Model paper on nursing in respiratory medicine 1: materials and methods of nursing papers in respiratory medicine 1
1. 1 general information
72 critically ill patients from 20 12 to 20 13 and 12 were randomly divided into two groups. There were 465,438+0 cases in the observation group and 365,438+0 cases in the control group. Among them, chronic respiratory failure 13 cases, severe lung cancer 6 cases, bronchitis 39 cases, bronchiectasis 14 cases. There were 48 females and 24 males. The age ranged from 27.2 to 865438 0.3 years old, with an average age of (565438 0.39? 5.07 years old. There was no significant difference in sex, age and clinical symptoms between the two groups (P & gt0.05).
1.2 method
Patients in the control group were given basic routine nursing mode, and after symptomatic treatment, the changes of symptoms were closely observed. The patients in the observation group adopted careful clinical nursing mode, and carried out nursing intervention in view of the patient's hospitalization environment and treatment. The specific implementation is as follows.
1.2. 1 environmental psychological intervention
Respiratory medicine patients have high requirements for air quality. In order to ensure good air circulation in the ward, air purifiers can be installed in the ward. And clean the ward every day, especially the dust, try to clean it with a vacuum cleaner to keep the ward clean and tidy. It is forbidden to place flowers and plants, visit the bouquets brought by patients, explain the reasons and bring them back to avoid aggravating the patient's condition due to pollen allergy. Because of the long illness time, patients are prone to fidgety and other emotions, especially severe patients, who feel hopeless for treatment and are prone to despair and negative psychology. Nurses should do a good job in patients' psychological work according to their different emotions, so that patients can establish the courage to overcome the disease.
1.2.2 therapeutic intervention
After giving symptomatic treatment to patients with different diseases, we should closely observe their vital signs and pay special attention to their breathing frequency and rhythm. Once there are symptoms such as hemoptysis and expectoration, report to the doctor in time for rescue. At the same time, according to each patient's condition and short-term treatment results, making corresponding rescue plans and making basic preparations can buy time for rescue. Explain the basic information such as drug name and curative effect to patients, and accurately grasp the dosage and concentration of patients. Establish two venous pathways, namely, the input of general drugs and the input of specific drugs. Another way of administration is atomizing inhalation, which can ensure the safety of drug treatment.
1.2.3 ventilation intervention
Timely ventilation treatment can improve the symptoms of respiratory disorders in patients. In the process of treatment, it is necessary to keep the patient's respiratory tract unobstructed and remove the secretions in the respiratory tract and oral cavity in time, which can reduce the occurrence of infection. Patients with severe illness can't breathe spontaneously, so they can use a ventilator to assist breathing. During assisted breathing, the changes of various parameters on the ventilator should be carefully implemented, and if there is any abnormality, it should be handled and corrected in time.
Statistical analysis of 1.3
The experimental data obtained in this paper are tested by SPSS 14.0 statistical software, the measurement data are tested by t, the counting data are tested by X2, and the data are tested by P.
Two results
After nursing 4/kloc-0 patients in the observation group, 38 patients got better, their vital signs returned to normal, 3 patients were ineffective, and the improvement rate was 92.68%. After timely rescue, 3 patients have basically recovered their vital signs; No dead patients. In the control group, 3 1 case, 23 cases were improved and 8 cases were ineffective, and the improvement rate was 74. 19%. Eight patients were rescued in time, 6 patients were rescued successfully, and 2 patients died suddenly, with a mortality rate of 6.45%. The overall curative effect of the observation group was significantly better than that of the control group (P
3 discussion
For severe patients in respiratory medicine, if effective rescue plan is not implemented in time and nursing intervention is given, it is likely to aggravate the patient's condition, lead to respiratory failure and even death. In the treatment, making an effective rescue plan for each patient can shorten the preparation time for saving patients' lives and improve the rescue efficiency of patients. In the whole nursing, the nursing staff should observe the different psychological changes of each patient in detail and pay attention to the care of tiny details. Diet should be mainly digestible and nutritious liquid food or semi-liquid food, and pay attention to the safety and hygiene of diet. Strengthening the knowledge explanation of diseases and letting patients understand the treatment process can alleviate the worries of patients. And carry out health education for patients, so that patients can pay attention to the cleanliness of personal hygiene and change clothes frequently to prevent unnecessary infection. In this study, after careful clinical nursing, the improvement rate of patients in the observation group was 92.68%, and there were no deaths. The overall curative effect was significantly better than that of the control group (P
4 conclusion
To sum up, applying meticulous clinical nursing to critically ill patients in respiratory medicine will greatly protect patients' lives and improve their rescue efficiency.
The second model of respiratory medicine nursing: hidden dangers and measures of respiratory medicine nursing I. Analysis of hidden dangers of respiratory medicine nursing
Accident 1. 1
1. 1. 1 down
Most of the patients in respiratory medicine are elderly people, and there are some factors such as weak constitution, poor eyesight and poor response ability. Some patients use diuretics, vasodilators, antiallergic drugs, hypoglycemic drugs and other drugs that are easy to fall, which are prone to accidents.
1. 1.2 falling into bed
Patients with pulmonary encephalopathy often show excitement and irritability, while patients with nervous system diseases, such as Alzheimer's disease, are prone to fall.
1. 1.3 Asphyxia and aspiration
Patients with hemoptysis and increased sputum that are not easy to cough up are prone to suffocation; Patients with nervous system diseases (such as cerebral infarction). ) It is prone to dysphagia, and food choking causes suffocation and aspiration.
1. 1.4 Pipeline falls off.
Patients with pneumothorax and pleural effusion often use closed thoracic drainage, such as improper fixation, improper activity, excessive traction and other reasons will lead to catheter fall off; Whether it is possible to pull out the stomach tube, catheter, tracheal intubation and tracheotomy.
1.2 specialist operating procedures are not implemented in place.
1.2. 1 hidden danger of oxygen therapy
Oxygen poisoning can occur when the oxygen concentration is too high and the oxygen inhalation time is too long during oxygen therapy. In patients with chronic obstructive pulmonary disease, continuous high-concentration oxygen inhalation will cause carbon dioxide retention and cause or aggravate type ⅱ respiratory failure; Some patients have poor compliance with oxygen therapy, and stopping oxygen inhalation by themselves can not achieve the expected curative effect.
1.2.2 nursing hidden trouble of sputum aspiration
Inadequate assessment of the condition, too long time of single sputum aspiration and too short interval between two sputum aspiration can all lead to hypoxemia, aggravate the condition and cause accidents.
1.3 factors of nursing staff
1.3. 1 lack of comprehensive ability.
Although the knowledge level of nurses has improved at this stage, their ability to find and solve problems in practical work is uneven. Factors such as inadequate specialist training, insufficient first aid skills and poor emergency ability directly affect the rescue effect; The same patient is often complicated with many diseases, and there will be some nursing contradictions because of the nursing problems involving many specialties, which puts higher demands on nurses.
1.3.2 Lack of high sense of responsibility in work
Careless work, lack of cautious and independent spirit; The observation of the disease is not careful enough, the hidden danger is not found in time, and the intervention is not timely; The implementation of responsibilities, systems and processes is not standardized.
1.4 nursing management factors
The quality management system of 1.4. 1 is not perfect.
Nursing management monitoring pays too much attention to assessment, lacks refined management concept, the emergency plan is not implemented in place, the measures are not effective, and the nursing core system is not strictly implemented, which leads to nursing defects, which is a risk with high incidence and great loss.
1.4.2 The allocation and work intensity of nursing staff are asymmetric.
The allocation of nursing staff can not meet the needs of patients, and the lack of nursing human resources, especially the growing nursing needs of patients, makes nurses overload and work hard, resulting in insufficient energy, inattention, uncontrollable link quality and inadequate service, which brings insecurity to patients; Imperfect management system and inadequate quality control are all important factors that cause nursing insecurity.
Two, respiratory medicine nursing safety hidden trouble prevention countermeasures
2. 1 accident prevention
2. 1. 1 Fully evaluate patients and take corresponding protective measures.
For patients with high risk factors of accidents, establish warning signs at the bedside; Communicate effectively with family members, gain their trust and cooperation, and give them care; At the same time, seriously implement the system of succession and graded nursing. Patients who are prone to fall should avoid walking alone and stay in bed if necessary; Patients who are prone to bed accidents such as excitement and irritability should take necessary protective measures, such as applying bed railings and limb straps; For patients with risk factors of suffocation and aspiration, effective measures should be taken in time, and an aspirator should be equipped at the bedside, and the patient should be placed in the rescue room if necessary; For patients with dysphagia and cough, turn the food into paste and raise the bedside by 30? ~45? , if necessary, indwelling gastric tube; All kinds of drainage tubes are properly fixed to avoid folding, twisting, falling off and being pressed, to maintain effective drainage and avoid unplanned extubation; For patients with closed thoracic drainage, there are related items at the bedside, such as blood forceps and sterilized vaseline gauze.
2. 1.2 Make emergency plans for common accidents in respiratory department and organize nurses to study.
The morning meeting and shift change are used to simulate the situation and how to deal with emergencies, so as to continuously improve the problem-solving ability of nurses.
2.2 Standardize specialist nursing operation and strengthen supervision and management.
2.2. 1 oxygen therapy nursing
Correctly evaluate the condition and conscientiously implement the doctor's advice; Strictly master the requirements of oxygen therapy indications, oxygen concentration, oxygen inhalation mode and time; Closely observe the effect and reaction of oxygen therapy; Strengthen patients' safety and health education and improve patients' compliance with oxygen therapy.
2.2.2 Master the essentials of sputum aspiration operation.
Correct control of negative pressure (40.0 ~ 53.3 kpa, children
2.3. 1 Improve the overall quality of the nursing team, encourage nurses to participate in various forms of continuing education and training, and obtain new knowledge, new trends and new concepts at home and abroad through multiple channels; Strengthen the training of young nurses, cross-train as needed, and implement? Three schemes for dynamic continuous observation and evaluation of young nurses' growth.
2.3.2 Strengthen the sense of responsibility.
Educate nurses to implement various treatment and nursing measures in strict accordance with their duties, systems and procedures, overcome their careless working attitude, and cultivate their due cautious and independent spirit.
2.4 Strengthen nursing safety management and rationally use human resources.
2.4. 1 Strengthening nursing safety management
Formulate the nursing quality standard and emergency plan of respiratory medicine specialty, and revise the nursing routine and operating routine of respiratory medicine specialty; The ward implements the quality control mode of full participation, establishes a quality control team, establishes a follow-up checklist for continuous improvement of nursing quality, strengthens quality control, and corrects problems in time when found.
2.4.2 Rational use of human resources to improve the working conditions of overload.
Head nurses make full use of existing human resources according to the specific conditions of their own specialties; Improve the nursing work mode and implement the responsibility system; Improve workflow and implement flexible scheduling. (This article is from the journal of Nursing Practice and Research. For a brief introduction of nursing practice and research, please refer to. )
Three. abstract