Model of nursing summary paper the first paper: minimally invasive percutaneous nephrolithotomy for children's nursing medicine paper
Clinical data of 1
Two pediatric patients 1 2 who underwent MPCNL in our hospital from June1day in 2008 to April 20 1 day in 2008 were selected, including 2 children aged 1 ~ 2, 3 children aged 2 ~ 3 and 7 children aged 3 ~ 4. According to B-ultrasound diagnosis, stones at the junction of renal pelvis and ureter or stones at the upper ureter are different in size from those in kidney calculi, and the smallest stone is 4mm? 5mm, the largest stone is 14mm? Five millimeters.
2 surgical methods
Tracheal intubation is used for general anesthesia. After successful anesthesia, the lithotomy position was taken, the ureteral catheter was inserted retrograde under cystoscope, and then it was changed to prone position. Guided by B-ultrasound, the puncture needle was inserted into the renal pelvis, the needle core was placed in the guide wire, and the ureteroscope was placed in the expanded channel of the guide wire dilator. Ureteroscopy was used to observe the situation in the renal pelvis. At the same time, the stones were crushed by pneumatic ballistic lithotriptor, and the perfusion fluid was used to make them flow out smoothly. j？ Tube and nephrostomy fistula.
3 nursing experience
3. 1 Preparation of greenhouse
The main central neuron for regulating body temperature is hypothalamus. However, due to the underdeveloped hypothalamus of infants, the surface area is relatively large and there is little subcutaneous fat, it is easy to cause the body temperature to drop. In the process of MPCNL, a large amount of lavage fluid passes through the body of the child, which is easy to cause the child's body temperature loss. Therefore, during MPCNL, the room temperature should be kept at 26℃ ~ 28℃ [2], and a warm blanket should be used to keep warm.
3.2 Correct posture
Because this operation needs to change the child's posture many times: from supine position to lithotomy position for retrograde intubation, then to prone position for lithotripsy, and then back to supine position after lithotripsy, it is necessary to strengthen the care of children in various positions at any time.
3.2. 1 Change the supine position to the lithotomy position.
Infants and young children have short limbs, so there is no need to use a tripod during surgery. Lift the child to the lower edge of the operating table, take off the edge of the bed, bend the knee joint of the child, separate the calf and wrap it with cotton pad, fix the calf with restraint belts on both sides of the operating table, and raise the buttocks at the same time. Avoid the common peroneal nerve when using the restraint band, and the foot should be 100? ~ 1 10? It is suggested to separate the angles to avoid excessive intervention [3]. Observe the skin temperature and blood circulation of lower limbs at all times during the operation, and remind the children in time to avoid being oppressed by the operator's arm or body.
3.2.2 Change the lithotomy position to prone position.
After retrograde intubation, the operation sheet should be removed first, the lower limbs of the child should be leveled, and the lithotomy position should be changed to supine position. While the surgeon and anesthesiologist work together to lift the child, the visiting nurse should spread a cushion on the operating table, which should be suitable for the child's hips and shoulders. Children should lie prone on the mat, with their heads tilted to one side, and put a compressible mat to prevent their eyes and nose from being oppressed. The upper limbs naturally lie flat on both sides of his head and are fixed with restraint belts. Compression pads are placed on the feet and shoulders.
3.2.3 Fix all kinds of pipes and wires to prevent them from falling off.
Because the child underwent tracheal intubation under general anesthesia, he changed his position many times during the operation, and every time he changed his position, he should pay special attention to the placement of various pipes and wires. Such as intravenous infusion tube, tracheal intubation, retrograde intubation, vital signs monitoring line, nephrostomy tube, etc. Visiting nurses should always do a good job of monitoring to ensure that all kinds of pipes are unblocked, prevent wires from falling off and ensure the safety of children.
3.3 Strict aseptic operation
This kind of surgical patients need to put double J tubes for drainage after lithotripsy, and renal puncture causes renal injury. Aseptic operation is particularly important, so urinary tract infection and infection at renal injury should be avoided. All kinds of sterile cloth should be fully prepared when changing the child's position, and all cloth should be replaced after the child's position changes. Cover surgical instruments with sterile towels and place them properly to avoid long-term exposure to air. The instruments used in the operation are long, such as guide wire, ureteroscope and lithotripsy needle. , easy to contact with non-sterile areas, causing pollution, be careful when using.
Minimally invasive percutaneous nephrolithotomy for children can avoid the large-scale cutting and suturing of children's kidney tissue by nephrolithotomy, with minimal trauma, greatly shortened intraoperative and postoperative treatment time and good effect. Strict surgical care is the key to ensure the safety of children and the success of surgery. Therefore, it is necessary to establish a strict concept of aseptic operation, fully understand the surgical steps, actively cooperate with the surgeon, and do a good job in various operations.
Model of nursing summary paper Part II: Postpartum visit to community nursing medical papers
First, the current status of postpartum visit in community nursing in China.
(A) Postpartum visit development started late
The development of postpartum visit in community nursing in China started late. In order to meet the national conditions of China, postpartum visit in community nursing in China has absorbed foreign experience. After the initial development in recent years, some central cities have realized the importance of postpartum visit in community nursing and established it as a community postpartum visit service center. Through community nursing, the community postpartum comprehensive service model has been realized, providing health education, rehabilitation and health care for community postpartum women.
(B) uneven level of development
The development of postpartum visit service in community nursing marks the development of community nursing. Each community has its own different modes and forms of community nursing postpartum visit. Due to the attention of some big city governments, the government has invested a lot of money, which has promoted the rapid development of community nursing postpartum visits. At the same time, some underdeveloped small cities are hindered by external conditions. To sum up, the development level of community nursing postpartum visit is not balanced among cities with different economic development levels.
(C) imperfect organization and management
With regard to the specific documents of community nursing postpartum visit, the Ministry of Health has issued a document to carry out community nursing postpartum visit, but at present, there are no relevant laws and regulations to restrict community nursing postpartum visit, and there is no specific plan to promote development. For this newly established community nursing institution, there is no perfect and independent community nursing management system. Community nursing postpartum visit lacks clear division of labor and systematic management.
(D) The quality of employees is not high.
At present, there is no professional community nursing postpartum visit education in China, and no school can train the needed professionals. In addition, many colleges and middle schools usually do not offer courses in related majors. At the same time, the knowledge system of the staff required for community nursing postpartum visit is inconsistent with that of the nurses trained by the school, which leads to the nurses trained by the school can not adapt to the work content of community nursing postpartum visit. Therefore, most nurses engaged in community nursing postpartum visits have low professional quality and relatively low quality.
Second, do a good job in community nursing postpartum visit countermeasures and suggestions
With the continuous development of society, community nursing postpartum visit has become an important part of community health service. Therefore, the postpartum visit of community nursing is closely related to the national health quality. According to the present situation of postpartum visit of community nursing in China, the author puts forward some measures and suggestions on how to do well postpartum visit of community nursing.
(A) to strengthen publicity and awareness
Because the postpartum visit of community nursing started late in China, we should increase the propaganda of postpartum visit of community nursing, so that people, especially parturients, can realize the importance of postpartum visit of community nursing and actively cooperate with it to improve the quality of community health service.
(2) Balanced nursing level
Hospitals should support community health service centers, arrange nurses with relevant qualifications to go to the community for business guidance and knowledge training regularly according to the needs of supporting the community, and receive professional knowledge training from community nurses to the hospital regularly to improve their professional skills and management ability. On the one hand, the government should give policy support to community nursing from the aspects of treatment, establishment, software and hardware construction, and raise people's understanding of community nursing through vigorous publicity; On the other hand, community health service centers should implement open recruitment for all staff, compete for posts, and employ people who know and love work, have strong professional level, communication skills and good professional ethics to enrich the community nursing team and serve the community residents.
(3) Improve the management system
Give full play to the macro-control role of the government, improve relevant laws and regulations, make unified planning for community health work, formulate unified work objectives, detailed standards and management regulations for community nursing postpartum visits, establish posts and posts, supervise each other, improve the human resource management system and quality evaluation system for community nursing postpartum visits, and raise residents' awareness of health promotion through vigorous publicity.
(4) Pay attention to the way of visiting
1, focusing on on-the-job training.
According to the present situation of knowledge structure of nurses in China, targeted professional training should be carried out regularly to improve the professional ability of nurses and establish a comprehensive medical and health knowledge structure. Community nurses should establish a lasting service relationship with community residents, provide active and humanized services, meet the growing health needs of the people, and promote the development of community health services in China.
2. Scientific visiting methods.
(1) Bedside visit
Bedside visits only give lying-in women and community nurses an opportunity to get to know each other. During bedside visits, nurses need to ask about the parturient's delivery, collect relevant information, record matters needing help, contact telephone numbers and establish personal files.
(2) Family visits after discharge
(1) Methods used in community nursing visits: A. Look: The main contents include the living environment of parturient and newborn, indoor temperature, humidity and environmental sanitation, and even details such as the warmth of bedding and the breathability of clothes; B. Q: The main contents include their daily life and other general conditions, as well as the problems in hospital bedside visits and telephone follow-up records, as well as the feeding of newborns and the involution of maternal uterus; C. Listening: The main contents include listening to questions from family members and parturients and giving patient answers; D. Inspection: mainly check whether the newborn's complexion is ruddy, whether the body temperature is normal, whether the umbilical cord bleeds, whether the jaundice disappears, etc. Check whether the maternal body temperature and blood pressure are normal, whether the uterus degenerates, whether the color, quantity and taste of lochia are normal, and whether the cesarean section incision or perineal incision is restored.
2. Guidance: The main contents include advising mothers and babies to do some health care that is beneficial to physical and mental health or physical and mental recovery, for example, instructing mothers to do a good job in umbilical care of babies, and advising mothers and babies to walk in sunny environments; To understand the situation that neonatal physiological jaundice subsided for about a week, and give targeted guidance or suggestions to go to the hospital for treatment according to the severity of jaundice. For special infants such as premature infants, more scientific and subtle special care is needed. In the process of recovery, it is necessary to guide the lying-in women to eat according to their healthy diet. The purpose is to balance the intake of vitamins and other nutrients in protein. It is suggested that pregnant women should eat more soups instead of pungent food such as cold and spicy food. To change the traditional eating habits of pregnant women, the traditional maternal recipes are only millet porridge, eggs and brown sugar. But now, in order to balance the nutrition of pregnant women, pregnant women must match meat and vegetables according to recipes. In view of the unscientific part of the traditional confinement method, we should correct it and instruct the parturient not to take a bath in the basin, but to take a shower with hot water, brush her teeth with warm water with a soft toothbrush to stimulate her appetite and comb her hair every day. Maternal women should massage their breasts in the right way during the puerperium, feed their babies in the right posture, insist on breastfeeding to help uterine contraction, and guide them to do physical rehabilitation exercises and health exercises after delivery, which is beneficial to their recovery. Psychological problems are also one of the problems that women often encounter after giving birth. Therefore, we should give women psychological care, try our best to solve their anxiety and depression after discharge, and help them enhance their confidence and maintain their physical and mental health from psychological understanding. For those with obvious symptoms, professional psychological consultation or drug treatment should be given in time.