脑梗塞病人护理查房20100820[1]

the principle of simplified EIA of construction projects in the region. In terms of land, linked to the implementation of urban and rural construction land increase and decrease, replacement indicators for priority areas project. Charges, into the projects of water, electricity, administrative charges and preferential policies. In the area of taxation, and settled in areas of industry and its production company, within 5 years after the completion of fiscal incentives to enterprises. In terms of financing, integration of land, tax, financial and other resources, and construct Government credit + business credit credit system, establishment of marketization, commercialization and modernization of the investment and financing platform; effective Bank-enterprise docking, encourages private capital into the Park, to raise industry development fund. 5, optimize the environment and service industries. To create policy lowlands, Highlands, integrity of service land, development land as the goal, to optimize the area under development environment. All administrative law enforcement departments to appoint a full-time personnel stationed in areas dedicated to coordinating and solving problems associated with businesses in this sector. When there are substantial issues, sector leaders arranged to personally intervene, in-person, in-person push tangible area building a green light, easy line. To further reduce and standardize administrative examination and approval items, simplify examination and approval links, improve efficiency; according to the .Since the educational practice of the mass line of the party, himself seriously in the education, practical control central eight rules and opposing the four winds and practicing three Suns, and check the spirit of Jiao Yulu, ideology, solicit opinions based on outstanding problems checked swing, careful analysis and reflection. Will now check report is as follows: first, adherence to the partys political discipline, eight in the central provision, change the style of the basic situation of 1, in compliance with the partys political disciplines. Conscientiously abide by the partys political discipline, abide by the Constitution and the rules and regulations of the party, in the political, ideological and maintain highly consistent with the CPC Central Committee on the action, there is no violation of the partys political discipline problems. 2, in the implementation of the central authorities of the eight provisions. Improving research, improving research methods, but there are less grass-roots units, primary first-hand an inadequate grasp of the problem, which is to be strengthened in the future. Second, construction, strictly in accordance with the provisions to streamline and improve the quality of meetings of the Conference. Third, streamlining file briefs, culture involves all aspects of propaganda and ideology, sometimes due to the practical needs of invention notifications, this area needs further脑梗塞病人护理查房时 间：2010年7月8日 地 点：门诊七楼会议室参加人员：全体护理人员主 持 人：赵 贞记 录 人：赵 贞患者男性，张胜华，60岁。因吐词不清，右侧肢体运动障碍，反应迟钝3+小时入院于2010年7月1日03:00。患者3+小时前在家休息时，无明显诱因，出现吐词不清，右侧肢体运动障碍，站立不稳，反映迟钝。无呕吐，不伴发热，畏寒，咳嗽，腹痛，腹泻等。门诊以“ 脑血管意外 ”收入我科。入院时平车送入病房，T36.5 ，P74次/分，R20次/分，BP150/100mg。神志模糊，双侧瞳孔等大等圆约0.3cm，对光反射灵敏。全身皮肤无黄染，头颈部无畸形，口唇无发绀，颈软，胸廓无畸形。双肺呼吸音粗未闻及干湿啰音。律齐。神经系统查体：口角无歪斜，吐词不清，双侧瞳孔等大能圆约0.3cm，对光反射灵敏，四肢肌张力不高，右侧肌力0级，左侧肌力4级。右下肢巴氏征（+）头颅CT：脑梗塞。 病因：脑动脉粥样硬化 脑血栓形成最常见的病因是脑动脉粥样硬化，它多与主动脉弓，冠状动脉，肾动脉及其他外周动脉硬化同时发生。但脑动脉硬化的严重程度并不与其他部位血管硬化完全一致。高血压常与脑动脉樱花并存，两者相互影响，使病情加重。高脂血症，糖尿病等则往往加速脑动脉硬化的进展。脑动脉炎 如钩端螺旋体感染引起的脑动脉炎。胶原系统疾病，先天性血管畸形，巨细胞动脉炎，肿瘤，真性红细胞增多症，血液高凝状态等。颈动脉粥样硬化的斑块脱落引起的栓塞称为血栓-栓塞。发病机制 在颅内血管壁病变的基础上，如动脉内膜损害破裂或形成溃疡，在睡眠，失水，心力衰竭，心律失常等情况时，出现血压下降，血流缓慢，胆固醇易于沉积在内膜下层，引起血管壁脂肪透明变性，纤维增生，动脉变硬，迂曲，管壁厚薄不匀，血小板及纤维素等血液中有形成分黏附，聚集，沉着，形成血栓。血栓逐渐扩大，使动脉管腔变狭窄，最终引起动脉完全闭塞。缺血区脑组织因血管闭塞的快慢，部位及侧支循环等提供代偿的程度，而出现不同范围，不同程度的梗死。脑部任何血管都可发生血栓形成，但以颈内动脉，大脑中动脉多见。血栓形成后，血流受阻或完全中断，若侧支循环不能代偿供血，受累血管供应区的脑组织则缺血，水肿，坏死。经数周后坏死的脑组织被吸收，胶质纤维增生或瘢痕形成，大病灶可形成中风囊。 初步诊断：1）脑梗塞 2）高血压2级治疗方面：1）一般治疗及卧床休息，低盐饮食。 2）活血化瘀护脑对症支持治疗。辅助检查：头颅CT示左侧基底节区小片状稍低密度影，血常规，大小便常规，电解质,肝肾功,血脂均正常,随机血糖5.3mmol/L。 根据患者入院情况所收集的资料，提出了如下护理问题： 1）自理缺陷：与肢体无力有关；2）躯体移动障碍：与肢体活动障碍有关；3）有皮肤受损的危险：与长期卧床有关；4）感知改变：与感知觉障碍有关；5）潜在并发症：消化道出血；6）缺乏知识：与对病情及治疗不了解有关。根据患者病情，采取了如下护理措施：1）密切观察病情变化及每小时测量生命体征情况，予每1/2小时巡视病房1次，发现异常，即使告知医生。2）保持呼吸道通畅，呕吐时头偏向一侧，即使吸出呼吸道分泌物。3）病人的一切生活护理由护士给予完成。4）准确记录24小时出入量。5）协助并指导家属做好患者患肢功能锻炼。6）做好病人的皮肤护理，给予每2小时翻身拍背防褥疮护理。7）做好病人的心理护理，消除紧张情绪，使其增强战胜疾病的信心。以上是该患者具体的病情介绍及制定的护理计划。一、 该病人使用了阿斯匹林，请问在用药期间应如何观察及注意事项？贺晓容主管护师：我们应观察病人是否有胃肠道反应，如：恶心、呕吐，便血情况；注意观察是否有皮肤出血情况；注重观察是否有过敏反应，如荨麻疹、血管神经性水肿、过敏性休克或哮喘。长期服用定期查肾功能；年老体弱老年病，应尽量避免使用。二、 脑梗塞可在分为几种类型，请问脑梗塞的类型及常见的梗塞部位？任奉琼主管护师：可分为四种类型：大面积脑梗塞；分水岭脑梗塞；出血性脑梗塞；多发性脑梗塞。最常见的部位：颈内动脉系统；大脑中动脉。三、根据患者的病情及辅助检查，该病人合并有脑出血，应该如何做好脑梗塞合并脑出血病人的护理及病情观察？李燕护士：脑梗塞为缺血性脑血管疾病，脑出血为出血性脑血管疾病，脑梗塞合并脑出血时给治疗和护理带来了新的问题：做好急性期的基础护理，有效减少和预防并发症的发生，病人取平卧位，抬高床头15度以利于减轻脑水肿，持续吸氧，流量3升/分，每天更换湿化瓶，每班更换吸氧管，每小时监测生命体征，做好口腔护理。做好家属的解释工作，脑梗塞与脑出血是两个相对立的疾病，当脑梗塞合并脑出血时，病程会延长很多，应与家属做好解释工作，帮助病人及家属建立战胜疾病的信心。脑梗塞合并脑出血后在治疗上就只能是脱水，营养脑细胞，能量合剂以增强机体的反抗力来促进疾病的恢复，而不能采取止血或者抗凝具有针对性的治疗，故而疾病的恢复与病人的意志状态有很大的关系。恢复期的护理，加强肢体功能锻炼。四、脑梗塞患者一般都有肢体偏瘫现象，那么我们应该如何做好脑梗塞患者在急性期、恢复期的肢体功能锻炼？卢本娟护师：急性期：预防关节弯缩，变形及废用性肌萎缩。保持各关节功能位置。如：肩关节，肘关节，手指各关节等的屈、伸、外展、旋内及环绕活动，不可用力过大，防止扭伤或骨折。经常翻身变动体位。指导病人每2小时翻身一次。床上被动运动。如：教会病人以健手为着力点，健肢为支点在床上进行上下移行。恢复期：指导患者进行自我运动练习。如：捡豆子、拨算珠、书法等。指导患者站立练习：如教病人收腹，挺胸，抬头，放松肩，颈部肌肉。指导患者行走练习。如：伸髋曲膝，上下楼梯练习，重心转移练习等。五、健康指导是一项很重要的内容，针对此病人的情况，我们该如何做好健康教育？彭婕护士：从三方面做健康教育。心理护理：多与病人接触交流，了解其心理动态情绪，鼓励家属多探视；向病人解释所患疾病的性质、预后、治疗方案及目的，消除紧张情绪，使其树立战胜疾病的信心。饮食指导：指导病人低盐、低胆固醇、适量碳水化合物，丰富维生素饮食。控制总热量，饮食要有规律，切忌暴饮暴食或过分饥饿。休息活动指导：急性期卧床休息，应取平卧位，注意保持瘫痪肢体功能位置并适当被动运动患肢与关节。病情稳定后，应尽早进行床上，床边及下床活动，主动运动患肢。六、现在患者病情好转，预备出院，该如何做好脑梗塞患者的出院指导？黄晓蓉护师：指导患者出院后注重休息，逸事，增加营养，增强体质。出院后继续坚持肢体功能锻炼及语言沟通。坚持按时服药，巩固疗效。注意保持皮肤清洁。定时监测血压，定期复诊。陈晓兰总长总结：发包人指定专人负责协调施工中的有关事宜，并监督施工进度、安全与文明施工。发包人对承包人施工中违规操作有权做好处理决定或经济处罚。streamlining. Four are standard visits, except as required to participate in training, no other activity. Five is to improve news reporting, for propaganda work strictly according to the regulations. Six is strictly your presentation published strictly according to the regulations. Seven is strictly thrift, required the use of vehicles and office space and corporate hospitality. 3, change the style. Propaganda and ideological work of the new situation and new requirements of the new tasks, had done a lot of fruitful work, has made many achievements, but further closer to the grass roots, close to reality, close to the masses and also inadequate innovation must continue to improve. Second, the four winds some outstanding issues 1, oppose formalism. One theory is that he didnt, with less close contact. Theoretical study of consciousness is not high enough, system performance is not strong enough; more passive learning, active learning few generalities and learn more, delving into less. Especially based on rational thinking on major issues, applying theory to guide the work done is not good enough, not really understand and grasp the spirit and essence of the scientific Outlook on development, did not truly achieve mastery, to apply, to a certain extent, affect the development and implementation of ideas and initiatives. Second, work arrangements, and less supervision. Propaganda and ideological work is the objective, which needs to keep the continuity efforts deployed, but stressed in the work time, less supervision. For example, color weekends in the summer theatrical activities, city square performances, urging townships, communities and rural areas shows the implementation is inadequate, insufficient cultural an educational role to play. Third base enough, master grass-less real. Propaganda and ideological work in the new situation of characteristics and regularity of enough, deep enough for grass-roots public opinion Dynamics survey, for grass-roots typically drive less. For example, rural culture team active, . Im not actively take the initiative to take up, the lack of spirit of daring to, resulting in some job had a lot of power, but no tangible results. Third, innovation, lack of motivation. Emancipation did not end, innovation does not exist. In practical work, not your head, previous work experience, lack of innovation initiatives, study on the characteristics of propaganda and ideological work under the new situation through, grip on grassroots ideological trends and changes are not deep, to promote new initiatives and explore new methods of ideological and cultural work is not much, and some lack of relevance and timeliness. 4, discipline, lowering, and hard work are lacking. While working and enterprising spirit down. No real solution to treat yourself right, correctly treat past honors, their complacency, and work to see their scores more, less checking his own shortcomings, like to listen to the praise, satisfied face, online promotion, there are typical, and lack of high standards and strict requirements, the effect is real. Second hard drive less. On hard and