Internal medicine is one of the levels of health qualification examination. Do you know what the knowledge of internal medicine nursing is? The following is the knowledge of internal medicine nursing that I brought to you. Welcome to reading.
1. Common symptoms of respiratory system (P 13): cough and expectoration, pulmonary dyspnea (inspiratory, expiratory and mixed dyspnea) and hemoptysis.
2. Correct oxygen therapy for pulmonary dyspnea.
General hypoxia without carbon dioxide retention: oxygen can be given at a general flow rate (2 ~ 4 l/min) and concentration (29% ~ 37%).
Severe hypoxia without carbon dioxide retention: oxygen can be given by mask for a short time, with intermittent high flow (4 ~ 6L/min) and high concentration (45% ~ 53%).
People with carbon dioxide retention due to hypoxia (pao 2
3. Nursing measures for hemoptysis and asphyxia:
1, rest and posture: rest with a little hemoptysis; A large number of hemoptysis is absolutely bedridden, assisting the patient to lie on his side. Take the affected lateral position.
2, diet care: people with large hemoptysis should fast, and those with small hemoptysis should eat a warm and cool liquid diet. Drink plenty of water, eat foods rich in cellulose, keep defecation unobstructed and avoid forced defecation.
3, symptomatic care: keep clean and comfortable, stabilize the patient's mood, can be given sedatives.
4. Keep the respiratory tract unblocked: those who have sticky sputum and are unable to cough up can suck sputum through the nasal cavity. The oxygen concentration should be appropriately increased before and after sputum aspiration in critically ill patients. Ask the patient to gently cough up sputum and hematocele in the trachea. When hemoptysis occurs, pat the back of the healthy side and tell the patient not to hold his breath, cough violently, sneeze or laugh, so as not to induce Hericium erinaceus spasm, which will lead to poor blood drainage, blood clots and suffocation.
5, medication care: when using pituitrin for massive hemoptysis, it is necessary to control the dripping speed. Hypertension, coronary heart disease, heart failure and contraindications for pregnant women. After applying sedatives and antitussive drugs, the elderly, the weak and the people with pulmonary insufficiency should pay attention to the suppression of respiratory center and cough.
Observe the characteristics of vital signs, consciousness, pupils, hemoptysis, etc., pay attention to whether there is any aura of suffocation, prevent suffocation, and keep the respiratory tract unobstructed.
6. Asphyxiation rescue: immediately take a prone position with head down and feet 45 degrees high, face to one side, pat the back, quickly expel blood clots in the airway and oropharynx, or directly stimulate the pharynx. If necessary, suction the sputum suction tube with negative pressure, and prepare and cooperate with tracheal intubation or tracheotomy.
7. Observation of illness: Observe the patient's vital signs, the amount, color, nature and bleeding speed of hemoptysis. (Precursor) Whether there are signs of suffocation such as chest tightness, shortness of breath, dyspnea, cyanosis, pallor, cold sweat and irritability, and whether there are manifestations of complications such as obstructive atelectasis, lung infection and shock.
How to effectively instruct patients to cough (P14);
(1) Try to take a semi-sitting and lying position, first take a deep breath and breathe slowly for 5-6 times, then take a deep breath until the diaphragm drops completely and hold your breath for 3-5 seconds, then shrink your lips, exhale slowly, take a deep breath and hold your breath for 3-5 seconds, lean forward, make a short and powerful cough from your chest for 2-3 times, and contract your abdominal muscles when coughing, or press it with your hands. Can also let the patient go to the prone position, with the help of diaphragm, abdominal muscle contraction, increase abdominal pressure, cough up phlegm.
(2) Changing body position frequently is beneficial to expectoration.
(3) For patients with chest pain who dare not cough, cough should be avoided to aggravate the pain. For example, if there is a wound in the chest, you can gently press both sides of the wound with your hand or pillow to make the skin and soft tissue on both sides of the wound shrink towards the wound, which can avoid the pain caused by expanding the chest and pulling the wound when coughing. When the pain is severe, you can give painkillers according to the doctor's advice, and take a deep breath after 30 minutes to effectively relieve cough.
8 several common pneumonia:
(1) Pneumococcal pneumonia is pulmonary parenchymal inflammation caused by pneumococcus, which is common in out-of-hospital infection and often manifests as lobar pneumonia. V is characterized by sudden onset, chills, high fever (up to 39 ~ 40℃), missed diagnosis of fever, cough with rusty phlegm and chest pain. There may be signs of lung consolidation in the middle of the course. V penicillin g is the first choice for treatment. V nursing is mainly for patients with high fever.
(2) Gram-negative bacilli pneumonia is mainly caused by Gram-negative bacilli infection. Often infected in the hospital. It is related to the low resistance of patients. The clinical symptoms are atypical. It is easy to be complicated with shock and multiple lung abscesses. V treatment is difficult and the mortality rate is high. The nursing emphasis is the nursing of shock pneumonia and the prevention of hospital infection.
(3) Fungal pneumonia can only occur under certain conditions, such as decreased immunity and long-term use of broad-spectrum antibiotics. V sputum is often white and sticky, and it is not easy to spit out. V is usually treated with fluconazole. Nursing is mainly to observe and gargle with 5% sodium bicarbonate solution.
Nursing care of patients with 9 P23 pneumonia;
A. Hyperthermia: stay in bed and do oral care; Give a liquid or semi-liquid diet with high calorie, high protein and high vitamins to encourage patients to drink more water; High fever should be cooled physically, and children should be prevented from convulsions. Aspirin or other antipyretic drugs should not be used to avoid sweating, dehydration and interference with the observation of heat type. Monitoring and observing vital signs; Take medicine according to the doctor's advice
B. cleaning the respiratory tract is ineffective:
(1) Environment and rest: room temperature 18-20℃ and humidity 50-60%. Quiet and comfortable ward environment, keep the indoor air fresh and clean, and pay attention to ventilation. In order to keep the patient comfortable, sit or semi-sit.
(2) Diet care: 1) A diet with high protein, high vitamins, high calories and low oil; 2) Drinking more than 1500ml of water every day has the following functions: a. To ensure the wetting of respiratory mucosa and the repair of diseased mucosa; B. it is beneficial to the dilution and discharge of sputum.
(3) Observation of illness (4) Promotion of effective expectoration 1) Effective cough (2) Humidification of airway: ① Prevention of asphyxia ② 10-20min is generally appropriate; ③ Humidification temperature is controlled at 35-37℃; Percussion of chest ① Percussion of each lobe1-3min; ② Avoid directly hitting the skin; It is recommended to use a single layer of thin cloth to isolate the force. The time should be 2 hours after meals to 30 minutes before meals. 4) Postural drainage 5) Mechanical sputum aspiration. Note: ① Inhalation time is less than 15s. ② The interval between sputum aspiration is more than 30 minutes. ③ The oxygen concentration should be increased appropriately. (5) Medication care: antibiotics, antitussive and expectorant drugs are given according to the doctor's advice. Anti-cough drugs such as codeine can inhibit cough reflex and aggravate the accumulation of sputum. Don't take it yourself.
C. Potential complications: septic shock: concave lying position, oxygen inhalation, blood volume supplement, use of vasoactive drugs and antibiotics, and disease monitoring.
12 Clinical classification, main characteristics and nursing measures of pulmonary tuberculosis P39:
(1) Primary pulmonary tuberculosis: X-ray chest film shows dumbbell-shaped shadows, namely primary focus, drainage lymphadenitis and hilar lymphadenopathy, forming a typical primary syndrome.
(2) Blood-group disseminated pulmonary tuberculosis: X-ray showed that both lungs were covered by miliary shadows with uniform size, density and distribution; Acute onset, systemic toxic blood symptoms, often accompanied by tuberculous meningitis.
(3) Secondary pulmonary tuberculosis: the most common type of pulmonary tuberculosis in adults.
1) infiltrative pulmonary tuberculosis: X-ray shows flaky and flocculent shadows, which can fuse to form cavities.
2) Cavity pulmonary tuberculosis: it is an important source of infection, and bacteria are often excreted through sputum.
3) tuberculoma: the cheese-like substance in the cavity is concentrated into a spherical lesion.
4) Cheese pneumonia: X-ray showed frosted glass shadow, with dense leaves, gradually dissolved areas and wormlike cavities.
5) Fibrocavitary pulmonary tuberculosis: One or more fibrous thick-walled cavities can be seen on one or both sides of the X-ray film, and the lung texture is weeping willow-like.
(4) Tuberculous pleurisy (5) Other extrapulmonary tuberculosis (6) Bacterial negative pulmonary tuberculosis.
Nursing measures:
A. Rest and activities: Patients with obvious symptoms of pulmonary tuberculosis should stay in bed, and outdoor exercise can be appropriately increased during the recovery period. Mild patients can work normally while insisting on chemotherapy, but pay attention to the combination of work and rest. Patients with non-infectious or low infectious diseases should be encouraged to live a normal family life and social life to alleviate their anxiety.
B. Drug therapy guidance: introduce relevant knowledge about drug therapy to patients and their families purposefully, planned and step by step; Emphasize the importance of early, combined, moderate, regular and whole-course chemotherapy, urge patients to take medicine according to the doctor's advice, and establish the habit of taking medicine on time; When explaining adverse drug reactions, we should pay attention to the therapeutic effect of drugs, make patients realize that the possibility of adverse reactions is small, and encourage patients to adhere to the whole process of chemotherapy; If you find any adverse reactions, contact your doctor in time and don't stop taking the medicine by yourself. Most of the adverse reactions can disappear completely after treatment. C. diet: eat foods with high calorie, high protein and high vitamins; Increase the variety of food, increase the appetite of patients, chew slowly and promote digestion and absorption.
19 clinical manifestations of pulmonary tuberculosis;
1) Systemic symptoms: fever is the most common (mostly long-term low-grade fever in the afternoon, the most typical), fatigue, loss of appetite, night sweats, weight loss, and menstrual disorders and amenorrhea may occur in women of childbearing age;
2) Respiratory symptoms: cough at night, expectoration (most typical), hemoptysis, chest pain and dyspnea.
Principles of chemotherapy for pulmonary tuberculosis: early, combined, moderate, regular and whole course.
Early stage: Once found and diagnosed, treat immediately.
Combination medication: two or more drugs are used in combination to ensure the curative effect.
Appropriate amount: too low affects the curative effect and is easy to produce drug resistance; Too large is easy to produce adverse reactions.
Regularity: Take medicine on time, and don't change the medication plan without authorization to avoid drug resistance.
Whole course: patients must adhere to the treatment plan and complete the course of treatment to improve the cure rate and reduce the recurrence rate.
2 1. Positive tuberculin test (OT test):
Flexion of left forearm. When the diameter of skin induration is measured at 48~72h, it is negative when it is less than or equal to 4mm, weakly positive when it is 5~9mm, strongly positive when it is 10~ 19mm, and strongly positive when it is greater than or equal to 20mm or lymphangitis. A strong positive indicates active pulmonary tuberculosis.
Prevention and control of tuberculosis: control the source of infection, cut off the route of transmission and protect the susceptible population.
(Measures to cut off the route of transmission) Conditional patients should be in a separate room; Pay attention to personal hygiene. No spitting. When coughing or sneezing, cover your nose and mouth with a double-layer tissue and burn it. Sputum left in the container must be disinfected and then discarded. Wash your hands with running water after touching sputum. Tableware is boiled for disinfection or soaked in disinfectant; Bedding and books are exposed to the sun for more than 6 hours; Wear a mask when going out; Ensure nutritional supplements.
23. The relationship between chronic obstructive pulmonary disease and chronic bronchitis and obstructive emphysema?
① Chronic obstructive pulmonary disease. ② Pulmonary function examination of patients with chronic bronchitis and/or emphysema shows that the airflow is limited and cannot be completely reversed. ② Chronic bronchitis is nonspecific inflammation of bronchus. Smoking, cold and respiratory infection are the most important causes, and the main symptoms are cough, excessive phlegm and asthma. Cough, phlegm and asthma last for three months every year for two years or more, and COPD can be diagnosed by excluding other diseases. Emphysema refers to the abnormal and continuous expansion of the distal air cavity of the pulmonary terminal bronchioles, accompanied by the destruction of alveolar walls and bronchioles, without obvious pulmonary fibrosis.
③ Patients with chronic bronchitis and/or emphysema can be diagnosed as COPD when the lung function examination shows that the airflow is limited and not completely reversible.
④ If the patient only has chronic bronchitis and/or emphysema without airflow restriction, the diagnosis of COPD is considered as high-risk period; ⑤ Bronchial asthma also has airflow limitation, but bronchial asthma is a special airway inflammatory disease, and airflow limitation is reversible and does not belong to COPD.
24 asthma P50( 1) stimulating factors (inducement):
Inhalable allergens: such as dust mites, pollen, fungi, animal dander, sulfur dioxide, ammonia and other specific inhalants.
B infection: such as bacteria, viruses, protozoa, parasites, etc.
C food: such as fish, shrimp and crab, eggs, milk, etc.
Class D drugs: such as propranolol and aspirin.
E others: climate change, exercise, pregnancy, etc.
(2) Clinical manifestations:
1) Symptoms: (typical) difficulty in exhaling and breathing; Paroxysmal chest tightness and cough; intestinal gurgling sound
2) Signs: there are signs of excessive expansion in the chest during the attack; A wide range of wheezing sounds can be heard in both lungs, and the exhalation sounds are prolonged. In severe cases, there may be increased heart rate, strange pulse, abnormal movement of chest and abdomen and cyanosis. However, wheezing sounds may not appear in mild asthma or very serious asthma attacks, which is called silent chest.
(3) Diagnostic points:
Recurrent wheezing, shortness of breath, chest tightness or cough are mostly related to contact with allergens, cold air, physical or chemical stimuli, viral upper respiratory tract infections and exercise.
During attack B, wheezing mainly in expiratory phase is scattered or diffused in bilateral lung engraving machines, and expiratory phase is prolonged.
C the above symptoms can be relieved by themselves or through treatment.
D does not include dyspnea, shortness of breath, chest tightness or cough caused by other diseases.
E. Patients with insignificant clinical manifestations have at least one of the following three items:
1) positive in bronchial provocation test or exercise test; 2) Bronchiectasis test is positive; The change rate of PEF in day and night is greater than or equal to 20%, and those who meet the above requirements of A~D or d and e can be diagnosed as bronchial asthma.
(4) Treatment points: hormone theophylline, oxygen therapy, anti-inflammation, acid correction and symptomatic treatment, atomized rehydration, first fast and then slow, first concentrated and then weak, first salt and then sugar, and then potassium supplementation in urine.
(5) Nursing diagnosis: ① Gas exchange disorder: related to bronchospasm, airway inflammation and increased airway resistance; ② Ineffective airway cleaning: related to bronchial mucosal edema, increased secretion, sticky sputum and ineffective cough; ③ Lack of knowledge: lack of knowledge about the correct use of metered-dose inhalers; (6) Nursing measures P57.
25. Chronic pulmonary heart disease
Concept: Chronic pulmonary heart disease is a kind of heart disease with or without right heart failure, which is caused by chronic lesions of lung tissue, pulmonary vessels or chest cavity, resulting in increased pulmonary vascular resistance and pulmonary artery pressure.
Etiology: chronic bronchial and pulmonary diseases: the most common cause of COPD in China; Severe thoracic deformity; Pulmonary vascular diseases; Others: neuromuscular diseases, sleep apnea syndrome, etc.
Pathogenesis: Formation of pulmonary hypertension (1) Functional factors (hypoxia, hypercapnia, acid respiration). (2) Anatomical factors (exacerbation of chronic bronchitis, destruction of alveolar wall, destruction of capillary network, anatomical remodeling of pulmonary vessels).
The potential complication is pulmonary encephalopathy (pulmonary encephalopathy, also known as carbon dioxide anesthesia), which appears with the aggravation of carbon dioxide retention in respiratory failure. Manifestations are: apathy, muscle tremor or flapping-wing tremor, convulsion, lethargy, coma, etc. ) Pulmonary encephalopathy is the main cause of death of chronic pulmonary heart disease.
Medication and nursing precautions of using diuretics (1): Observe urine volume and electrolytes, and correct water-electrolyte disorder in time according to the doctor's advice. (2) Use digitalis: correct hypoxia and hypokalemia according to the doctor's advice before use, and pay attention to observe the side effects and toxic side effects. (3) Using vasodilators: Pay attention to the observation of heart rate and blood pressure. (4) Use antibiotics: Observe whether the infection is under control and whether there is secondary fungal infection. Main clinical manifestations: decompensated respiratory failure and right heart failure.