(1) myocardial injury

Such as coronary heart disease, myocardial ischemia, myocardial infarction, myocarditis and cardiomyopathy; Diabetic cardiomyopathy is the most common disease of myocardial metabolic disorder.

(2) Long-term cardiac overload

Excessive post-ventricular load (pressure load), such as hypertension, pulmonary hypertension, aortic stenosis, etc.

Mitral valve insufficiency, aortic valve insufficiency and systemic blood volume increase (hyperthyroidism, chronic anemia, pregnancy) can lead to premature ventricular overload (volume load).

What should be observed in heart failure

① Observe the growth and decline of edema.

② Monitoring patients' dyspnea: According to the severity of hypoxia, adjust oxygen flow and oxygen supply mode, generally 2 ~ 4l/min, and patients with cor pulmonale should continue to take oxygen at 65,438+0 ~ 2l/min.

③ Closely observe the changes of body temperature, cough, expectoration and breath sounds. Prevention and timely detection of lung infection.

④ Observation of defecation: Keep defecation unobstructed. Crude fiber food should be added to the diet, and laxatives should be taken orally or anus should be opened when necessary.

⑤ Regularly monitor blood electrolytes and acid-base balance.

⑥ Observe the physical condition.

Treatment of low liquid level of Murphy's dropper for intravenous infusion

(1) Regardless of whether there are adjustment holes in the side wall of the dropper, you can clamp the infusion tube at the lower end of the dropper and squeeze the dropper by hand. When the liquid level in the dropper rises to the required height, you can loosen the infusion tube at the lower end and continue infusion.

(2) If the side wall of the dropper has an adjusting hole, the infusion tube can also be clamped at the lower end of the dropper and the adjusting hole can be opened. When the liquid level rises to the required height, the adjusting hole can be closed and the infusion tube at the lower end can be loosened to continue infusion.

Treatment of non-dripping during intravenous infusion

(1) Needle slipped out of vein: liquid was injected into subcutaneous tissue, showing local swelling and pain; The needle should be pulled out and replaced, and another vein should be inserted.

(2) The inclined plane of the needle clings to the vein wall, showing that the liquid drops poorly or does not drop; The needle position should be adjusted or the limb position should be changed appropriately.

(3) Confirm that the needle is blocked: it can be confirmed that the needle is blocked because the liquid medicine does not drip, and there is resistance when the infusion tube is gently squeezed, and there is no blood return; The needle should be pulled out, replaced and re-punctured.

(4) Low pressure: because the position of the infusion bottle is too low, the patient's limbs are lifted too high or the peripheral circulation is poor; The height of the infusion stand can be appropriately raised to raise the infusion bottle, increase the pressure, or lower the limbs of the patient.

(5) Venous spasm: the patient's punctured limbs are exposed to cold environment for a long time, or the temperature of the input liquid medicine is too low, which leads to venous spasm; Local hot compress and massage can be performed to dilate veins and promote blood circulation.

Basic nursing care of threatened premature delivery

Bed rest is one of the effective methods to treat threatened premature delivery. High-risk pregnant women need to stay in bed absolutely, and the left lateral position is suitable, which can reduce the pressure of inferior vena cava, increase blood flow, reduce spontaneous contractions, relieve the right position of uterus, increase uterine blood circulation, improve fetal oxygen supply and nutritional metabolism, and be beneficial to fetal growth and development. Avoid activities that cause uterine contraction, such as lifting heavy objects and having sex, and be careful of anal examination and vaginal examination. Keep the perineum clean and dry to prevent infection. Keep the environment quiet, the air in the ward is fresh, and do the corresponding life care. Adhere to adequate rest and a happy mood, because mental stress will lead to the contraction of small blood vessels in the whole body, leading to high blood pressure; On the other hand, sleep disorder caused by stress will also aggravate the progress of the disease. Monitor fetal heart rate 1 time every 2 ~ 4 hours, teach pregnant women to count fetal movements, observe fetal movements regularly, and closely observe vital signs and conscious symptoms of pregnant women. Actively treat complications and prevent premature delivery.

Crystal solution commonly used in nursing

(1) glucose solution: commonly used are 5% glucose solution and 10% glucose solution, which can supply moisture and heat energy.

(2) Isotonic electrolyte solution: used to supply water and electrolyte. Commonly used solutions are 0.9% sodium chloride, 5% glucose sodium chloride and compound sodium chloride.

(3) Alkaline solution: it can correct acidosis and adjust acid-base balance. Commonly used are 5% sodium bicarbonate, 1 1.2% sodium lactate solution.

(4) Hypertonic solution: diuresis and dehydration, commonly used 20% mannitol, 25% sorbitol and 25% ~ 50% glucose.

Principles of disinfection and sterilization

(a) clear the main disinfection targets

The route of infection, the vectors involved and the types of pathogenic microorganisms should be analyzed in detail, and disinfectants should be used in a targeted manner.

(two) take appropriate disinfection methods.

According to the disinfection object, choose a simple, effective, non-destructive, abundant and affordable disinfection method.

According to the degree of harm caused by pollution and the different contact parts in the human body, hospital diagnosis and treatment equipment can be divided into three categories:

1. High-risk equipment enters sterile tissues or organs through skin and mucosa, or equipment that is in close contact with damaged skin and mucosa, such as surgical instruments, syringes, pacemakers, etc. Efficient disinfection (sterilization) must be selected.

2. Moderately dangerous equipment is only in close contact with skin and mucous membrane, and does not enter sterile tissues, such as endoscopes, thermometers, oxygen tubes, ventilators and their accessories, anesthesia instruments, etc. Intermediate disinfection should be used to kill all kinds of microorganisms except spores.

3. Low-risk equipment and articles do not enter human tissues or contact mucous membranes, but only directly or indirectly contact healthy and undamaged skin. If there is not enough pathogenic microorganism pollution, it is generally harmless, such as masks, clothes, medicine cups and so on. , you should choose inefficient disinfection methods or only do general sanitation treatment. Only common bacterial propagules and lipophilic viruses need to be removed.

(3) control the factors that affect the disinfection effect

Many factors will affect the function of disinfectants, and the sensitivity of various disinfectants to these factors varies greatly.

1. Types of microorganisms Different kinds of pathogenic microorganisms have different resistance to disinfectants, so they must be treated differently during disinfection.

(1) Bacterial propagules are easily destroyed by disinfectants. Generally, Gram-positive bacteria are sensitive to disinfectants, while Gram-negative bacilli are often more resistant. The transmitter is sensitive to heat, and the disinfection method is mainly thermal disinfection.

(2) Bacterial buds have the strongest tolerance to disinfection factors, and the most reliable methods to kill bacterial buds are thermal sterilization, ionizing radiation and ethylene oxide fumigation. Among chemical disinfectants, glutaraldehyde and peracetic acid can kill spores, but their reliability is not as good as thermal sterilization.

(3) The tolerance of viruses to disinfection factors varies greatly from species to species, and hydrophilic viruses are more tolerant than lipophilic viruses.

(4) Fungi are resistant to dryness, sunlight, ultraviolet rays and most chemicals, but not to heat (killing at 60℃ 1 hour).

2. Microbial quantity: The more contaminated microorganisms, the longer the disinfection time and the greater the dosage.

3. Existence of organic matter: ① Organic matter forms a protective layer on the surface of microorganisms, which hinders the contact between disinfectants and microorganisms or delays the action of disinfectants, so that microorganisms gradually develop adaptability to drugs. (2) Organic substances react with disinfectants to produce compounds with low solubility or weak bactericidal effect. ③ Some disinfectants react with organic substances, but the microbial concentration decreases. ④ Organic matter can neutralize some disinfectants. Heavy metals and surfactants in disinfectants are greatly influenced by organic matter, but have little influence on glutaraldehyde.

4. Temperature: With the increase of temperature, the bactericidal effect is enhanced, but the change of temperature has different effects on various disinfectants. If the humidity of formaldehyde, glutaraldehyde and ethylene oxide increases 1 times, the sterilization effect can increase 10 times. Phenols and alcohols are less affected by temperature.

5.PH value: it affects sterilization from two aspects: ① it affects disinfectant: it changes its solubility and molecular structure. ② Too high or too low pH will affect the growth of microorganisms. Under acidic conditions, the negative charge on the surface of bacteria is reduced, which has a good bactericidal effect. Under alkaline conditions, the negative charge on the surface of bacteria increases, which is beneficial to the function of cationic disinfectant.

6. Dosage and monitoring: ensure disinfection and sterilization dosage, strengthen effect monitoring, and prevent secondary pollution.

Introduction of laying method of aseptic therapeutic towel

1. Folding method of sterile therapeutic towel. Fold the double-layer cotton treatment towel horizontally twice, then fold it inward, and turn the opening edges outward respectively to align.

2. Laying method of aseptic treatment towel. The outer corners of the two openings of the hand-held therapeutic towel are unfolded in double layers and unfolded from the far end to the near end in the therapeutic tray. Hold the two outer corners of the upper layer of the treatment towel with both hands, and fan up to fold the three layers, with the inner surface facing outward.

3. Put the required sterile articles into the sterile area, cover the upper sterile towel, align the edges of the upper and lower layers, and fold the excess parts upwards.

Nursing points of phlebitis

Phlebitis refers to inflammation of venous blood vessels. Phlebitis can be divided into superficial phlebitis and deep phlebitis according to different lesion sites. Its pathological changes include intimal hyperplasia, lumen stenosis and slow blood flow. Congestive erythema can appear on the surrounding skin, sometimes accompanied by edema. After that, it gradually subsided, the congestion was replaced by pigmentation, and the erythema turned brown. A few patients can cause reactions, such as chills, fever and leukocytosis. Patients often complain of pain and swelling.

Phlebitis nursing is a knowledge in basic nursing, and the principle of phlebitis nursing is to avoid infection and reduce the stimulation to blood vessel wall.

1) Strictly implement the principle of aseptic operation to prevent infection; Drugs that are irritating to the blood vessel wall should be fully diluted before infusion, so as to slow down the infusion speed and prevent drugs from overflowing veins; Intravenous medication should be planned, and the infusion site should be changed frequently to protect the vein; When using intravenous indwelling needle, catheter with no irritation or little irritation should be selected, and the indwelling time should not be too long.

2) Stop local infusion immediately, raise the affected limb and brake it, and use 95% ethanol or 50% magnesium sulfate for local hot compress and wet compress.

3) External application of Ruyi Huangjin Powder.

4) ultrashort wave physiotherapy.

5) If infection occurs at the same time, antibiotic treatment can be given according to the doctor's advice.

Adaptability and operation of bed bath method

Bathing in bed is suitable for patients who stay in bed in summer, not for elderly and frail patients.

Operation method:

Take things to bed and explain to the patient. Put the sink under the patient, then inflate it to make a trough-shaped washbasin to stand around, put warm water at about 40℃, and put a screen around the bed to help the patient take off his clothes and trousers and take a bath. After cleaning, open the drain hole at the lower end to discharge the sewage, then plug the drain hole to change the water, rinse off the sewage, dry the whole body, remove the sink, put on clean clothes and pants, and make the bed unit. This method saves manpower and time, and it is thoroughly cleaned.

There is also a bed basin made of polyethylene plastic sheets, which consists of a basin body, an inflatable pillow, an inflatable valve, a drain valve and a plastic pipe. Inflatable rubber boats are small in size and easy to operate.

Introduction of special examination of intestinal obstruction

The most helpful special examination for intestinal obstruction is abdominal plain film and barium enema.

Abdominal plain film in upright position can show flatulence. When the intestinal cavity is inflated, the jejunal mucosa folds like "fishbone", and the colon can show colonic pouch. The intestinal cavity expands above the obstruction. When the small intestine is completely obstructed, the colon will not be displayed. Left colon obstruction, right colon will swell. When the lower colon is blocked, the left colon can expand.

However, it should be reminded that barium enema can be used for patients suspected of colon obstruction, which can show the location and nature of colon obstruction. However, gastrointestinal barium meal radiography is not suitable for acute obstruction of small intestine, so as not to aggravate the condition. Water-soluble contrast agents are much safer.

Although the familiar B-ultrasound examination is simple and convenient, the diagnosis effect is affected by flatulence, and the accuracy of ct diagnosis is better than that of B-ultrasound, which can diagnose obvious solid masses or hydrops outside the intestinal cavity. Sometimes abdominal CT can also find the cause and pathological changes of intestinal obstruction, providing important information for surgery.

Guidance education program for schizophrenia

After the patient's self-knowledge is restored, introduce the contents of disease knowledge and health education to the patient, help the patient to build up the confidence and ability to return to society, and teach the patient how to respect others and family members and gradually return to normal life.

Guide family members to learn relevant knowledge, treat the symptoms of mental patients correctly, respect patients' care for their loved ones, create a good home care environment for patients after discharge, let patients have extensive contact with real life, participate in housework as much as possible, gradually adapt to social life, keep close contact with the surrounding environment, and improve their mental state, so as to avoid mental decline caused by long-term hospitalization and social isolation.

Teach patients to take medicine on time and actively cooperate with the treatment. Teach patients how to avoid all kinds of mental stimulation and prevent the recurrence of the disease. Such as the law of life, pay attention to the combination of work and rest, overcome personality defects, maintain good interpersonal relationships, correctly treat and handle events in life, adapt to and correctly handle related social contradictions, eliminate inferiority and dissatisfaction, and establish a strong will.

Mouth-to-mouth resuscitation and mouth-to-mouth resuscitation

Mouth-to-mouth artificial respiration is a quick and effective ventilation method. Specific methods: press the thumb and forefinger of one hand on the forehead to hold the patient's nostrils, and open the patient's mouth with the thumb of the other hand. After the rescuer takes a deep breath, open his mouth close to the patient's mouth, completely wrap the patient's mouth in a sealed manner, and slowly blow air for more than 2 seconds each time to ensure that the chest is raised when breathing. In order to reduce flatulence, most adults need to give 10ml/kg tidal volume for more than 2 seconds, which can provide enough oxygen. Immediately after blowing for the first time, separate from the patient's mouth, gently raise your head, look at the patient's chest and breathe in fresh air, and relax your hands holding your nose. At this time, the patient's chest collapses downward, and the airflow is exhausted from the nose and mouth. The ventilation frequency is 10 ~ 12 times/minute.

In some cases, mouth-to-mouth resuscitation is impossible, such as clenching teeth, serious oral injury or the rescuer can't completely wrap the patient's mouth tightly. Mouth-to-mouth artificial respiration should be used at this time. Specific methods: press one hand on the forehead, so that the patient's head leans back, and lift the jaw with the other hand and shut up. The rescuer takes a deep breath, then wraps the patient's nose with his mouth and blows hard into the patient's nostrils.

Brief introduction to the location/nature of abdominal pain in acute abdomen

The characteristics of acute abdominal pain are as follows:

The site of abdominal pain

The first site may be the primary site of the lesion. For example, perforation of gastric and duodenal ulcers begins with upper abdominal pain. During perforation, digestive juice flows to the lower abdomen, and abdominal pain spreads to the right lower abdomen or even the whole abdomen, which is easy to mix with appendicitis perforation. Acute appendicitis is metastatic abdominal pain, which starts from navel or upper abdomen and is inflammatory and irritating visceral pain. When the inflammation spreads to the serosa or peritoneum around the appendix, it shows pain in the right lower abdomen. The most obvious part of abdominal pain is often the most serious part. If there is peritoneal irritation, it often indicates peritonitis in this area. As mentioned above, the affected part of abdominal pain is also helpful for differential diagnosis.

The nature of abdominal pain

Persistent severe dull pain, patients used to lie on their side and bend their knees in order to relieve abdominal pain. Cough, deep breathing and talking loudly all aggravate the pain, and the location is accurate, suggesting that the inflammatory stimulation of the peritoneal wall in this area-acute peritonitis. Persistent distending pain is often aggravated by visceral peritoneal dilatation and compression, such as paralytic intestinal obstruction and liver tumor. Paroxysmal colic is caused by paroxysmal spasm of smooth muscle in hollow organs, which often suggests that there are obstructive factors in digestive tract, biliary tract or ureter, such as mechanical intestinal obstruction, biliary calculi, ascaris lumbricoides, stenosis or tumor, ureteral calculi and so on. Persistent pain is paroxysmal aggravation, which is characterized by coexistence of obstruction and inflammation. It is common in strangulated intestinal obstruction, bile duct stones complicated with cholangitis, gallbladder stones complicated with cholecystitis and other early stages.

Abdominal pain degree

It can be divided into mild (dull pain), moderate and severe (severe pain), indicating that the lesions are mild, moderate and severe respectively, but they are also different due to different tolerance levels of individuals.

Overview of blood viscosity

Overview of blood viscosity: The relative viscosity of blood or plasma relative to water is usually measured in vitro. At this time, the relative viscosity of blood is 4 ~ 5, and the relative viscosity of plasma is 1.6 ~ 2.4. The viscosity of whole blood mainly depends on the number of red blood cells, and the viscosity of plasma mainly depends on the content of protein in plasma. The viscosity of so-called "ideal liquids" in physics, such as water and alcohol, does not change with the flow rate, while the viscosity of blood is similar to that of ideal liquids with fast blood flow rate (such as in arteries) and does not change with the flow rate; However, when the blood flow rate is less than a certain limit, viscosity is inversely proportional to the flow rate. This is mainly because when the blood flow is slow, red blood cells can overlap or aggregate into other forms of particles, which increases the viscosity of blood.

When the blood flow velocity of microenvironment is obviously slowed down due to a certain disease, red blood cells overlap and gather in it, which causes great resistance to blood flow and affects normal circulation; At this time, plasma albumin or low molecular dextran can be injected to increase the scouring force of blood flow and disperse red blood cells.

The concept of human growth and development

(1) concept: growth and maturity.

(2) Content: 1. Physiology; 2. Cognitive aspect; 3. Social aspects; 4. Emotional aspects; 5. Spiritual aspect; 6. Moral aspects.

(3) Basic principles

1. Growth and development are carried out in a continuous, orderly, regular and measurable way.

Everyone has to go through the same stage of development.

3. Everyone's development has their own unique personality, and they all go through it in a unique way and speed.

4. Each development stage has certain characteristics and certain development tasks.

Everyone's basic attitude, temperament, lifestyle and behavior will be influenced by the development of infancy.

6. Development is achieved through gradual maturity and continuous learning.

Factors affecting growth and development

Genetic factors and environmental factors (family, school); Factors such as religion, culture, society, study and life experience will all affect the growth and development of individuals.

Psychological nursing of parturient during cesarean section

1, the operating room must be neat and clean, the sheets should be free of blood, the surgical instruments should be covered, the doctors and nurses should be dignified and generous, have a kind attitude and kind words, so that the parturient can feel safe.

2. During the operation, doctors and nurses should pay attention to the emotional changes of the parturient and comfort them in time when they are excessively nervous. They shouldn't talk and laugh, nor should they whisper to each other. The impact sound of surgical instruments should be reduced and lightened as much as possible to avoid all adverse stimulation to the parturient.

3. Nurses should closely observe the general situation of parturient and fetal heart rate, find problems as soon as possible and deal with them decisively. Visiting nurses always accompany the parturient, explaining that there will be some discomfort during the operation, such as discomfort and pain when pulling organs or taking out the fetus, and telling the parturient to take a deep breath. Tell the parturient the sex and development of the fetus and the benefits of breastfeeding in time after delivery, so as to start early, suck early and get in touch early.

Correct use of blood drawing belt

Blood-expelling belt is commonly used in limb trauma surgery, which can obviously reduce intraoperative bleeding, provide a clear surgical vision for the operator, reduce intraoperative blood preparation and blood transfusion, and reduce the economic burden of patients. However, due to the different conditions of some patients, improper use may bring adverse effects and even serious complications to patients. Based on our many years' experience, this paper systematically introduces the specific use method, contraindications and matters needing attention of blood drive belt.

1 How to use the blood exchange belt

At present, the blood displacement belt is made of rubber sheet with good elasticity, beige in color, about 15cm wide, and its length can be cut by itself according to needs, generally about 1m, and it can be fumigated or boiled by gas before use.

Before use, fold the blood drive belt into two layers about 7cm, and then roll it into a roll. After disinfecting the affected limb, raise the affected limb to the level of the heart. This will take a little time. Firstly, one end of the blood drive belt is tightened from the extremity and wound around the proximal end, and no soft tissue is allowed to be embedded between each turn until it is wound around the root of the limb, so that the blood in the soft tissue of the surgical limb can be driven away from the limb. When winding the last lap, first pad the local skin with sterile gauze, and then tie it with another tourniquet to avoid soft tissue injury. Finally, loosen the blood drive belt from the proximal end to the proximal end. If there is an inflatable tourniquet, wrap it around the last lap of the blood-driven belt, inflate the airbag to about 300mmHg (children can inflate it to about 150mmHg), keep the pressure constant, and inform the anesthesiologist to record the start time of the blood-driven belt. The inflation time should not exceed 60 minutes. If the operation is done properly, the limbs will be pale after blood drawing, the peripheral artery will not pulse, and there will be no blood flow after skin incision.

2 Matters needing attention when different patients use blood-driven belt

(1) Patients with limb fractures, especially comminuted or open fractures, may displace broken bone fragments and aggravate the damage to local blood vessels and nerves due to the need to repeatedly wind the blood drive belt on the affected limb. It should be used with caution. When necessary, the assistant must pull the distal end of the affected limb as far as possible to maintain the physiological position of the affected limb to the maximum extent and prevent the affected limb from twisting into an angle. The open wound should be padded with sterile gauze first, and then bandaged with a blood-expelling belt.

(2) For patients with foreign bodies in the soft tissue of the affected limb, the blood-expelling belt should not be used, because the squeezing of muscles during the winding of the blood-expelling belt may lead to the displacement of foreign bodies.

(3) For patients with varicose veins and thrombosis, it is not advisable to use blood drawing tape during operation, because blood drawing may lead to thrombus shedding and serious complications.

(4) For tumor patients, especially patients with malignant tumors, it is not appropriate to use blood-expelling belt in limb surgery, because blood-expelling may cause tumor cells to fall off and transfer with blood.

(5) For patients with congestive heart failure and right heart failure, it is not advisable to use a blood-expelling belt, because winding a limb with a blood-expelling belt, especially the lower limb, can increase the blood volume of patients by about 500ml in a short time and increase the circulatory burden. Acute congestive heart failure occurred.

(6) Patients who have obvious allergic reaction to rubber should wrap the affected limb with sterile bandage first, and then use the blood drive belt to drive blood, so as to complete the operation as soon as possible.

(7) After the operation, before closing the wound, loosen the tourniquet, fully ligate the active bleeding, and check the blood supply and arterial pulsation at the distal end of the limb. After confirmation, close the incision and record the time to loosen the tourniquet.