先天性耳前瘘管护理查房

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,2020/11/30,*,先天性耳前瘘管的护理查房,1,2020/11/30,疾病,知识,护理,查房,2,2020/11/30,疾病知识,3,2020/11/30,病因,先天性耳前瘘管,是一种常见的先天耳畸形。为胚胎时期形成耳廓的第一、二鳃弓的,6,个小丘样结节融合不良或第一鳃沟封闭不全所致。,4,2020/11/30,病理,呈树枝状分支和弯曲的盲管，深浅长短不一。瘘口位于耳轮脚前，瘘管可有分支，管壁衬以复层鳞状上皮，内有脱落上皮及角化物，偶有白色乳酪样分泌物，内含脱落的角蛋白碎屑。因感染腐败可排出具臭味的分泌物。反复感染可形成囊肿或脓肿。瘘管分支一般较短，个别深达鼓沟外,。,5,2020/11/30,病理,耳前瘘管瘘口多位于耳轮脚前，另一端为盲管，深浅、长短不一，还可呈分枝状。瘘管多为单侧性，也可为双侧。管腔壁为复层鳞状上皮，具有毛囊、汗腺、皮脂腺等，故挤压时有少量白色粘稠性或干酪样分泌物从管口溢出。,平时无症状，继发感染时则局部红肿疼痛。反复感染破溃后可形成瘢痕。,6,2020/11/30,先天性耳前瘘管,7,2020/11/30,8,2020/11/30,治疗,若无感染史者，不必处理。,在急性感染时，全身应用抗生素控制炎症，对已形成脓肿者，则应先切开引流。待感染控制后，再行瘘管切除术。,术前注少许亚甲蓝于瘘管内，并用探针为引导，将瘘管及其分支彻底切除，以免复发。,9,2020/11/30,护理查房,10,2020/11/30,病例介绍,姓名：谢利,性别：女,年龄：,42,岁,入院时间：,2014-05-12,入院方式：步,行,11,2020/11/30,病例介绍,四测,80,20,123/80,12,2020/11/30,病例介绍,主诉：,发现右耳耳前瘘管30余年，复发一年余。,现病史,：自诉30余年前无明显诱因发现右耳前瘘管，2年前瘘管出血感染，伴脓液流出，在当地医院手术治疗，治疗后再次复发来我院就诊。,既往史：,2年前行右耳前瘘管切除术。,13,2020/11/30,专科情况,右耳前可见一针孔大小瘘管口，引流口红肿，按压时有脓性分泌物渗出，周围可见陈旧性手术疤痕。,14,2020/11/30,入院诊断：,先天性耳前瘘管复发并感染,诊疗计划：,1，完善术前检查,2，择日手术,3，暂予美洛西林抗炎对症治疗,15,2020/11/30,患者于05-16在局麻下行右侧耳前瘘管切除术。,16,2020/11/30,术后生命体征平稳，伤口敷料干洁，一般情况可。,17,2020/11/30,患者的护理诊断有哪些？,18,2020/11/30,护理诊断,知识缺乏：,缺乏疾病日常及手术后自我护 理知识,疼痛：,与手术切口有关,有感染的危险：,与抵抗力下降或细菌入侵 引起感染化脓有关,19,2020/11/30,护理目标,1，患者掌握疾病的日常和手术后的自我护理知识,2，疼痛减轻或消失,3，患者能保持耳部清洁，预防感染。,20,2020/11/30,患者的护理要点是什么？,21,2020/11/30,术前护理,（,1),术前心理护理：热情认真的和患者沟通，消除患者紧张焦虑心情。,（,2),协助患者完善辅助检查，如胸透、心电图、血尿便、凝血四项、肝功能,（,3,）检查耳郭、外耳道有无局部感染性病变，并治疗局部存在的疾病。,22,2020/11/30,术前护理,（4,),皮肤准备,术前,1,天理发（瘘口周围,5cm,毛发）、沐浴、更衣、剪短指甲，女病人将头发梳 理整齐用软头绳绑好或梳成三股辫。,23,2020/11/30,术后护理,体位,平卧位,健侧卧位,24,2020/11/30,术后护理,饮食,25,2020/11/30,术后护理,护理要点,1，观察生命体征,2，定期换药，保持伤口敷料清洁干燥，避免感染。,26,2020/11/30,健康指导,保持外耳道清洁，勿用手自行挤压瘘管，避免污水进入瘘管。,术后注意休息，防感冒。加强锻炼，增强机体抵抗力。,27,2020/11/30,评价,患者掌握防止耳前瘘管感染的方法,患者掌握先天性耳前瘘管的自我护理知识,患者疼痛轻微或无疼痛,28,2020/11/30,Thank You !,29,2020/11/30,