护理教学查房双语课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Nursing Teaching Round,护理教学查房,护理教学查房双语课件,Case Report,病例报告,Case Report,买买提,艾山，男，,58,岁，新疆籍新疆军区副政委。,主因发现心脏杂音,32,年，发作性心悸,5,年于,2007,年,3,月,7,日入院。,Patient Mai Mai Ti,male, 58 year-old ,was born in xinjiang.,He was admitted to the hospital on March 7th 2007.,Chief complaint:,He has had cardiac murmurs for 32 years, Palpitation for 5 years.,买买提艾山，男，58岁，新疆籍新疆军区副政委。主因发现心,现 病 史,Present Health History,缘于,32,年前查体发现心脏杂音，患者始终无症状。,自,5,年前经常于劳累或饮酒后感心悸，伴轻度胸闷,The patient had cardiac,murmurs 32 years ago, but he was asymptomatic.,He felt palpitation after fatigue or alcohol intake 5 years ago, sometimes accompanied by chest discomfort.,现 病 史 Present Health History缘,现 病 史,Present Health History,无头晕、恶心、呕吐及晕厥,无胸痛,休息后可缓解,No nausea and vomiting, chest pain, dizzy, faint .,These symptoms can be relieved by rest,.,现 病 史 Present Health History无,现 病 史,Present Health History,2005,年,6,月,动态心电图,显示频发多型室性早搏和阵发性室速,给予口服胺腆酮治疗,超声心动图,提示左室流出道压力阶差高,PG,113mmHg,Continuous ECG,revels premature ventricular contractions and paroxysmal ventricular tachycardia on June 2006.,Oral Amiodarone was given him to control them.,Echocardiography,shows left ventricle hypertrophy, left ventricle outflow was narrow.,PG is 113mmHg.,现 病 史 Present Health History2,现 病 史,Present Health History,2005,年,7,月明确诊断为肥厚型梗阻性心肌病,会诊决定暂时应用,-,受体阻滞剂和钙拮抗剂行药物治疗,观察血流动力学，如左室流出道压差降低，则继续药物治疗，如左室流出道压力阶差降低不明显，考虑射频消融结合起搏治疗。,He was diagnosed as HCM(Hypertrophic Cardiomyopathy) on July 2005.,Beta blockers and calcium channel blockers were used.,The haemodynamy must be observed.,现 病 史 Present Health History2,既 往 史,Past Health History,否认冠心病、糖尿病病史,否认肝炎、结核等传染病史,否认手术外伤及输血史,无药物过敏史,Deny history of CAD ,diabetes mellitus.,Deny history of heritage family disease,Deny history of surgical operations, injuries and blood transfusion.,No medicine allergy,既 往 史 Past Health History否认冠心,个人史,Personal History,：,生于原籍，长期居住新疆，到过全国各地,否认疫区居住史，否认化学毒物及放射性物质接触史。有吸烟史数十年，已戒烟，偶尔饮酒，无明确规律。,已婚，配偶子女均体健,大学文化程度,Has never been to epidemic area, deny history of poison touching.,Has history of smoking for many years, he has already quit smoking. Drinking occasionally.,His wife is healthy. The two daughters are also healthy.,Bachelor degree,.,个人史 Personal History： 生于原籍，长期,家 族 史,Family History,父母双亡，死因不详,家族中无类似疾病患者,否认家族遗传病病史,It has not been found similar disease in his family.,Deny history of family heritage disease.,His parents were died, the reason has not been clear.,家 族 史 Family History父母双亡，死因不详,入院查体,physical examination,T36.5,P69,次,/,分，,R18,次,/,分,BP120/80mmHg,发育良好,一般情况好，双肺呼吸音清，未闻及干、湿性罗音,T:36.5, HR:69 b/m, R:18t/m, Bp 120/80mmHg,Developed well,Generally speaking, he is in good condition .,入院查体 physical examinationT36.,入院查体,physical examination,心前区无异常隆起，心尖搏动于左锁骨中线外,0.5cm,，无细震颤，心界增大，心率,69,次,/,分，律齐,主动脉瓣听诊区可闻及,3-4/6,级收缩期吹风样杂音,腹部未见阳性体征。双下肢无水肿。,Systolic murmur was heard at aortic area.,The rest was normal.,入院查体 physical examination心前区无,心电图示：心电图不正常，窦性心动过缓，左心室肥厚伴劳损，偶发室性期前收缩。,心电图示：心电图不正常，窦性心动过缓，左心室肥,E C G,The ECG reveals sinus bradycardia, premature ventricular contractions , left ventricle hypertrophy and changes in ST segment and T wave.,E C GThe ECG reveals sinus bra,入院后复查超声心动图示：,入院后复查超声心动图示：,超声心动图结果：,肥厚型梗阻性心肌病；,左室肥厚：,室间隔,24mm,，心尖部,16mm,，后壁,19mm,，侧壁,16mm,收缩期左室流出道可见五彩高速血流,PG,168mmHg,较前比较,PG,有所升高,超声心动图结果：肥厚型梗阻性心肌病；左室肥厚：,Echocardiography,Echocardiography shows left ventricle hypertrophy, left ventricle outflow narrowing at the same time.,Septal wall is 24mm,the apex of left ventricle is 16mm,posterior left ventricle is 19mm,inferior surface of left ventricle is 16mm,PG is more than before.,High speed blood flow were found in,Systole.,EchocardiographyEchocardiograp,动态心电图,动态心电图,动态心电图结果,Continuous ECG,频发多源室性期前收缩,部分呈双型，部分形成加速的室性逸搏性心律及室性心动过速,Continuous ECG reveals multi-focal PVCs,partly ventricular couplets and paroxysmal ventricular tachycardia,.,动态心电图结果 Continuous ECG频发多源室性期,治 疗 经 过,Treatment process,2007,年,3,月,27,日植入,5386DDDR,型起搏器,增加,-,受体阻滞剂量,超 声 心 动 图示主动脉跨瓣压缩小,PG=101mmHg,于,4,月,18,日出院,Dual-chamber, sequential atrioventricular pacing has been inserted on March 27th 2007.,The dose of Beta blockers was increased to acquire better effect.,PG is less than before.,The client was discharged on April 18th,.,治 疗 经 过 Treatment process,心理社会评估,Psychosocial Assessment,鉴于肥厚性心肌病无法根治以及无法预料的严重后果，患者有明显的不确定感，并导致恐惧和焦虑,患者担心女儿患病,Because of the incurable nature of the disorder and the unforeseeable of the serious consequences of the disease, the client is faced with uncertainty that may create fear and anxiety.,He was worried about his daughter,conditions,心理社会评估 Psychosocial Assessmen,Nursing Diagnosis 1,Potential Complications,including arrhythmias, heart failure, and sudden death,Nursing Goals,No occurrence of or early detection of complications,including arrhythmias, heart failure, and sudden death,Nursing Diagnosis 1Potential C,护理诊断,潜在并发症,心律失常,心衰,猝死,护理目标,无心律失常,无心衰,无猝死等,并发症,护理诊断潜在并发症 护理目标无心律失常,Nursing interventions,Avoid impairing ventricular filling, such as sudden position change, strenuous physical activities, competitive exercise.,Observe the effects of therapy applied, the possible side effects of medications, complications,Observe vital signs, complaints .pay more attention to sudden death.,Nursing interventionsAvoid imp,护理措施,避免可降低心室充盈的情况，如突然变换体位、体力活动、竞技运动,药物治疗的护理：观察药物作用与付作用,病情观察：生命体征、主诉，警惕猝死,护理措施,Nursing Diagnosis 2,Activity intolerance,related to the imbalance between oxygen supply and demand as a result of cardiac insufficiency,Nursing Goals,Increased exercise tolerance,Nursing Diagnosis 2Activity in,护理诊断,活动无耐力,与心功能受损所致的氧供需失调有关,护理目标,足够的心排出量,活动耐力增强,护理诊断活动无耐力 护理目标足够的心排出量,Nursing interventions,Instruct the patient on pacing the daily activities and rest to prompt comfort,Carefully monitoring before and after pacemaker insertion,Nursing interventionsInstruct,护理措施,指导患者合理安排休息与活动，增进舒适,安置起搏器前后的护理,护理措施指导患者合理安排休息与活动，增进舒适,Nursing Diagnosis 3,Fear/Anxiety related to the unknowing of and perceived threat of the disease,Nursing Goals,Less,anxiety and apprehension about his condition and prognosis,Nursing Diagnosis 3Fear/Anxiet,护理诊断,恐惧或焦虑,与对疾病缺乏了解和感知疾病威胁有关,护理目标,对疾病和预后,的焦虑与恐惧感减轻,护理诊断恐惧或焦虑 与对疾病缺乏了解和感知疾病威胁有关 护理,Nursing interventions,Emotional support:,creating an environment in which he can express concerns and acknowledge fears,showing a caring attitude,offering encouragement ,acceptance.,Nursing interventionsEmotional,护理措施,心理支持：,接纳和理解患者,创造有利于患者倾诉的环境,给予关怀、鼓励、支持,促进有效应对,护理措施心理支持：,Nursing Diagnosis 4,Lack of HCM self-management knowledge and skills,Nursing Goals,Adequate self-management,knowledge and skills,Nursing Diagnosis 4Lack of HCM,护理诊断,知识缺乏,缺乏肥厚性心肌病自我管理知识与技能,护理目标,有足够的自我管理知识与技能,护理诊断知识缺乏 护理目标有足够的自我管理知识与技能,Nursing interventions,Knowledge of HCM,Explain the effects and side effects of medication,Carry a medical condition card in case of emergency,Family members be trained the basic life support techniques,Keep adherence to the therapeutical regimen and self-monitoring,Prompt self-management by health teaching,Nursing interventionsKnowledge,护理措施,健康教育,有关疾病知识,有关用药知识,家庭成员急救技能训练,携带病历简卡,遵从治疗方案，加强自我监测,促进自我管理,护理措施健康教育,Nursing Evaluation,Demonstrate an adequate cardiac output,Increased exercise tolerance, improve the client,s quality of life.,Demonstrate proper management of physical and emotional activities.,Administer medications safely and recognize possible side effects.,Obey the therapeutical regimen.,Nursing EvaluationDemonstrate,护理评价,足够的心输出量，无并发症发生,患者活动耐力增加，生活质量提高,患者显示对活动与情绪的恰当管理,患者能安全用药和识别可能发生的副作用,遵从治疗方案,护理评价足够的心输出量，无并发症发生,Instructions,Avoid over exciting and be emotionally stable.,Adjust lifestyles.,Monitor the effects and side effects of medications.,Come back to the hospital for follow up checks regularly.,Family member can master the basic life support techniques.,InstructionsAvoid over excitin,出 院 指 导,避免情绪激动，保持情绪稳定,改变生活方式,监测药物作用与付作用,定时复查,患者家庭成员掌握基本生命支持技术,出 院 指 导避免情绪激动，保持情绪稳定,讨 论,为什么该病人非常关心女儿的健康？,讨 论为什么该病人非常关心女儿的健康？,Discussion,Why was he worried about his daughter,s health?,The exact etiology of HCM is yet unclear. About one third of the affected clients have family history. It is currently recognized as a genetically transmitted disease that is associated with multiple gene alterations,.,DiscussionWhy was he worried,讨 论,患有,HCM,的病人常有明显的心理问题，为什么？,讨 论患有HCM的病人常有明显的心理问题，为什么？,Discussion,The patients with HCM often have more emotional reactions, why?,To many people ,heart is the symbol of their life. A client with HCM perceives it as a major life crisis. They may confront not only the possibility of death, but also fears ,forced changes of daily life , family and social roles.,DiscussionThe patients with HC,讨 论,起搏器治疗的目的是什么？,讨 论起搏器治疗的目的是什么？,Discussion,What is the goal by pacemaker insertion?,The beneficial effect is attributable to the modification of the ventricular activation sequence ,therefore, preventing or lessening the left ventricular outflow obstruction,.,DiscussionWhat is the goal by,讨 论,治疗该病，常用哪些药物？,讨 论治疗该病，常用哪些药物？,Discussion,What kinds of medicines are most often used to treat the disease?,Beta blockers and calcium channel blockers,DiscussionWhat kinds of medic,讨 论,此病常见症状是什么？它是怎样引起的？,讨 论此病常见症状是什么？它是怎样引起的,What,s the most common symptom of HCM? What,s the reason?,It is dyspnea after physical activity, which is due to high pulmonary pressure caused by the elevated left ventricular diastolic pressure.,Discussion,Whats the most common,讨 论,本病中,-,受体阻滞剂的作用是什么？,讨 论本病中-受体阻滞剂的作用是什么？,Discussion,What,s the action of beta blockers?,Beta blockers decrease outflow obstruction and heart rate, allowing greater time for filling of the chambers,.,Discussion,护理教学查房双语课件,护理教学查房,护理教学查房,什么是,护理教,学查房,需要注,意什么,如何,开展,什么是需要注如何,一、护理教学查房的概念,是以,临床,护理,教学,为,目的,、以,病例,为引导,（,case based study CBS),、,、以,问题为基础,(problem based learning PBL),、,以,护理程序,为框架,PBL,与病程相结合,的护理查房。旨在培养学生理论与实践相结合的能力，并提高其综合能力。,一、护理教学查房的概念 是以临床护理教学为目,解决临床实际工作的疑难问题，评价护理计划、,护理措施的落实与效果，确保护理工作质量,提高教学质量及护理实习生及带教老师的综合,素质。,目,的,意,义,解决临床实际工作的疑难问题，评价护理计划、提高教学质量及护理,教学查房的方法,预告式方法,随机式方法,事先告知,查房的内容，积极准备（看病例、查体、查阅资料、提问题）,是临床,最常采用的教学查房方法。,临时的、随机的,晨交班后的床旁查房,急重症病人查房,教学查房的方法 预告式方法 随机式方法事先告知查房的内容,三、护理教学查房的类型,按教学查房的护理能级分类：,1,、由护士长或护理部组织的教学查房,：,方式：,以疾病或问,题为重点,病例选择：,疑难、危重、大手术病人、新技术开展项目等,2,、由带教老师组织的教学查房：,方式：,以教学大纲、,计划、课程,要求为重点,病例选择：,以典型病例为主,三、护理教学查房的类型按教学查房的护理能级分类： 1、由护士,60,根据教学查房的内容分类：,以病人为中心的护理程序查房,以护理程序为框架进行分析、讨论及补充，,以检查护生解决实际问题的能力。,以护理质量为中心的评价性查房,床前由责任护生简要汇报例、带教老师补充，护士长在每个责任组抽查,2,、,3,名危重、新入院或大手术病人，,以检查工作职责落实及工作质量，协助护士解决疑难问题,.,（护理部查房形式）,以护理技术为中心的操作性查房,有一定难度的护理技术作为教学查房内容，如：三腔二囊管的应用及压力测定、胸腔闭式引流瓶的更换。,重点：操作流程、注意事项及管理方法示教或指导。,以护理管理为中心的管理性查房：,由护士长主持，查各班工作职责落实、病区管理、查对制度、消毒隔离制度等落实情况,目的：增强护生管理意识、全方位承担护士的技术责任与管理责任。,（护理部查房形式,),1,2,3,4,根据教学查房的内容分类：以病人为中心的护理程序查房以护理程序,按教学查房的指导思想分类：,传统的护理查房,整体护理查房,以护理程序,为框架查房,以问题为基,线展开讨论，,带教老师对,讨论的问题,进行点评与,小结,.,从评估,、,诊断,计划,、,实施,、,评价五个步,骤进行讨论,与评价,病人得到了,什么样的护理,?,护士为病人,解决什么问题,?,病人是否达,到健康目标,?,+ ,两种,方式的结合,以问题为,基础查房,从疾病的病因病理、临,床表现、治疗护理等作,为讨论的重点。,缺点：,A,重知识的传授,而轻能力的培养,B,只见疾病不见人,C,与业务学习相混,该种查房模式,现已少用,按教学查房的指导思想分类：传统的护理查房整体护理查房以护理,以问题为基础（,PBL,）,三、教学查房的,指导思想,以护理程序,为框架,整体护理查房,以问题为基础（PBL）三、教学查房的以护理程序整体护理查房,1,评估,2,诊断,3,计划,5,评价,4,实施,护理程序为框架,病人,1评估2诊断3计划5评价4实施护理程序为框架 病人,以问题为基础（,PBL,）,1,2,3,以问题为基础,学生为中心,教师为导向,以问题为基础（PBL）123以问题为基础学生为中心教师为导向,整体护理查房,护理程序,PBL,整体护理查房护理程序PBL,护理教学查房病例的选择,1,普通病例,2,疑难危重病例,3,新业务、新技术,护理教学查房病例的选择1普通病例2疑难危重病例3新业务、新技,四、护理教学查房制度,查房次数：,1,次,/,月，,1,小时左右,1,查房对象：现住院病,人,2,查房者要求：被查者：实习同学、护士,查房者：带教老师或护士,长,3,教学查房要求：,（,1,）学生（主查护士）按护理程序汇报病史,（,2,）老师对查房内容进行补充、提问、讨论,（,3,）老师总结和点评，对学生不足提出改进措施,（,4,）老师评价,4,四、护理教学查房制度查房次数：1次/月，1小时左右1查房对象,五、护理教学查房的程序,1,、查房前准备,2,、床旁查房,3,、评价、总结,查房,五、护理教学查房的程序1、查房前准备2、床旁查房3、评价、总,1,、查房前的准备,老师的准备,(1),(2),病人的准备,(3),查房人的站位,4,(4),(5),学生的准备,物品的准备,1、查房前的准备老师的准备(1)(2)病人的准备(3)查房人,四、教学查房的实施,（以带教老师教学查房为例）,（一）、查房准备与要求：,1,、查房前准备：,提前,2-3,天确定病人、明确查房目标（根据教学大纲要求，并告知相关人员）、查阅相关资料,2,、物品准备：,车或治疗盘、病历、听诊器、血压计、消毒洗手液、手电筒、专科物品等,3,、查房人员：,要求参加的人员,四、教学查房的实施 （以带教老师教学查房,教学查房程序,查房准备与要求,4,、查房人员的站位：,（可根据实际情况进行调整）,病人右侧,病人左侧,床尾,主查护生,(,士,),责任护生或辅查护 其他护生、,及指导老师 生、护士长 护士,（带教老师） （护理部人员）,护师、护士,教学查房程序查房准备与要求4、查房人员的站位：（可根据实,教学查房的程序,（查房准备与要求）,5,、查房时限：,一般为,1,小时,左右,6,、查房内容：,要求以病人为中心，以护理程序为框架，以,解决护理问题,为目的，突出对重点内容的讨论，并制定解决方案，达到护理,教学目标,7,、,注重,启发式教学,方法，激发护生学习积极性,教学查房的程序（查房准备与要求）5、查房时限：一般为1小时,2,、,床旁查房,老师说明目的,（,1,）,（,2,）,主查人护理评估,（,3,）,（,4,）,主查人评价,责任护生病情汇报,2、床旁查房老师说明目的（1）（2）主查人护理评估（3）（4,1,2,3,病人基本情况,病人的护理问题、采取的治疗护理措施及效果,目前存在的问题与依据,教学查房的程序,（二）、查房实施程序：,1,、病例汇报：,在办公区完成，先由实习生汇报，然后由,指导老师补充,，并说明本次查房的目标。,123病人基本情况病人的护理问题、采取的治疗护理措施及效果目,教学查房的程序,（查房实施程序）,2,、床边查房：,入病房：,（,1,）、,主查护生和指导老师在前,，及其他人员随后，按要求站位,（,2,）、注意礼貌、介绍人员及目的、取得病人及家属配合，注意病房,其他病人,的反应,教学查房的程序（查房实施程序）2、床边查房：,教学查房的程序,（查房实施程序）,护理评估：,1,、护理体检：,生命体征、皮肤、管道、肢体功能、专科情况等（,结合目标，有重点,）,2,、带教老师指导：,指导老师应结合本次查房目标及病人实际情况，进行,现场指导、操作示教,等,教学查房的程序（查房实施程序）护理评估：,教学查房的程序,（查房实施程序）,3,、评估治疗护理措施效果：,检查护理计划、治疗与护理措施落实与效果,4,、与病人及家属沟通,：病人对护理工作的满意度、实施健康教育、解答病人提出的疑问等,5,、离开病房：,病人用物归位，整理床单位向病人致谢,教学查房的程序（查房实施程序）3、评估治疗护理措施效果：检,3,、评价、指导、总结,根据护理程序进行评价,（,1,）,总结本次查房效果及存在的问题,（,2,）,指导重点、难点并提问讨论,（,3,）,介绍该疾病护理新进展,（,4,）,3、评价、指导、总结根据护理程序进行评价（1）总结本次查房效,教学查房的程序,（查房实施程序）,讨论（在办公室进行）,1,、主查护生：,根据评估资料对护理问题、措施、效果等发表意见或提出疑问。,2,、其他人员：,补充或提问,3,、指导老师：,小结、答疑、,评价、布置任务等,（注意：结合本次查,房目标及病人实问题,）,。,教学查房的程序（查房实施程序）讨论（在办公室进行）,五、教学查房中应掌握的七项内容,：,（一）、教学准备：,1,、熟悉病情,2,、按教学大纲要求计划教学内容,3,、参考相关专业资料,4,、时间安排（一般至少提前两至三天）,五、教学查房中应掌握的七项内容：（一）、教学准备：,81,（二）,.,确定教学目标,1,、本次查房要传授给学生什么？,2,、要求学生掌握哪些知识与技能（基础,/,专科知识与技能）？,3,、解决什么问题？（结合病,人当前的情况，选择最需,要解决的护理问题为目标，,不要面面俱到，不要变成,讲小课。,）,（二）. 确定教学目标,（三）、床旁查房,1,、注意礼貌、保护性医疗、病房其他病人的感受等。,2,、要求学生结合病人具体情况作,重点体格检查,。生命体征测量、专科体查等，带教老师予以,现场指导或纠正,3,、将体查的发现与护理问题、观察病情和评估疗效等结合起来，,教师起指导作用。,（三）、床旁查房1、注意礼貌、保护性医疗、病房其他病人的感受,1,、注意是分析,病人,，不是分析,疾病,2,、密切结合病人，深入讨论护理问题,3,、示范科学的临床思维方式与过程，,解决实际问题,4,、通过有序的分析，使学生学习如何,发现问题，提出问题和解决问题,的方法,。,（四）,.,临床分析,1、注意是分析病人，不是分析疾病（四）. 临床分析,1,、,调动学生的主动参与，活跃教学气氛，增强,教学效果,。,2,、对一些,重点,和,难点,，采用,提出问题,的形式引导学生思考，使学生有更鲜明和深刻的印象。,3,、提问与答疑是常用的形式，但教师在讨论问题时的,条理性、逻辑性和对重点问题,的,准确,把握，本身就是很好的启发。,（五）,.,启发教学,1、调动学生的主动参与，活跃教学气氛，增强教学效果。（五）.,应留几分钟时间进行此项工作,呼应,教学目标,，概括本次查房要求学生掌握的内容。,点评学生在查房中的,表现,，提出,改进,的意见。,根据需要，,提出问题和布置,下一次查房内容，要求学生作好准备。,（六）,.,归纳总结,应留几分钟时间进行此项工作（六）. 归纳总结,老师通过自身的,仪表,，,语言,和与,病人沟通,的艺术，渗透对学生的医学伦理、人道主义和“以人为本”的人文教育，塑造学生的,健康人格和崇高医德,。,（七）,.,为人师表,老师通过自身的仪表，语言和与病人沟通的艺术,对带教老师的要求,组织能力,教学能力,创新思维,综合素质,对带教老师的要求组织能力教学能力创新思维综合素质,谢,谢,！,谢,