As a nurse, how to provide health help for patients with hearing loss?

Case nursing of patients with cerebral infarction treated by rtpa: Wu Miaozhu's cerebral infarction in the Department of Cerebrovascular Medicine of Jiangmen People's Hospital is one of the major diseases that seriously endanger human health, and it is the primary cause of long-term disability, and its mortality rate is second only to myocardial infarction and cancer, ranking third. The decisive factor of cerebral infarction is the duration and severity of cerebral ischemia. 75% of cerebral infarction is due to acute thrombosis or thrombus metastasis in other parts, resulting in local cerebral vascular occlusion, leading to 1. Thrombolytic therapy of cerebral infarction is to recanalize the occluded artery in the early stage, restore blood supply and try to save neurological function. With the research and development of neurology and thrombolytic agents, thrombolytic therapy has become the most effective method to reduce infarction area and disability rate, especially for patients with moderate and severe neurological disorders. According to the treatment methods and standards studied by ninds, it was applied to the treatment of stroke patients in daily hospitals. After 90 days, 43% of patients could achieve functional independence. However, at present, less than 3%~5% of patients with cerebral infarction can get thrombolytic treatment, most of them miss the best treatment opportunity because of exceeding the time window, and a few people are unwilling to receive treatment because of complications such as cerebral hemorrhage. Their contraindications are also one of the reasons that affect the treatment, which requires our nurses to popularize health, carefully evaluate, closely observe, prevent complications, and cooperate closely with many disciplines to make patients recover physically and mentally. Therefore, nursing plays an important role in thrombolytic therapy. In the past, we used urokinase for thrombolysis. On July 9, 2009, a patient with cerebral infarction was treated with rtpa and achieved good results. The nursing experience is reported as follows. Case introduction: A 54-year-old female suffered from sudden weakness of her left limb during exercise on 20091October 30th 10: 00. No abnormality was found in emergency head ct, and blood routine was normal, with pt 10.8 l, INR 0.9 and aptt 30.4. Emergency lathe 12:00 was admitted to our department. Physical examination on admission: the muscle strength of the left upper limb is Grade III, and that of the left lower limb is Grade III. The nursing evaluation at admission is as follows: Evaluate the general situation of the project patients. The patient was conscious when he was admitted to the hospital, t37.2. C, p 1 12 times/min, r20 times/min, bp 173/72mmhg, sao2 97%, and his weight was 58kg. Nihss 5, gcs 15/ 15. Good nutrition, good appetite, healthy teeth and good oral hygiene. Normal hearing and vision, clear speech, good sleep and normal defecation. In the past, he was healthy and had no history of allergies. Before the onset, my daily activities were normal, and I usually liked dancing. Bed rest after onset, left limb weakness, daily life and personal hygiene need assistance. Patients with personal medical history and social relations are from Taiwan Province Province, graduated from primary school, housewives and part-time salespeople. They can communicate with people in Cantonese and Mandarin. I don't smoke or drink, my husband is still working, my two daughters are both working, and I have a good relationship with my relatives and friends. Living with family, husband and daughter, the house has an elevator, the home environment is general, there is a toilet and a shower umbrella. No religious belief, usually like listening to music, dancing and watching TV. Psychological patients are anxious when they are admitted to hospital. They kept asking the medical staff about their illness, worried about the prognosis, and suspected that the illness was related to their own exercise. After the medical staff explained, the mood was slightly stable. Initial diagnosis: right cerebral infarction. The muscle strength of the affected limb before and after medication is as follows: time left upper limb muscle strength (level) left upper limb muscle strength (level) left lower limb muscle strength (level) left lower limb mobility 30/ 10/2009 12:00 3 can barely lift, fingers can barely lift, toes can't move 30/10. Finger can move slightly 5- can resist most resistance, toe can move slightly 2/1/2009 4-can resist some resistance, finger can move slightly 5- can resist most resistance, toe can move slightly 5/1/2009 5- can resist most resistance. Title: Nurse Tel: 13555640984 Nursing Plan: Time Nursing Diagnosis Nursing Objective Nursing Measures Evaluation 30/ 10/2009 12:22 Exercise intolerance-related to the weakness of patients' left limbs 1. Patients learn correct active and passive movements. 2. Patients learn the skills of self-help exercise. 1. Inform patients of the importance of early active and passive exercise. 2. Methods The patients were instructed to do passive and active physical exercises, such as "crossing fingers to shake hands" self-help exercise and "bridge exercise" training. 3 110 goal achieved 30/ 10/2009 self-care ability decreased-related to the weakness of the patient's left limb1. The patient's life can be satisfied during bed rest. 2. Patients can achieve the best level of self-care under this condition, such as using a walker, washing and going to the toilet. 1. Prepare a pager, and put common items where the patient's healthy limbs can reach them. 2. Provide a toilet in time to assist in cleaning after defecation. 3. Assist in washing and dressing. 4. Provide suitable dining position and dining table board. 5. Evaluate the patient's ability and assist the patient to use a walker, wheelchair, etc. So as to carry out self-care activities as much as possible. 2/1110: 001.The life needs of patients were met during hospitalization. 2. Patients can take care of themselves by wheelchair. 30/ 10/2009 anxiety-related to the patient's unclear condition and worrying about the prognosis. 1. Patients can tell the causes of anxiety and their feelings. Patients can cope with anxiety in effective ways. 3. Patients' anxiety is reduced and their physical and mental comfort is increased. 1. Listen to the patient patiently and analyze the causes and discomfort of anxiety with the patient. 2. It shows that the muscle strength has been improved after medication, which should be gradual. 3. Give clear and positive information about patients' problems. 4. Guide patients to face up to the fact that the affected limb may not be able to recover its original function, and discuss with them how to adapt to the existing life in the best way. 5. Do a good job of psychological counseling for family members, strive for their understanding and support, and make patients relieve their worries about the impact on social status, living ability and social ability after functional disability. Family members can promote patients' functional recovery and improve their quality of life on the existing basis. 6. Explain to patients the adverse effects of anxiety on body and mind. 7. Instruct patients to relax, massage and listen to music. 8. Create a quiet and non-stimulating environment for patients. 9. Fully understand the patient's mood, allow the patient's emotions to vent, and give appropriate persuasion and comfort. 2/ 1 1 10:00 Patients should accept the reality, learn the self-regulation method, and their anxiety will be relieved. The goal is to partially achieve 3110/2009 constipation, which is related to gastrointestinal peristalsis dysfunction or decreased activity. Patients without constipation 1. Guide a reasonable diet. 2. Guide the abdomen to do circular massage. 3. Use drugs reasonably and appropriately according to the doctor's advice. The patient has no constipation. Objective To understand the potential complications of 3010/2009: patients with cerebral hemorrhage can find cerebral hemorrhage in time and take corresponding measures. 1. Observe the patient closely for signs of cerebral hemorrhage. 2. Accurate medication and strict blood pressure measurement. 3. Provide patients with a safe, quiet and comfortable rest environment. 2/ 1 1 10:00 to achieve the goal of no cerebral hemorrhage in patients 30/ 10/2009 lack of knowledge: patients lack knowledge about functional exercise, using walker and preventing disease recurrence. 1. Patients can follow correct functional exercise methods. 2. Patients learn to use a walker that suits them. The patient can tell how to prevent the disease from recurring. 1. Explain the necessity and methods of functional exercise. 2. Teach patients how to choose the right walker and how to use it correctly. 3. Inform patients of the importance and necessity of preventing disease recurrence, guide patients to prevent disease recurrence in daily activities, diet, correct use of drugs and other aspects, inform patients of premonitory symptoms of disease recurrence, and seek medical advice in time once found. 2/1110: 001.Patients can do functional exercise in the right way. 2. Patients can use a walker that suits them. 3. Patients can tell the premonitory symptoms of disease recurrence and the precautions to prevent disease recurrence. The objective part is to realize the situation/progress, patients' psychology and performance after rtpa thrombolysis, and the corresponding nursing measures are as follows: the time, illness, psychology and performance, nursing measures and blood pressure fluctuation of 30/ 10 on the day of medication. According to the doctor's advice, labetalol 10mgx2 will be tested again after half an hour 165/78mmhg. After that, the vital signs were stable, and there was a small amount of gingival bleeding after half an hour of medication, and the muscle strength of the affected limb was improved compared with that before medication. Anxiety, constantly asking about his illness, thinking that his illness is related to doing exercise, worrying about the prognosis. Close monitoring of vital signs, accurate and timely medication according to the doctor's advice, and close detection of neurological changes. Rinse your mouth with normal saline to get rid of bad breath. After drinking water and eating test, give the patient soft food and tell the patient not to eat rough food to avoid damaging the mucosa. Correct patients' wrong thoughts, introduce the treatment process to patients in detail, relieve patients' anxiety symptoms and assist life care. On the second day, the vital signs were stable at 3110. After reexamination, the head ct was diagnosed as right cerebral infarction, and was referred to a stroke rehabilitation therapist for functional exercise of the affected limb, using wheelchairs, walkers and other exercises. I feel anxious about the incomplete recovery of the affected limb, and my mood is relatively low. Explain the rehabilitation process of the disease to patients, introduce successful examples to enhance their confidence, continue to monitor the changes of blood pressure and neurological function, and assist patients in life care. On the third day111vital signs were stable, and he was referred to a stroke rehabilitation therapist for daily living exercise. The patient's mood is slightly depressed, and he is worried that relying on family care will become a burden for his family in the future. Explain to patients that medical staff will try their best to help them adapt to their present life, introduce successful cases in which other patients with dysfunction are still actively facing life, and advise them not to overstretch patients, prevent shoulder dislocation and assist in life care. On the fourth day, 2/ 1 1 The vital signs were stable and the condition was stable, so further rehabilitation treatment was needed. Patients can actively cooperate to do various functional exercises. Instruct patients to eat correctly, tell them how to prevent another stroke, and assist patients in life care. 5/ 1 1 The limb function of discharged patients recovered well, and patients could actively cooperate with various functional exercises. Give discharge guidance before discharge: 1. Psychological nursing: encourage patients to talk with their families and medical staff, actively express their worries and thoughts about future rehabilitation and life, introduce and exchange experiences with patients who have successfully adapted to the role of limb dysfunction, establish the concept that limb function can be gradually restored, encourage patients to establish confidence in overcoming diseases, and enable patients to actively cooperate with treatment and nursing and actively carry out rehabilitation exercises. Eliminate pessimism and despair, introduce them to participate in the activities of stroke patients, such as the "Stroke Club" organized by our department, encourage patients to participate in social activities, truly reflect their personal values, and enable patients to regain their self-confidence, maintain a positive attitude and re-enter the society. 2. Rehabilitation instruction 3. Stroke prevention health education online, you can refer to it.