5例阴道壁大血肿致出血性休克的急救护理体会

总结了5例阴道壁大血肿致出血性休克的急救与护理.包括实施及时抢救处理措施、密切观察病情、做好心理护理、用药护理、基础护理及饮食护理.认为对产后产妇加强观察,早发现,就能为抢救产后出血,抢救产妇的生命争取到宝贵时间.     

浅谈出血性脑卒中的四阶段护理

脑出血是指脑实质内的出血，又称脑溢血或出血性脑卒中，本主要讨论非损伤性脑出血，也叫原发性或自发性脑出血。由于CT和MRI的应用及治疗水平的提高，其急性期死亡率有所下降，但护士对病人病情的观察、抢救及护理，对挽救患的生命仍然有着重要作用。恰当的康复护理可以最大程度地减少残疾对正常生活的影响。本从临床实用的角度，总结分析出该病的四阶段护理程序：抢救性护理、观察性护理、预防并发症性护理、功能康复性护理，现介绍如下。     

儿童急性出血性结膜炎的护理

总结了儿童急性出血性结膜炎的护理方法和有效控制儿童急性出血性结膜炎流行的方法.护理方法主要包括:实施严格隔离措施、及时准确按医嘱用药、做好家庭护理指导及健康教育等.认为做好儿童急性出血性结膜炎的护理,能有效控制交叉感染,使临床症状迅速改善,大大缩短治疗时间,同时也可有效防止疫情的流行扩散.     

急诊血液透析特点分析与护理

目的 探讨急诊血液透析的临床特点及护理配合.方法 回顾分析2008年1月～2009年12月收治的急诊透析465例次.结果 急诊透析病因中,以急性中毒最多(41.08%),其次为维持性透析发生并发症(36.34%)、急性肾衰(11.61%)、其他疾病(10.97%).急诊透析时间段分布中,以夜间为最高峰(47.10%),其次为晚间(36.13%)、日间(16.77%).465例次血液透析均顺利完成.结论 急性中毒、维持性透析并发高血容量性心衰、严重氮质血症、高钾血症是急诊透析的主要原因,夜间为急诊透析的高峰时段.针对急诊透析的特点,采取合理安排人力物力资源、加强透析护理配合、完善健康宣教等护理对策,可有效应对急诊透析,挽救更多患者的生命.     

护理程序在急诊救护中的应用探讨

本针对急诊救护中的新型急救护理工作模式-整体护理程序展开了深入的研究，并在实施过程中进行总结和完善，使急诊护理工作进行的更加规范和高效。     

急诊护理的特点与对策

急诊是医院工作的第一线,是面向社会的主要窗口.门急诊服务质量是衡量医院医疗质量及医院应急能力的重要标准,护理工作又是医疗服务的重要组成部分.急诊护理工作以急、危、多学科、易感染性、涉及暴力事件多为特点[1].现总结如下.     

急性中毒的抢救与护理

探讨急性中毒发病机制、临床表现、抢救与护理。     

急性一氧化碳中毒的抢救与护理

目的:探讨急性一氧化碳中毒有效的抢救和护理措施.方法:回顾性分析60例一氧化碳中毒患者,均采用综合抢救和积极的护理,并使用高压氧舱治疗.结果:60例患者抢救处理后,58例治愈,2例合并迟发性脑病.结论:一氧化碳中毒后如能采取综合抢救和积极护理,及时使用高压氧舱治疗,可以明显提高治愈率.     

腹主动脉破裂的抢救与护理

总结了腹主动脉破裂的抢救配合与护理,包括:术前护理、术后护理等.认为对腹部锐器伤后出现休克者,应果断迅速的配合医生进行抢救,分秒必争,术后的观察与护理对患者康复非常重要.     

东莨菪碱在呼吸衰竭抢救中的护理

总结了37例东莨菪碱在呼吸衰竭抢救中的护理体会.主要护理措施有:严密观察生命体征与神志瞳孔的变化,重视人工气道的管理,加强基础护理与营养支持.认为护理上的精心配合对于提高东莨菪碱在呼吸衰竭患者中的抢救成功率具有非常重要的意义.     

A shock reaction from insect bites in patients with urticaria pigmentosa

The examination of 11 urticaria pigmentosa (UP) patients included allergological history, skin prick, scarification tests and intracutaneous tests with noninfectious and bee poison allergens, total and specific serum IgE measurements, in vitro reaction of histamine release from peripheral blood basophils induced by bee poison. The response of mastocytosis patients to insect sting was characterized by a rapid (within 5 min) development of severe systemic reactions or shock. The skin reactions and serum antibodies to bee poison were not registered in 9 of 11 patients. They also had a negative reaction of allergen-specific histamine release from basophils. This gives evidence for nonimmunological, pseudoallergic mechanism of the shock reaction. The latter can be prevented by bee poison immunotherapy. IgE-antibody-mediated allergic reaction to bee sting could not be excluded in 2 patients. For them specific immunotherapy with bee poison, possibly with purified poison preparations containing the allergens alone, are indicated.     

Behavioral analysis and nursing interventions for reducing disruptive behaviors of patients with dementia

In this study, two cases were used to examine the potential of behavioral analysis as an intervention to decrease disruptive behaviors of institutionalized individuals with dementia. Behavioral modeling was used to teach the principles of behavioral analysis. The nurses observed a behavior change plan implemented by the investigator, revised the plan based on behavioral analysis techniques, and subsequently implemented the revised behavioral strategies. The patients' disruptive behaviors decreased markedly when the behavioral intervention was implemented. Patients resumed disruptive behaviors when care was provided without the behavioral plan. The findings suggest the need to address interventions in nursing research, education, and practice that use behavioral analysis to reduce disruptive behaviors in individuals with dementia.     

Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage

To characterize the recurrence of bleeding in patients who had hypertensive intracerebral hemorrhage (HICH), the authors reviewed 989 patients who underwent treatment for HICH between 1989 and 1995. Fifty-three patients (5.4%) had two episodes of HICH within a median interval of 22.9 +/- 16.3 months (range 1.5-72 months), and of these 3 (5.7%) had three episodes of HICH. The recurrence of bleeding most commonly occurred within 2 years of the first hemorrhage: in 66% of the 53 patients the second hemorrhage occurred soon after the first (within 1 year in 34%, within 1-2 years in 32.1%). The site of the second hemorrhage was different from the initial site in all patients. Only 1 patient had a third hemorrhage in the same site as the second hemorrhage. The common patterns of recurrence were 'ganglionic (putamen/caudate nucleus)-thalamic' in 26.8% and 'ganglionic-ganglionic' in 21.4%. The 'lobar-lobar' pattern was noted in only 2 patients. The volume of the hematoma was increased at the second hemorrhage. The overall mortality was 28.3%. The risk of recurrent hemorrhage significantly increased in the patients who had antihypertensive therapy of less than 3 months after the initial attack compared to those with further long-term therapy (p < 0.005). Long-term regular control for hypertension is needed to prevent recurrent hemorrhage.     

The medical care of patients with gastrointestinal bleeding after endoscopy

After endoscopic hemostasis, eradication therapy should be given to those who are infected by H. pylori to prevent ulcer relapse and recurrent bleeding. Maintenance acid suppression is not required after successful eradication of H. pylori. Proton pump inhibitor is preferred for the healing of NSAID-induced ulcers. Use of the lowest possible dose, or discontinuation of NSAIDs, is recommended for those with history of ulcer disease. High risk patients who require long-term NSAID therapy should be put on maintenance misoprostal.     

Circadian occurrence of variceal bleeding in patients with liver cirrhosis

Several clinical events have a rhythmicity over the 24 h period. We assessed the presence of periodic rhythm in the occurrence of haematemesis in patients with liver cirrhosis under different daylight regimens, namely during standard time and during daylight savings. Over a 48 month period there were 212 consecutive admissions of 118 cirrhotics with variceal bleeding. Complete data were available for 181 episodes of bleeding: 121 (66.9%) started with haematemesis and 60 (33.1%) started with melaena. One hundred and two (56%) episodes occurred during daylight savings and 79 (44%) occurred during standard time. The cosinor test showed a 24 h biphasic peak for the occurrence of haematemesis (09.45 and 21.45 h). Moreover, a biphasic diurnal asymmetric frequency was also found by multiple component rhythmometry. The time peaks of onset of variceal haemorrhage did not change significantly during standard time and daylight savings. Patients with more than one haematemesis episode significantly bled over the same time interval. The present study confirms that over the 24 h period variceal bleeding in cirrhotic patients occurs with a predictable rhythmicity that does not seem to be under the control of the light-dark cycle. The finding of a chronorisk for variceal haemorrhage addresses specific questions for pathophysiological studies as well as for new treatment strategies.     

Recurrent source of bleeding in patients with esophageal varices]

During last 7 years were in Endoscopic Centre of Brno Traumatologic Hospital treated 824 patients (624 male, 200 female) with esophageal varices, indicated to endoscopic sclerotherapy, ligation, or tissue adhesive injection. For one or more episodes of bleeding were treated 659 patients and resting 165 received therapy prophylactically. Recurrent acute bleeding from upper GIT occurred from 1 January 1990 to 30 April 1997 in 212 of them. In patients with previously proved esophageal varices were investigated for repetitive acute bleeding in this period 212 of them. In 157 (74%) patients endoscopy confirmed expected repetitive bleeding from esophageal varices, but in 55 (26%) was found bleeding from other source of upper gastrointestinal tract. The bleeding from gastroduodenal ulcers in 18 (8%) patients, in 22 (10%) from apths, Mallory-Weiss syndrome was source of bleeding in 8 (4%) patients, and hemorrhagic gastropathy in 7 (3%) was found. The authors draw attention to the fact that, in their big group patients with esophageal varices, duplicity of source of bleeding occurred in 1/4 patients. They concluded, that in patients with previously proved esophageal varices in necessary to perform in case of recurrent bleeding emergency of urgent endoscopy not only of esophagus, but even of whole upper GIT. Therapeutic mistake can happen in 1/4 of patients, if repetitive bleeding from varices would be expected and automatically treated by balloon tube. The patients could be damaged by delay in the treatment of bleeding from other source.     

A cost and value analysis of two interventions with incontinent nursing home residents

OBJECTIVE: More than half of nursing home residents suffer from urinary incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of living again in a noninstitutional environment The value of interventions to change functional status of this chronically institutionalized population is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have been shown to improve functional status: (1) Functional Incidental Training (FIT), and (2) Prompted Voiding (PV). The relative value of the different interventions for the nursing home population was estimated using paired preferences. DESIGN: The cost of two interventions (FIT and PV) that target incontinent nursing home residents was related to the value of these interventions as perceived by consumers of nursing home services. Both interventions decrease incontinence frequency, and one intervention also improves mobility endurance. PARTICIPANTS: Ninety incontinent nursing home residents received the intervention; 37 older nondemented board and care residents and 31 family members of the nursing home residents provided estimates of the intervention's value. MEASUREMENT: The staff-time allocations involved in implementing both interventions were documented in more than 85 resident care episodes. These time data were converted to labor cost based on the cost of nursing aides who would actually implement the intervention. The value of each intervention was assessed by asking consumers to make choices between the intervention and its associated outcomes (such as increased dryness) and other nursing home services of known cost (e.g., moving to a private room). RESULTS: Both interventions had labor costs that were greater than "usual care" costs. The additional cost was estimated to be $4.31 per resident per day for PV and $6.42 per resident per day for FIT if these programs were implemented from 7 AM to 7 AM. Consumer preference data indicated that consumers preferred the FIT and PV outcomes to more expensive alternative services, calculated to cost $10.00 per day, often marketed to consumers, CONCLUSION: Consumers may prefer the FIT and PV interventions relative to the typical services often marketed to the nursing home consumer. The analysis completed in this paper suggests that both interventions have value for frail residents likely to live out their lives in a nursing home.     

Acute bleeding after bone marrow transplantation (BMT)- incidence and effect on survival. A quantitative analysis in 1,402 patients

Acute bleeding after bone marrow transplantation (BMT) was investigated in 1,402 patients receiving transplants at Johns Hopkins Hospital between January 1, 1986 and June 30, 1995. Bleeding categorization was based on daily scores of intensity used by the blood transfusion service. Moderate and severe episodes were analyzed for bleeding sites. Analysis of the cause of death and the interval of the bleeding episode to outcome endpoints was recorded. Survival estimates were computed for 1,353 BMT patients. The overall incidence was 34%. Minor bleeding was seen in 10.6%, moderate bleeding was seen in 11.3%, and severe bleeding was seen in 12% of all patients. Fourteen percent of patients had moderate or severe gastrointestinal hemorrhage, 6.4% had moderate or severe hemorrhagic cystitis, 2.8% had pulmonary hemorrhage, and 2% had intracranial hemorrhage. Sixty-one percent had 1 bleeding site and 34.4% had more than 1 site. Moderate and severe bleeding was more prevalent in allogeneic (31%) and unrelated patients (62.5%) compared with autologous patients (18.5%). Significant distribution of incidence was found among the different diagnoses, but not by disease status in acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, Hodgkin's disease, and non-Hodgkin's lymphoma. Bleeding was associated with significantly reduced survival in allogeneic, autologous, and unrelated BMT and in each disease category except multiple myeloma. Survival was correlated with the bleeding intensity, bleeding site, and the number of sites. Although close temporal association was evident to mortality, bleeding was recorded as the cause of death in only the minority of cases compared with other toxicities after BMT (graft-versus-host disease, infections, and preparative regimen toxicity). Acute bleeding is a common complication after BMT that is profoundly associated with morbidity and mortality. Although bleeding was not a direct cause of death in the majority of cases, it has a potential prognostic implication as a predictor of poor outcome in clinical assessment of patients after BMT.     

The effects of prostacyclin on gastric intramucosal pH in patients with septic shock

OBJECTIVE: To investigate whether infusing prostacyclin (PGI2) in patients with septic shock improves splanchnic oxygenation as assessed by gastric intramucosal pH (pHi). DESIGN: Interventional clinical study. SETTING: Surgical ICU in a university hospital. PATIENTS: 16 consecutive patients with septic shock according to the criteria of the ACCP/SCCM consensus conference all requiring norepinephrine to maintain arterial blood pressure. INTERVENTIONS: All patients received PGI2 (10 ng/kg x min) after no further increase in oxygen delivery could be obtained by volume expansion, red cell transfusion and dobutamine infusion. The results were compared with those before and after conventional resuscitation. The patients received continuous PGI2 infusion for 33-32 days. MEASUREMENTS AND RESULTS: O2 uptake was measured directly in the respiratory gases, pHi was determined by tonometry. Baseline O2 delivery, O2 uptake and pHi were 466 +/- 122 ml/min.m2, 158 +/- 38 ml/min.m2, and 7.29 +/- 0.09, respectively. While O2 uptake remained unchanged, infusing PGI2 increased O2 delivery (from 610 +/- 140 to 682 +/- 155 ml/min.m2, p < 0.01) and pHi (from 7.32 +/- 0.09 to 7.38 +/- 0.08, p < 0.001) beyond the values obtained by conventional resuscitation. While 9 of 11 patients with final pHi > 7.35 survived, all patients with final pHi < 7.35 died (p < 0.01). CONCLUSIONS: Infusing PGI2 in patients with septic shock increases pHi probably by enhancing blood flow to the splanchnic bed and thereby improves splanchnic oxygenation even when conventional resuscitation goals have been achieved.     

Septic shock in patients with the acquired immunodeficiency syndrome

OBJECTIVE: To evaluate the prognosis of patients with septic shock admitted to an intensive care unit (ICU), according to their HIV serostatus. DESIGN: Retrospective study. SETTING: Medical ICU of a university hospital. PATIENTS: 76 patients with septic shock admitted to the same ICU, of whom 28 were HIV positive and 48 were HIV negative. MEASUREMENTS AND RESULTS: Severity scores, number and type of organ failures, and survival rates were assessed in the two groups of patients. Glasgow Coma Scale and general severity scores [Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score (SAPS)] were significantly worse in HIV-infected patients. The total number of organ failures was also higher in the HIV-positive group: 3.7 +/- 0.2 vs 3.1 +/- 0.2 in the HIV-negative group (p < 0.001). On day 28, 21 (46%) HIV-negative patients were dead compared to 26 (93%) patients in the HIV-positive group (p < 0.001). In the multivariate analysis, HIV infection was an independent risk factor for mortality, as were the SAPS score, use of mechanical ventilation, and the McCabe score. CONCLUSIONS: This study reports a considerable excess mortality in HIV-infected patients with septic shock. Although severity of illness was clearly much more pronounced in HIV-positive patients, retroviral infection was independently associated with death. Improving survival in HIV-positive patients with septic shock may require earlier diagnosis and treatment of the causative infection.