Objective: To explore the role of nursing safety management methods and approaches in hospital transport of critically ill patients. Methods: Assess the condition and risk of critically ill patients before transport, implement the nursing safety management mode in the hospital transport of critically ill patients, pay attention to the condition observation and pipeline nursing during transport, and make oral and written handover of critically ill patients. Results: The safety of in-hospital transport nursing for critically ill patients was improved. Conclusion: The hospital transport management for critically ill patients can shorten the transport time, improve the transport efficiency and reduce the incidence of adverse events and accidents during transport.
Critically ill patients; Transportation in hospital; Safety nursing
China Library Classification Number R473 Document Identification Number B1004-4949 (2014) 02-0228-01
It is important and necessary to do a good job in the safe nursing of all kinds of critically ill patients in transit for their treatment, prognosis and rehabilitation [1]. Since 2011110, our hospital has strengthened the management of safe transport of critically ill patients in the hospital and reduced the occurrence of adverse events and accidents. The report is as follows.
1 data and methods
1. 1 Clinical data: 600 critically ill patients are safely transported in the intensive care unit every year, including 346 males and 254 females; Age 16 ~ 90 years old, with an average of 45 years old; 80 cases of internal medicine patients and 520 cases of major surgery patients were transferred back to the ward after their condition was stable, and 6 cases died.
2 nursing methods
2. 1. Care before transportation
2. 1. 1 Introduce yourself to patients and their families before transportation, explain the purpose and necessity of transportation, and get their maximum cooperation. It received cooperation.
2. 1.2. Pre-transport condition assessment The condition of critically ill patients is complex, dangerous and changing rapidly, and there may be different degrees of complications and some unexpected situations during transport. Therefore, it is the key for nurses to accurately and comprehensively evaluate the patient's condition before transferring the patient [2]. The nurse on duty must fully understand and evaluate the condition of all patients before transferring to hospital. According to the evaluation, make corresponding preparations.
2. 1.3 For potentially dangerous patients, such as patients with severe craniocerebral trauma and massive cerebral hemorrhage, the factors that increase intracranial pressure should be removed as much as possible, including sputum aspiration before transport, control of restlessness, raising head during transport, and appropriate restraint. , and bring a portable sputum aspirator; For coma patients, oropharyngeal snorkel, artificial respiration skin and tracheal intubation should be prepared. For tracheostomy, the fixation of artificial airway should be checked, and the fixation should be strengthened if necessary to prevent the intubation from falling off or shifting.
2. 1.4. Check whether the venous access is unobstructed and the connection is tight. It is best to use intravenous indwelling needle for infusion to ensure effective venous access during transportation.
2. 1.5 preparation of articles, medicines and instruments needed for transshipment; Prepare different rescue drugs according to the patient's condition, such as adrenaline, atropine, lidocaine hydrochloride, nikethamide, lobeline, diazepam, sodium lactate ringer's solution, etc. At the same time, prepare a good electric monitor, oxygen bag, simple breathing airbag, sputum aspirator, etc. , and prepare a portable ventilator when necessary.
2. 1.6 Strengthen effective communication and coordination with ICU. Before transport, inform ICU to make corresponding preparations, and inform patients about the basic situation, including patients' initial diagnosis, current vital signs, drugs and instruments that need to be prepared, so as to reduce waiting time and win time for patients' diagnosis and treatment.
2. 1.7 Nursing care during transportation. Nurses in charge of transshipment should have a strong sense of responsibility, accurate judgment and the ability to work independently and deal with problems in an emergency. If the patient's vital signs are unstable, at least two accompanying personnel are needed during transportation, and a competent doctor is required to accompany him.
2. 1.8 Preparation by the receiving department. The preparation of the receiving department is also very important. Before transshipment, you should call the relevant departments to make corresponding preparations. If the patient has an artificial airway and uses a ventilator, it should be informed in advance to inform the patient of the basic situation. Before departure, reconfirm that the receiver has made relevant preparations, inform the patient of the arrival time or contact the inspection department to find out the exact time, so as to ensure that it can be completed on demand.
2.2 Nursing during transshipment:
2.2 Nursing in transit.
2.2. 1 Monitoring vital signs.
Keep a close eye on all kinds of pipelines. Check whether the pipeline is in place and fixed correctly. Check whether the pipes are firmly fixed one by one from head to toe, and tighten the joint of the joint and tee. Keep all kinds of pipelines unblocked and effective, and prevent twisting, pressing and slipping. Pay attention to the color, nature and quantity of drainage fluid. Ensure smooth intravenous infusion during transportation, so as to take medicine during rescue. Clamp drainage tubes that can be temporarily closed, such as urinary catheter and partial abdominal wound drainage tubes, and fix the clamped tubes and drainage bags on the patient's abdomen.
2.2.2 During transshipment, keep the flat car at a steady speed to prevent bumping, and keep the head at the end of the big wheel, which can reduce the vibration due to the slow and steady speed of the big wheel. When going up and down the slope, the patient's head is always at the high end so as not to cause discomfort to the patient. Pay attention to keep warm in winter, and cover the patient in summer and rainy days. Soothe and restrain emotional patients to prevent patients from falling and getting hurt.
2.2.3 Handling of complications in transportation. Once serious complications occur, they should be rescued on the spot, and at the same time, contact the relevant departments in order to get specialist treatment.
2.2.4 Monitoring and recording during transportation. During transportation, the patient's vital signs, blood oxygen saturation, patient's conscious state, breathing frequency and breathing pattern should be closely monitored, and the values of various monitoring indexes, conscious activity state during transportation, rescue and treatment should be recorded.
2.2.5 do a good job in succession. After arriving at the receiving department, make a good handover with relevant personnel. The contents of handover include the patient's diagnosis, consciousness, pupil, vital signs, oxygen flow, the names of various pipes and the depth of implantation, drainage fluid, special medication, skin condition, etc.
3 discussion
3. 1 The management of safe transport of critically ill patients in hospital is of great significance. The transport of critically ill patients is a very important link in the treatment process. Proper operation can not only harmonize the relationship between doctors and patients in the process of patient treatment, but also reduce legal disputes. As nursing management, nursing safety management should be put in the first place. According to the literature, 1 1. 6% of critical patients have different degrees of complications and accidents. Through the predictive nursing procedure, the incidence of adverse events, such as falling off the bed, falling off the tube, worsening condition and cardiac arrest, can be significantly reduced. Attention should be paid to keeping the respiratory tract unobstructed, and sputum should be sucked in time when there is phlegm to prevent suffocation caused by phlegm blockage. Patients with craniocerebral trauma should have a safe and suitable posture when carrying, such as supine position. In order to prevent vomit from being inhaled by mistake, the head of patients with cerebrospinal fluid otorrhea is tilted to the affected side, and patients with cervical spine injury are fixed with neck support. When moving patients with hemopneumothorax, the closed thoracic drainage tube should be clamped to prevent the catheter from falling off, air leakage or liquid backflow. Pay attention to check all kinds of catheters in patients with gastric cancer and intestinal cancer after operation, keep them unobstructed and properly fixed to prevent them from falling off, folding and twisting. After the patient returns to the department, the senior responsible nurse or nursing team leader will re-evaluate the patient and observe the condition.
3.2 Pretreatment of critically ill patients before and during in-hospital transport is an important measure to reduce risks and ensure the transport safety of high-risk critically ill patients. Clear the secretions and aspirates in the airway before transport. Patients with dyspnea or low oxygen saturation should be intubated in advance to keep the airway unobstructed. The bleeding site should be effectively bandaged for hemostasis and blood transfusion. Patients with hemorrhagic shock should be expanded. Patients with heart failure should be adjusted with vasoactive drugs micropump. Patients with intracranial hypertension should be treated with dehydrating agent. In the case of hemopneumothorax, the chest cavity should be closed for drainage and the fracture site should be fixed. Observe the condition closely during transportation, deal with airway secretions in time, adjust the ventilator mode, stabilize blood pressure (such as speeding up the infusion and drip of vasoactive drugs), correct serious arrhythmia (such as ventricular fibrillation), and stabilize various pipes and splints. Through these predictive treatments, the transport safety factor of critically ill patients is obviously improved.
4 abstract
The purpose of in-hospital transport of critically ill patients is for better treatment and nursing. In-hospital transport may lead to changes in patients' vital signs, and even aggravate their illness, leading to different degrees of complications. Therefore, appropriate and safe nursing methods must be adopted to transport patients to ensure the safety and effectiveness of medical care services provided for patients. Successful transshipment is of positive significance to reduce the mortality and disability rate of critically ill patients.
refer to
[1] Wang Guanmin, Liu Xiying. Safety management of hospital transport of patients undergoing thoracotomy [J]. Nursing Research, 2009, 23 (Supplement 1): 129.
[2] Tang Meizong. Safety management of hospital transport of critically ill patients [J]. Nursing Research, 20 10/0,24 (1):105 ~106.
Mode 2: Nursing experience of enteral nutrition for critically ill patients Objective To explore the nursing measures of enteral nutrition for critically ill patients and summarize its therapeutic effect. Methods the nursing methods of 68 critically ill patients who were hospitalized in our hospital from 20 1 1 ~ 20 12 were analyzed retrospectively. Results Of the 68 critically ill patients selected in the data, 4 suffered from severe gastrointestinal bleeding and stopped nasal feeding, while the remaining 64 patients were well tolerated. After two weeks of nutritional support treatment, the blood sugar, hemoglobin and serum albumin levels of 68 patients returned to normal. Conclusion Early clinical gastrointestinal nutrition support and scientific and reasonable nursing measures can significantly reduce patients' internal environment disorder, improve their quality of life and reduce mortality.
Critically ill patients; Enteral nutrition; nurse
Studies have proved that reasonable nutritional support is an essential link in rescuing and treating critically ill patients. Because of this, the application of enteral nutrition in critically ill patients has made great progress in recent years. Enteral nutrition can not only protect gastrointestinal mucosa and maintain gastrointestinal function, but also maintain normal visceral blood flow. The body state of critically ill patients is in a state of high catabolism. On-site nutrition can provide patients with sufficient energy, correct negative nitrogen balance and prevent enterogenous infection caused by bacterial translocation. In this paper, the nursing methods of enteral nutrition for 68 critically ill patients in our hospital from 20 1 1 ~ 20 12 were analyzed retrospectively. Details are as follows.
1 data and methods
The general data of 1. 1 selected 68 critically ill patients in our hospital from 20 1 1 to 20 12. Among the 68 patients, 465,438+0 were male and 27 were female. The youngest is 18 years old, the oldest is 88 years old, and the average age is 47 years old. In terms of diseases, 39 cases were diagnosed as severe thoracoabdominal compound injury, 14 cases as head-chest compound injury, 15 cases as multiple organ dysfunction syndrome, and 68 patients all had gastrointestinal problems and could not eat by mouth. After professional diagnosis, they need more than 7 days of nutritional support treatment.
1.2 Methods After the patients started enteral nutrition therapy, serum albumin, hemoglobin and blood sugar were continuously monitored regularly.
1.3 nutritional support pathway ① nasogastric tube pathway: this nutritional support pathway is suitable for patients with normal gastrointestinal function, no coma during implementation, or who can complete the transition from nasal feeding to oral diet in a short time. ② nasojejunal intubation feeding: If the patient's gastrointestinal function is in a normal state and he is not in a coma, or he can complete the transition from nasal feeding to oral feeding in a short time, this nutritional support feeding route can be adopted, which can reduce the probability of aspiration and reflux caused by catheter route problems. ③ Gastrostomy and jejunostomy feeding: This method is traumatic and suitable for patients who need long-term enteral nutrition. This method requires surgical stoma to place the feeding tube in the stomach or jejunum.
The application principle of enteral nutrition 1.4 The application of enteral nutrition should fully consider the gastrointestinal function of patients, and two types of enteral nutrition can be selected: element type and whole protein type. Essential enteral nutrition: propafenone and propafenone. Total protein enteral nutrition: Patients who use this enteral nutrition supply need to use aspartame and omnipotent, so the intestinal function should be good. In the process of enteral nutrition therapy, we should pay attention to the determination of blood sugar and electrolyte, ask the patients about their gastrointestinal tract, and adjust the dosage and concentration of enteral nutrition solution according to their different physical conditions.
1.5 feeding mode ① One-time feeding: This method is a one-time injection of prepared enteral nutrition food, with many complications. (2) Intermittent feeding: the required enteral nutrition food is given in stages, and the injection frequency is once every 3-4 hours; If gravity drip is needed, the injection frequency is 30-40 minutes. ③ Continuous drip: This method requires continuous drip for 20-24 hours with the help of enteral nutrition pump, because it takes a long time and requires patients to have good tolerance. ④ Circulating drip: This method needs to control the infusion pump to continuously pump in for a certain period of time.
Two results
Among the 68 critically ill patients, 4 cases suffered from severe gastrointestinal bleeding and stopped nasal feeding, while the remaining 64 cases were well tolerated. After two weeks of nutritional support treatment, the blood sugar, hemoglobin and serum albumin levels of 68 patients returned to normal.
3 discussion
3. 1 The basic concept of nutritional support refers to the dietary nutrition measures taken according to the principles of nutrition, also known as therapeutic nutrition, in order to treat or alleviate diseases and enhance the clinical effect of treatment. The adopted diet is called therapeutic diet, and its basic forms generally include therapeutic diet, nasal feeding, tube feeding, essential diet and intravenous nutrition. It is the main and important measure to maintain and improve the function and metabolism of organs, tissues and cells and prevent the occurrence of multiple organ failure. Indications of enteral nutrition support include: ① those who are unable to eat or take enough orally. After surgery for oral tumor and throat tumor; Increased nutritional requirements and insufficient food intake, such as sepsis, hyperthyroidism, malignant tumors and their chemotherapy or radiotherapy, anorexia and depression; Central nervous system disorders, such as loss of consciousness, cerebrovascular accident and loss of pharyngeal reflex, can not be swallowed. ② Gastrointestinal diseases. Gastrointestinal fistula; Inflammatory bowel disease (ulcerative colitis and Crohn's disease); Short bowel syndrome; Pancreatic diseases, intestinal preparation. ③ Gastrointestinal diseases. Auxiliary burns and injuries caused by tumor radiotherapy and chemotherapy; Nutritional support before and after operation; Cardiovascular diseases; Changes in liver disease, nephropathy and parenteral nutrition; Congenital amino acid metabolism defect. Contraindications of enteral nutrition support include gastrointestinal failure; Complete intestinal obstruction; Severe intra-abdominal infection.
3.2 Nursing care of enteral nutrition in critically ill patients
3.2. 1 Nursing of nasogastric tube The choice of nasogastric tube is mostly nasogastric tube or nasogastric tube. After placing the catheter, we should pay attention to properly restrain the restless or uncooperative patients to prevent the catheter from being accidentally pulled out. Catheter should be fixed by non-invasive fixation method. The upper end of the rectangular stretched cloth should be attached to the lower end of the nasal tip, and then the lower end of the stretched cloth should be torn off, crossed left and right, and then spirally attached to the nasal feeding tube. Nurses should pay attention to check whether the position of nasal feeding tube is correct and extract gastric juice to ensure the smooth progress of enteral nutrition. In order to prevent catheter blockage, we should pay attention to the following aspects: ① If high-concentration nutrient solution is continuously infused, the catheter should be washed with 10-20 ml warm water every 2-4 hours, and the external infusion tube should be replaced every 24 hours. ② If it is necessary to administer drugs through nasal feeding tube, different drugs should be infused separately to avoid mixing drugs with nutrient solution.
3.2.2 The temperature of nursing nutrient solution for nutrient solution infusion should be effectively controlled between 35 and 37 degrees Celsius. If the weather is cold, the infusion should be heated first, and the infusion heater should be placed on the section of the infusion pipeline far from the input port, and the position of the heater should be changed to prevent the local temperature from being too high. When preparing nutrient solution, nursing staff should pay attention to check the outer packaging and factory date of nutrient solution to avoid infusion of expired and contaminated nutrient solution to patients. Before the operation, they should pay attention to washing their hands and shaking the nutrient solution evenly. The storage condition of nutrient solution after opening is no more than 24 hours at 2-8 degrees Celsius. The correct posture of nutrient solution infusion is to lie flat and raise your head for 30-45? You can adjust your posture after infusion for half an hour.
3.2.3 Oral care After summary and research, many patients with gastrointestinal catheterization will have stomatitis. This is mainly because once the oral glands lack food stimulation for a long time, the saliva secretion in the oral cavity will gradually decrease. Therefore, for patients with gastrointestinal catheterization, nursing staff should instruct them to gargle, generally using clear water or mouthwash, and comatose patients should wipe the whole mouth with normal saline.
3.2.4 Psychological nursing Some critically ill patients have undergone tracheotomy, and multiple drainage tubes will stimulate the patients and cause pain; In the process of enteral nutrition support, patients will have repeated abdominal distension and diarrhea, which will make patients resistant to treatment and unwilling to actively cooperate with medical staff. At this time, nurses should patiently explain relevant knowledge to patients and their families. Such as the advantages of enteral nutrition, possible complications in the process of enteral nutrition support, etc. , timely detailed introduction and communication to patients and their families, timely handling of problems, so that patients trust and rely on nursing staff.
4 abstract
Critically ill patients are one of the most important groups in clinical nutritional support. This is because the stress catabolism of patients has increased. Many critically ill patients also underwent mechanical ventilation and tracheotomy because of their diseases, and their energy consumption increased, and their demand for nutrition also increased. On the other hand, the liver and kidney function of critically ill patients are incomplete, and the nutritional load is underground, so there will be metabolic disorders. Through research, early clinical gastrointestinal nutrition support and scientific and reasonable nursing measures can significantly reduce the internal environment disorder of patients, improve their quality of life and reduce their mortality.
refer to
Yan Haiping. Application and nursing of enteral nutrition in critically ill patients [J]. Qinghai Medical Journal, 2006(36).
[2] Zhang Shuijiao. Enteral nutritional support for critically ill patients [J]. Modern Medicine and Health, 2007(23).
Chen. Clinical psychological nursing guidance [M]. Beijing: Science and Technology Literature Publishing House, 200 1.38.