优质医学先天性高肩胛症

Postoperative nursing for sprengle deformity:a case report1 Contents 1 Sprengle deformity 2 Case report 3 Nursing process 4 Nirsing experience 2 Sprengle deformityThe disease is genetic,and more women than menMost are unilateral and bilateral incidence was 10%-20%3 Sprengle deformity Definition:It is a rare congenital deformity one or both scapulate that apears at birth.Characterize by one side shoulder joint is 2cm-10cm higher than normal one.And it causes restricted mobility of the shoulder and cervical spine 4 Sprengle deformity ClassificationI degrees:deformity is very light,on both sides of the shoulder joint in the same level,appearance is not obvious degrees:on both sides of the shoulder joint is almost the same level,the dress can be seen when the deformity degrees:shoulder joint is higher than the contralateral 2 5 cm,deformity.IV:is very serious,shoulder blades can be ascended the occipital Diagnosis:X-ray examination5 Sprengle deformity Operative treament Appropriate age:3-6 years old；I degrees does not consider surgery,IV degrees demand through surgery under 5 years old detiod nusclesubclavian artery and veinpectialismajor pectoralis minorbrachial plexus 6 Common complicationsbleeding hematomawoundsurgeryEndotracheal intubationLaryngeal edemaOppression of the tracheaDifficulty in breathinginfectionBrachial plexus injuryThe most serious complications7 Case report Huang XX female,3 y,by finding the left shoulder blade deformity,3 years ,generally in good condition,no shortness of breath,chest tightness and other discomforts;Children with smooth mood,good appetite,sleep good,normal to the toilet.Cultural degree:children kindergarten,social psychological reaction is good,acompamy with parents in the hospital 8 Case reportSpecialized examinationBone tissue pathological examinationBlood biochemical testhospital examinationElectrocardiogram(ecg)Chest RadiographyX-ray:The shoulder blade positive side Diagnosis:sprengle deformity9 Case report-Specialized examination and surgery degree of deformityOn the left shoulder blade Angle place is relatively higher than that of the right shoulder blade ca.4 cm,Limited lift on the left upper limb,outreach activities,left arm adduction,rotation,Forward bends after stretch no obvious limitations,fingers feel normal.Operation:4/8 in endotracheal hemp on her left shoulder blade edge,Muscle release+check point down around the excision reconstruction+bone bridge10 Case description-postoperative condition general situationLimb situationtreatmentphychology Left shoulder a wound drainage tube,drainage of the dark red hemorrhagic fluid 10 ml,shoulder wound dressings dry clean,Left upper limb activity limited mild,good blood supply5%GS100ml bid.muscosolvan15mg+0.9%NS10mlbid oxygen inhalation lansoprazole 15mg+0.9%NS100ml bidOften cried,emotional instability,family felt nervous.Continue to ecg monitoring and oxygen 2 l/min,stable vital signs,pain scores six points11 Nursing process assess planevalautediagnosisdo12 assess Postoperative evaluation of children with pain,Vital signs,especially respiratory and blood oxygen saturationAdmission assessment and evaluation of preoperative limb situation术后评估患侧肢体的活动、血运术后评估患侧肢体的活动、血运 患儿引流管患儿引流管 及伤口局部情况及伤口局部情况评估患儿与家属心理情况，及评估患儿与家属心理情况，及家属对术后注意事项掌握度家属对术后注意事项掌握度Postoperative evaluation of limb activity,blood supply drainage tube and wound local situationpsychological situation,and Master degree of families of postoperative consideratios13 diagnosisPotential complications:brachial plexus injury,acromegaly bloodLoop obstacle,bleeding,infection,hematomaLack of knowledge:families lack of postoperative nursing knowledgeAnxiety:and the child is not adapt to the environment pain:associated with postoperative wound14 Ease the painPsychological careObservationPostoperative guidance ObservationTo prevent infection Guide function exercisePlannear term（1-3d）medium term（4-10d）late period（10d后后）15 painnursingDoListen to the chief complaintAssessment of pain location,time,nature;With smiling face pain assessment scaleBody position nursing care:avoid lateral position,recommended the hypothesis or right side a little bit high(on the left side of the pad 10,15)in children with place sandbags fixed head on both sides of the headGuide the non-drug pain relief methodPrescribed drugs,drug effect and adverse reactions.16 Postoperative pain scores17 observationDoVital signs,especially pay attention to the childs temperature,breathing,complexion,blood oxygen saturation.Limb blood circulation:color,swelling,skin temperature,the radial pulse.observe Limb activity,muscle strength through induction and the finger grasping,and compared with preoperative.Wound observation:wound dressings ;Wound drainage s quantity,color,character;inflamed or hematoma 18 nursingDo Continue to ecg monitoring and give oxygen for 24h Write the nursing record Prevent infection nursing:dressing wound temperature monitoring Avoid shoulder joint activities within 2 weeks.start a limited range of active and passive joint training after 2 weeks.19 psychological nursing Do Explain to the family about treatment and nursing Giving more concern and sympathy,to obtain the trust and cooperation keep an comfortable environment The same age childrens encouragement and support Distraction:toys,anime Listen to children complained,understand the cause of the crying 20 Psychological change Children and family tensions ease,smooth mood21 health education(to the family)Do postoperative position requirements,turn and drainage tube care considerations observation points：kids complexion and abnormal crying,abnormal limb avtivity high protein,high quantity of heat,high vitamin diet;Guide function exercise,such as the recent massage distal limb,wrist,elbow flexion exercise;The late:monkey climbing training,weight training22 the awareness of familly before and after health education 23 evaluateNo complications occurredFamilies can be the first day after surgery with postoperative considerations,Before discharge can grasp the functional exercisePostoperative pain relief on the first day,Family members grasp the method of non-drug pain relief,and use the smiling face pain assessment scale correctly children,family members emotional stable two days after24 nursing experience psychological nursing.jiont the familyto nurse the child Do a good job of explaining to thefamily members To obtain the trust and cooperationundestand operation methodcommunicate with doctors about nursing emphsisin advance communication obervationchild care25 26