into trachea for 2 ~ 3 ml. Secondly, the room temperature should be kept at about 265438 0℃, the humidity should be kept at 60%, the tracheal intubation should be covered with two layers of wet gauze, and indoor ultraviolet disinfection should be carried out twice a day; Properly fix the intubation, keep the incision dry, observe the skin around the tracheal incision, and notify the doctor to deal with it actively if there are any abnormal conditions such as oozing blood, oozing liquid and subcutaneous emphysema. Daily tracheal intubation cleaning? 234 ? China Practical Medicine, June 20 10, Volume 5,No. 16, China Prac Ned, Jun 20 10, Vo 1.5,No. 16, cleaned and disinfected twice, and changed the incision gauze twice. The tracheal band should be replaced every three days. Pay attention to the tightness of the strap to accommodate one finger. Strict aseptic operation. When sucking sputum, suck the straw first, then suck the nose and mouth, and replace one sputum suction tube at a time. Generally speaking, the nursing of tracheotomy must be done well from three levels, namely, humidification, sputum aspiration and disinfection. 2.4 Psychological support to strengthen communication with patients and their families, and establish a good nurse-patient relationship. Analyze patients' psychological state through their exposed expressions, gestures and intonation, and judge whether psychological nursing is effective. Don't just pay attention to the changes of figures and numbers on the monitor and ignore the existence of patients. Because severe pneumonia gets better slowly, the course of disease is long, and most patients used to be in good health, once they get sick, they are under great mental pressure. Nurses should spend more time communicating with patients and their families, convey the information that the disease is getting better at any time, and enhance patients' confidence in overcoming the disease. 2.5 health education 2.5. 1 pay attention to the decrease of body resistance caused by infection in patients with respiratory isolation, and cross-infection is one of the causes of death. Therefore, according to the condition, our department is divided into rooms for treatment, sharing the same room with the same disease and reducing companionship. Disposable surgical masks are distributed to patients and their families to prevent cross infection. 2.S.2 Explain the relevant knowledge of swine flu to patients, so as to reduce the fear of patients and their families. Inform patients of the key points of fever care. 2.5.3 Inform bedridden patients of the methods and importance of turning over and knocking on their backs to prevent pressure ulcers and lung infections from aggravating. 2.5.4 Inform the patients about the precautions and adverse reactions. Such as adverse reactions of hormone drugs. 3 Summary Through the above targeted nursing measures, we can see that reasonable nursing measures are effective methods to shorten the course of severe pneumonia caused by influenza A and improve the cure rate ... References [I] Guo Qian, Zhou Xinlong, Zhou Honghua. Clinical analysis of 64 hospitalized children with severe pneumonia. Pediatric emergency medicine, 2005, 12 (1): 69. [2] Xian, Gao Yanfeng,. Nursing experience of 58 elderly patients with severe pneumonia. China modern internal medicine. 2 ( 1o)。 Nursing experience of severe pneumonia Hao (Yin, Department of Respiratory Medicine, Longnan Hospital, Daqing, Heilongjiang 1 63453) Modern nursing abstract Severe pneumonia refers to respiratory failure in addition to the common respiratory diseases of pneumonia, and other systems are obviously involved. Through the implementation of health education and humanized nursing for patients with severe pneumonia, this paper can effectively help patients improve their confidence in overcoming the disease, prevent complications, delay the development of the disease and improve the prognosis. Keywords nursing of severe pneumonia, Chinese picture classification number l R4 7 3, document identification number A1674-0742 (2010) 06 (a) A Clinical data 0158-01KLOC-0/This paper analyzed retrospectively 2000. 2. Nursing experience 2. 1 Basic nursing (1) Position: Patients with severe pneumonia, especially those who are unconscious, should take a semi-recumbent position, which is conducive to coughing up dry phlegm, relieving dyspnea and reducing the burden on the heart. The patient's head should be careful not to bend forward to prevent suffocation. (2) Rest: Patients with severe pneumonia must stay in bed, keep the air in the ward fresh, avoid convective wind, keep the temperature and humidity appropriate, avoid visiting, and keep quiet indoors and outdoors, which can reduce the energy consumption in the body and relieve the symptoms of hypoxia; Do not smoke, avoid all kinds of sudden noise, and exercise properly after remission. (3) Diet: According to the patient's condition, give light, digestible, nutritious and vitamin-rich semi-liquid food or general food, such as egg soup, vegetable soup and fish soup. Eat less and eat more, try to provide patients with a good dining environment and encourage them to eat, so as to supplement nutrition, enhance resistance and improve nutritional status. When you have heart failure, you should eat a low-salt diet. (4) Timely expectoration and improvement of alveolar ventilation function: For patients with various basic diseases, those who are weak in bed and have excessive and sticky sputum should be helped to turn over 65,438+0 times every 2 ~ 34 hours. At the same time, encourage patients to cough and pat their backs when exhaling, and promote the discharge of sputum. For those who are unconscious, mechanical sputum aspiration can be performed, attention should be paid to aseptic operation, and the pressure and action of sputum aspiration should be appropriate. (5) Oral care and bedsore care: Let patients rinse their mouths with normal saline to keep their mouths moist and clean. For the elderly, infirm, bedridden for a long time, and patients with inconvenient activities, bedsores are prone to occur. Assist or ask family members to help patients turn over and scrub, massage locally with 30% safflower alcohol, keep the bed clean, dry and flat, and do not use damaged toilets or forcibly plug in toilets. (6) Nursing of intravenous infusion: For patients with poisoning symptoms and severe wheezing, or when using antibiotics to treat infection, intravenous infusion should be carried out, and the amount of liquid should not be too much. Observe the dripping speed closely during infusion, keep the liquid dripping evenly, and don't be too fast or too slow in unit time to avoid pulmonary edema. If there is a rapid pulse, shortness of breath, sudden irritability, pallor, etc., you should immediately slow down the drip speed and notify the doctor for treatment. 2.2 Closely monitor vital signs and closely observe the patient's condition, such as consciousness, respiration, blood pressure, etc. Patients with severe pneumonia often faint and suffer from severe hypoxia if they have mental changes. It is necessary to find it in time and notify the doctor to deal with it in time. At the same time, it is necessary to analyze whether it is due to airway disorder or improper medication, and carry out comprehensive treatment according to different situations. The change of respiratory frequency and rhythm disorder are often the reaction of ventilation disorder and hypoxia of brain tissue; When blood pressure drops and body temperature does not rise, the possibility of toxic shock should be considered. 2.3 Observe the efficacy of drugs. Anti-infection is the main treatment for severe pneumonia. Pay attention to the curative effect of drugs, and observe whether there is fungal infection in the cavity after using a large number of antibiotics from China foreign medicine I:1.58; Clinical nursing requires us to execute the doctor's orders accurately and timely, be familiar with the side effects of drugs, closely observe the changes of patients before and after taking drugs, and prohibit respiratory stimulants when tracheal obstruction occurs. 2.4 Observe the changes of sputum and excrement. The increase of yellow phlegm and thick pus indicate that the infection is aggravated, which can be combined with atomized inhalation; Coughing up pink foam sputum indicates pulmonary edema; Being late is the result of gastrointestinal bleeding; Electrolyte should be replenished in time when urine volume increases, pulmonary edema and renal failure should be prevented when urine volume decreases, and patients with heart failure should accurately record the inflow and outflow. 2.5 Rational use of oxygen therapy is an important treatment measure for patients with severe pneumonia. However, the concentration and flow rate of oxygen inhalation should be strictly controlled in clinical nursing. Generally, nasal catheter method is used to absorb oxygen. If there are many nasal secretions or the symptoms of hypoxia do not improve after oxygen inhalation through nasal catheter, you should use a mask or hood to inhale oxygen. Symptoms of hypoxia improved, and oxygen inhalation was stopped after the condition improved. 2.6 Psychological Care In addition to medication and specialist care, such patients should also be supplemented by psychological care. Be close to patients, induce them to keep a good mood and avoid all kinds of mental stimulation. Nurses should have a good attitude towards patients, try to explain the problems raised by patients, make more rounds every day, establish trust between nurses and patients, and encourage patients to establish confidence in recovery. 2.7 Let patients and their families participate in nursing management. Nurses should educate their families and implement humanized management, so that family members can get material or spiritual help and support from patients' families, relatives, friends, units and other individuals or organizations. The strength of this power can relieve the pressure of patients and directly affect their physical and mental health, thus affecting their quality of life. Therefore, it is necessary to inform the family members of the patient's condition changes at any time, so that the family members can understand the patient's physical and mental pain and the law of disease prognosis. Nursing operation and basic nursing can get the understanding and cooperation of patients and their families as much as possible, and pay attention to the purpose and significance of informing, allowing patients to keep their personal privacy and their various lifestyles, working out a practical nursing plan with their families, providing appropriate personalized nursing, and meeting the physiological and psychological needs of patients to the greatest extent. Instead of just applying a standard care plan to all patients. Home care can greatly improve the quality of life of patients. Because once the patient is neglected and discriminated by his family, there will be negative emotions such as anxiety, depression and fear, which will make the patient's immune function decline and his condition deteriorate sharply, which is not allowed by our professional ethics. Reference [1] Luo Jun. Psychological care and nursing intervention for elderly patients [j]. China Journal of Modern Nursing, 2005,2 (3):147. Nursing countermeasures for elderly patients with severe pneumonia (Fuzhou 350003) Week, pneumonia in Feng and Lin is a common disease among the elderly, with a high mortality rate. The elderly are not sensitive to physical aging and organ function decline, so nursing is particularly important. The nursing countermeasures of 33 elderly patients with severe pneumonia admitted to our department are introduced as follows. 1 Clinical data 1. 1 General data: From June 2007 to June 2009, there were 33 cases of severe pneumonia in our department, including 2 cases of males and 2 cases of females. The age ranged from 67 to 92 years, with an average of 765,438 0.9 years. Clinical manifestations: fever in 20 cases (60.6%), chest tightness in 29 cases (87.9), cough and expectoration in 30 cases (90.9), lethargy, apathy and disturbance of consciousness in 8 cases (24.2). 1.2 diagnostic standard pupil of severe pneumonia]: disturbance of consciousness; Respiratory frequency >; 3O times/minute; PaO 2-LT6O mmHg, pao 2/fio2 (oxygen and index) ; 90 mmhg, urine volume >; 30 ml/hour. If the blood volume has been replenished, the urine volume is less than 400 ml/day, specific gravity.