1. sedative: intramuscular injection of morphine 3 ~ 5 mg can relieve patients' nervousness, reduce the extra heart burden caused by restlessness, and closely observe the curative effect and adverse reactions.
2. Cardiotonic: 20 ml of 5% glucose and 0.2~0.4 mg of cedilanid are diluted and slowly injected intravenously to enhance myocardial contractility. Heart rate was detected before and during use, and oxygen saturation was monitored at the same time. If any abnormality is found, stop the injection immediately and report to the doctor in time.
3. Diuretics: intravenous injection of furosemide 20 ~ 40 mg, diuresis, reduce the burden on the heart, reduce the circulating blood volume, reduce the venous return blood volume, reduce the diastolic pressure of pulmonary artery, pay attention to maintaining electrolyte balance and prevent hypokalemia.
4. Intravenous drip of diluted sodium nitroprusside plays the role of "internal bleeding". Adjust the speed at any time according to the blood pressure, so as to increase the volume and storage of blood vessels, reduce the pressure in blood vessels, reduce the blood flow of venous return to the heart, and reduce the heart load. Note that vasodilators should be used on the premise of supplementing effective blood volume.
5. Anti-spasm: After 0.25g aminophylline is diluted, it is slowly injected intravenously to dilate coronary artery, strengthen diuresis, relieve bronchospasm and relieve bronchial asthma.
6. Posture: Sit up straight, legs droop, and connect limbs in turn to reduce venous reflux.
7. Oxygen inhalation: oxygen inhalation with a large flow mask and alcohol humidification of 6 ~ 8 l/min can increase oxygen saturation and improve myocardial hypoxia. Adjust the oxygen flow in time, and often check whether the catheter is unobstructed to ensure the oxygen use effect.
8. Vital sign monitoring: closely observe the patient's vital signs, such as heart rate, blood pressure, pulse, respiration, body temperature, urine volume, 24-hour water inflow and outflow and changes of illness. Observe the condition and pay attention to cyanosis, cough and expectoration, as well as the amount, nature and color of sputum.
9. Prevention of infection: pay attention to cold prevention, prevent colds, keep the air fresh, ventilate in the morning 15 min, disinfect with ultraviolet rays for 30min, at room temperature of 20 ~ 24℃ and humidity of 55% ~ 65%, so as to keep patients in a clean and humid environment. Strict aseptic operation, rational selection of antibiotics before and after operation to prevent infection.
10. Psychological care: Because of the acute onset and rapid progress, patients often feel nervous and afraid, because fear stimulates the sympathetic nervous system, which increases the secretion of catecholamine in the body, leading to increased blood pressure, accelerated heart rate and aggravated hypoxia, which induces the attack of acute left heart failure. Therefore, nurses should not only race against time to rescue patients, but also establish a good nurse-patient relationship, and use the language of encouragement and comfort to appease and eliminate patients' nervousness and fear, so that they can cooperate with the rescue, thus achieving the best effect of rescue treatment.
Example:
The following statement about acute left heart failure is incorrect ().
A. Cough pink foam-like sputum
B. Sit in a sitting position with legs drooping.
C. take oxygen at a high flow rate of 6 ~ 8 l/min.
D. sedative, intramuscular injection of morphine 3 ~ 5 mg.
E. slow intravenous injection of 0.2 ~ 0.4 mg of cedilanid.
Answer C. Analysis: Acute left heart failure was given 6 ~ 8 l/min high-speed alcohol humidification oxygen inhalation.