Article 1
Discussion on community nursing of diabetic foot
Diabetic foot is one of the common complications of chronic diabetes diagnosed clinically, which refers to limb ischemia, secondary infection and gangrene caused by peripheral neuropathy and microangiopathy, and even requires amputation in severe cases. Clinical studies have found that the knowledge reserve and self-management ability of patients with diabetic foot are related to the therapeutic effect of diabetic foot. The purpose of this paper is to explore the community nursing measures of diabetic foot, so as to improve the community nursing effect of diabetic foot. From 20 1 1 to 20 14+ 1, 20 patients with diabetic foot were given nursing intervention in community medical work, and the nursing effect was good. Now described as follows.
1 data and methods
1. 1 general information
All the 20 patients in this group are diabetic foot patients, and the clinical diagnosis results meet the diagnostic criteria set by the first national academic conference of diabetic foot of Chinese Medical Association. Among them, male 13, female 7; The age ranged from 58 to 76 years, with an average of * * 67.2 2.5 * * * years; The course of the disease was 6 ~ 16 years, with an average course of * *10.4 3.5 * * years. Inducing factors: diabetic foot complicated with diabetic bulla in 8 cases, tinea pedis infection in 6 cases, hot water scald in 4 cases, and unknown inducement in 2 cases. All the above cases have different degrees of infection, and the gangrenous parts are toes and soles.
1.2 nursing methods
The main nursing measures include blood sugar control, psychological care, wound care and family health education.
1.3 Evaluation of curative effect
*** 1*** Healing: Healing: the wound has healed and scab skin has formed.
***2*** Improvement: The wound healed well and the secretion of gangrene was greatly reduced.
***3*** Invalid: if the above criteria are met, it can be judged as invalid.
Two results
After nursing intervention, among 20 patients, 16 cases were cured * * * 80% * *, 3 cases were improved * * * 15% * *, 1 case was ineffective * * * 5% * *. The wound healing time was 4-8 weeks, with an average time of * * 6.5 1.5 * * * weeks.
3 discussion
Diabetic foot is one of the serious complications of diabetes with high disability rate. According to relevant data, about 15% of diabetic patients have different degrees of foot ulcer infection, and about 1% of patients have amputation due to diabetic foot. In this study, 20 patients with diabetic foot were given nursing intervention, and the nursing effect was good. The results showed that 16 cases were cured * * * 80% * *, 3 cases were improved * * * 15% * *, 1 case was ineffective ***5%**. Similar to the general research results, it can be seen that nursing intervention is also helpful to improve the clinical symptoms of patients, improve the cure rate of diabetic foot and ensure the quality of life of patients.
According to the data of this study and years of clinical nursing experience, the author thinks that community nursing measures for diabetic foot should include the following contents:
* * *1* * strictly control blood sugar. Make a hypoglycemic plan according to the patient's weight, age and daily exercise. Instruct patients to eat regularly and quantitatively, because the gastrointestinal function of the elderly is declining and it is not appropriate to be full. But the nutrition should be balanced and the recipes should be diversified. Check the patient's blood sugar regularly, and adjust the injection amount of insulin according to the change of blood sugar to keep the blood sugar within the normal range.
***2*** Psychological nursing. In this study, 6 patients lost their confidence in resisting diseases at the initial stage of nursing, accompanied by depressive symptoms. Diabetes is a chronic disease, which is difficult to cure. The prevention and treatment of diabetic foot is a long process. It is very common for patients to get sick due to long-term behavioral intervention and produce negative psychological and mental stress. Therefore, nurses should give targeted education and guidance according to patients' family situation, personality characteristics and psychological characteristics. Establish a good communication relationship with patients and enhance emotional communication. In addition, some cured cases can be cited to illustrate the current research progress of the disease, so as to enhance their confidence in resisting the disease.
***3*** Wound care.
Supervise patients to check whether there are blisters, corns, discoloration of soles, cracks between toes and infection in both lower limbs. Inform the patient that the water temperature for soaking feet should not be too high and the time should not be too long, and the water temperature should be 38-40℃ for about 10 minute. At the same time, the medicine can be given on time according to the doctor's advice. According to the severity of the patient's foot ulcer and whether it is complicated with infection, if the patient is only swollen locally, it should be wet-packed with magnesium sulfate first, then washed with mixed liquid * * * insulin 8U+ anisodamine hydrochloride injection 10ml+ normal saline 100 ml * *, and finally applied with moist scald ointment. If an abscess has formed, measures should be taken in time to discharge pus.
***4*** Family health education. We can help patients and their families understand the importance and necessity of diabetic foot care by encouraging them to attend expert lectures, patient seminars and distributing rehabilitation manuals.
To sum up, in the process of community nursing of diabetic foot, the application of blood sugar control, psychological care, wound care and family health education nursing measures will help to improve the cure rate of patients and ensure the quality of life of patients, which is worthy of clinical application.
the second
Analysis of holistic nursing intervention for mumps
Mumps is characterized by non-suppurative swelling and pain of parotid gland, accompanied by fever, limited chewing and other symptoms. It can occur in any season, mainly in winter and spring. In severe cases, it can accumulate other gland diseases or organ systemic diseases, such as pancreatitis, oophoritis, orchitis, meningitis, etc., and prolong the rehabilitation program of children [1]. This study will introduce the epidemiology, clinical manifestations, complications, clinical treatment and nursing methods of mumps from 20 1 1 to 20 14+00. The report is as follows.
1 data and methods
1. 1 general information
50 children with mumps from 20 1 1 to 20 14 and 20 10 were randomly selected, all of which met the diagnostic criteria of mumps. According to the envelope method, 25 cases were divided into experimental group and control group. Experimental group: the ratio of male to female is 13: 12, and the age is 5- 13, with an average of * * * 8.32 0.53 * * years; Control group: the male-female ratio is 13: 12, the age is 5- 12, and the average age is * * * 8.36 0.55 * *. Comparing the baseline data of diarrhea children between the two groups, there is comparability * * * P & gt0.05***.
1.2 epidemiology
① Sources of infection: recessive infected persons and early patients. Parotid gland is infectious from 7 days before swelling to 9 days after swelling. ② Transmission route: mainly through air droplets. ③ Epidemiological features: Mumps is a self-limiting disease, and most children have a good prognosis and low mortality. It can occur all year round, with obvious dispersion, but the incidence rate is the highest in winter and spring. ④ Population susceptibility: mainly school-age children, and some adults without immunity will also get sick [2].
Clinical manifestations of 1.3
The incubation period is 14~25 d, with an average of * *18.521.65 * * d. Most children have no prodromal symptoms, and a few children have symptoms such as loss of appetite, general malaise, muscle aches, headache and fever. 1 ~ 2 days later, the parotid gland is swollen and the body temperature will rise. The skin in the area is bright but not red, the panel temperature rises, and there is obvious pain, which is aggravated after eating acidic food. Parotid swelling gradually subsided after 4~5 d [3].
1.4 Complications
① Neurological complications: Meningitis is the most common, which usually occurs 4-5 days after parotid gland enlargement, and the symptoms disappear within several weeks. ② orchitis: it is more common in men after puberty, and it occurs 6~ 10 d after parotid gland enlargement. ③ Ovaritis: pain in the lower abdomen, with or without tenderness, and the symptoms can subside after 3-4 days. ④ Pancreatitis: The body temperature rises again, accompanied by nausea, vomiting and upper-middle abdominal pain.
1.5 treatment and nursing
Treatment: antiviral therapy, hormone therapy, symptomatic treatment and complications treatment.
1.6 clinical nursing
① Control group: The children in the visiting group were given routine care, including diet care, disease observation, health education and prevention of complications. ② Holistic nursing measures were given to the children in the visiting group: according to their clinical symptoms, nursing measures were taken to isolate the respiratory tract, keep the ward air fresh and ventilate regularly; Observe the changes of body temperature and consciousness, the degree of swelling and the occurrence of complications; Understand the psychological needs of each child and give psychological support; Give a nutritious liquid or semi-liquid diet, avoid spicy and acidic foods, and rinse your mouth with normal saline after meals; Monitor the child's temperature changes. If the child's body temperature is lower than 39℃, conventional physical cooling methods such as ice salt water, alcohol rubbing and ice pack cold compress are given, and the cooling effect is observed and recorded. Children with high fever consume a lot, so they are encouraged to eat a digestible liquid or semi-liquid diet, eat less, eat more and eat more. Tell children to stay in bed and change quilts and clothes in time when sweating to prevent catching cold; If the child's parotid gland is swollen obviously, it can be treated with cold wet compress; Symptomatic nursing complications; In the popular season, educate the masses about health knowledge and urge them to do a good job in indoor ventilation.
1.7 observation index
Observe the complications of the two groups and compare the nursing satisfaction of the families of the two groups.
1.8 statistical method
With the help of SPSS 1 1.0 software, the data were statistically processed and counted, and the χ2 test was [n * * *% * *].
Two results
2. 1 Comparison of complications between two groups
The incidence of complications in the experimental group was 4.0% * * 1/25, 1 case complicated with orchitis * *, which was lower than that in the control group (16.0% * * 4/ 16), including 2 cases complicated with orchitis and 2 cases complicated with oophoritis. The difference between the two groups was statistically significant * * * χ 2 = 6.5 1 1, P < 0.05***.
2.2 Comparison of nursing satisfaction between the two groups
The nursing satisfaction of the experimental group was 96.0%, which was higher than that of the control group (80.0% * * * P < 0.05***, see table 1.
3 nursing experience
Mumps is an acute upper respiratory infection caused by mumps virus. Most children show parotid gland swelling, headache and fever. Mumps virus is transmitted through human saliva and nasopharyngeal secretions. Mumps is common in children and adolescents. In recent years, the symptoms of mumps have been obviously aggravated, and the incidence of complications has been greatly improved. Doing a good job in nursing children with mumps and its complications can promote the recovery of the disease and improve the prognosis.
Some scholars [4] took holistic nursing measures for 80 children with mumps on the basis of clinical treatment. Results: 59 cases were cured, 9 cases were improved/kloc-0, and 2 cases were discharged automatically. In this study, the incidence of complications in the experimental group was 4.0%, and the satisfaction degree of children's families was 96.0%, which was significantly different from that in the control group (16.0% and 80.0% * * P < 0.05***). Similar to the related research results [5].
Holistic nursing has high application value in children with mumps. Doing a good job in educating the families of children and explaining the relevant knowledge of the disease, including the etiology, symptoms, course of disease and prognosis, can eliminate the doubts of the families of children [6]; Actively communicate with children to meet their psychological needs, ensure their emotional stability, and urge them to actively cooperate with treatment; Close observation of the child's vital signs, understanding the changes of his consciousness and pupils, knowing whether he has a headache, knowing whether the male child has testicular swelling or pain, and timely reporting to the doctor and assisting in symptomatic treatment after finding abnormalities [7] can prevent the disease from progressing [8] [9]; Ensure that the children's mouth is clean, rinse their mouths with normal saline before and after meals to prevent suppurative infection; Telling children to avoid eating hard, acidic and sugary foods will reduce parotid gland secretion.
In order to ensure the overall nursing effect, we should do a good job in nursing patients with complications. The nursing points are as follows: ① Meningitis: Observe whether the children have conscious changes, vomiting, headache and other precursor symptoms of encephalitis, and make relevant records. If the child has increased intracranial pressure, continue to take oxygen * * * 1 ~ 2 L/min * *, give the child 200 g/L mannitol intravenously according to the doctor's advice, keep the ward quiet, and limit visits [10]. ② Testitis: instruct children to stay in bed, reduce activities, and protect scrotum with scrotum bag to avoid pain; Tell the children to take acetaminophen orally at a dose of 1 mg, three times a day for 3 ~ 5 days; When the child's pain is unbearable, the testicles can be intermittently cold-compressed; Pay attention to whether the testicles have purulent changes, and if so, deal with them in time. ③ Pancreatitis: intravenous rehydration, fasting drinking water, supine position and kneeling posture, placing ice packs on the upper abdomen to relieve spasm and pain, performing gastrointestinal decompression on children with severe abdominal distension, observing the amount and nature of vomit, and making relevant records. After the abdominal pain was relieved, a small amount of light liquid diet was given, and then it was gradually changed to semi-liquid diet, soft food and general food [1 1- 12].
To sum up, mumps is a common disease in children. Early diagnosis, early treatment and holistic nursing measures can improve the prognosis of children and improve the therapeutic effect.