Difference between the fifth and sixth editions of Surgical Nursing?
First of all, in the sixth edition of the textbook will be unified in the fifth edition of the textbook of the word patient to "patient", all the nursing operation will be "environment preparation" to "nurse preparation".
The sixth edition of the textbook changed the word "patient" to "patient" in the fifth edition of the textbook, and "environment preparation" to "nurse preparation" in all nursing operations, and the new version of the final hand-washing and recording of all nursing operations have been clarified to record the specific content, such as local administration of rectal suppositories insertion method has been clarified to record the contents of the content of the "insertion of suppositories, suppositories, name, dosage, and the patient's response, etc.".
Chapter II, the environment
1. Climate effects on health added: "winter ambient temperature is low, extremely cold environment increases the risk of respiratory diseases and skin frostbite occurs. In addition, the winter climate is dry, especially in the northern part of China, respiratory diseases, pulmonary heart disease incidence is higher".
2. The total area of the alveoli in adults has been changed from 55-70_ to 100_ (the fifth edition of Internal Medicine Nursing has a value of 100_).
3. The definition of a hospital in the hospital setting was changed to "A hospital is a medical institution whose primary goal is to provide medical and nursing services to people" (the fifth edition of the textbook defines a hospital as a place for the prevention and treatment of disease in a specific population).
4. Hospital environment in the classification of changes and new "according to the location of the environment is divided into:" 1, outpatient environment; 2, emergency environment; 3, ward environment ".
5. Hospital physical environment regulation: the new "delivery room, operating room temperature to 22-24 appropriate.
6. Hospital social environment in the control of "1, new hospital outpatient environment control; 2, hospital emergency environment control.
Chapter III: prevention and control of hospital-acquired infections
1. Transmission routes in the indirect contact with the transmission of the fourth article deleted: "through the animals or insects carrying pathogenic microorganisms as an intermediate host for the spread of human infectious diseases transmission mode". The fourth article "other ways" was added.
2. In the airborne transmission, "the spread of hemolytic hemorrhagic fever through the formation of aerosol particles in carious animals and poultry containing hemorrhagic fever virus through the contamination of dust with excreta" was deleted.
3. Cleaning, disinfection, sterilization for the first time in the new "cleaning"; the definition of sterilization was changed to "refers to the killing or removal of all microorganisms on the medical equipment, instruments and articles on the treatment, and to achieve the sterilization assurance level of the method"; for the first time, the definition of the sterilization assurance level; the fifth edition, including previous editions, is defined as "means the use of physical or chemical methods to kill or eliminate all microorganisms on the medium of transmission, also including bacterial spores and fungal spores".
4. Boiling disinfection method: the new method of "items after scrubbing all submerged in water ≥ 3cm, heating and boiling for ≥ 15min. boiling time counted from the boiling water".
5. ultraviolet disinfection method in the new "ultraviolet germicidal effect of the strongest 253.7nm. ultraviolet lamp disinfection precautions in the original version of the "2 weeks with anhydrous ethanol wipe" changed to "generally weekly 70% - 80% ethanol cloth towel wipe. 80% ethanol cloth towel wipe".
6. Ozone disinfection method in the air after disinfection "open the window ventilation ≥ 30min"; the fifth edition of the textbook for "20-30min".
7. Disinfection and supply center work: cleaning and disinfection: new "for Ruan virus, gas gangrene, and sudden outbreaks of infectious diseases of unknown pathogens contaminated with diagnostic and treatment items should be disinfected and sterilized, then cleaned". Stored in the distribution: The fifth edition of the textbook reads: "Sterilized items should be classified and stored in sterile storage areas in separate racks. The shelves or cabinets should be 20-25cm from the floor, 5-10cm from the wall, and 50cm from the ceiling." The sixth edition of the textbook was changed to read: "Sterilized articles should be classified and stored on separate shelves in the sterile article storage area. Article storage rack or cabinet should be from the ground height ≥ 20cm, away from the wall ≥ 5cm, from the ceiling ≥ 50cm."
8. New hydrogen peroxide plasma sterilization method
9. Pressure Steam Sterilization Method Note: Article 5 unloading after sterilization added "the temperature of the items to room temperature, the pressure gauge at 0 position when the items are removed. The pressure gauge in the 0 position when removing the items". Flow steam sterilization method to add "relative humidity 80% -100%".
10. Medium-dangerous items, low-dangerous items for the first time to add "the total number of colonies of medium-dangerous items should be ≤ 20CFU / piece; low-dangerous items should be ≤ 200CFU / piece of the colony number, shall not detect pathogenic microorganisms".
11. Drinking water, tea utensils, tableware and sanitary ware and other cleaning, disinfection: add Article 4 "rags, floor towels, mops and other sanitary ware should be used differently, after cleaning and then soaking disinfection for 30 minutes, rinse disinfectant solution and then dry for spare parts; recommended the use of dismantling the head".
12. Skin and mucous membrane disinfection in a more detailed, for the first time the requirements of disinfectant.
13. Hand hygiene in the new WHO proposed "five important moments of hand hygiene" (before contact with the patient, before aseptic operation, after contact with body fluids, after contact with the patient, after contact with the patient's surroundings); hand hygiene disinfectants in the addition of "ethanol and chlorohexidine composite preparations "
Chapter 4: Nursing Care of Patients Admitted to and Discharged from the Hospital
1. Various bed-making methods place environmental preparation first; the fifth edition of the textbook for the nurse to prepare first.
2. Self-care grading was added to graded care.
3. Prevention of low back injuries in nurses has been added to Human Mechanics in Nursing.
Chapter 5: Patient Safety and Nurses' Occupational Protection
1. Mechanical injury precautions has been added as "For the mentally challenged, care should be taken to place scissors and other instruments appropriately so as to avoid the risk of patient contact".
2. Physical factors in the harmful factors of occupational exposure have been deleted. Chemical factors in the separate addition of "mercury" poisoning. Add "occupational exposure to mercury leakage, preventive measures and emergency treatment".
3. Improvement of nursing protective equipment in protective equipment and supplies to delete Article 4, "general supplies"; personal protective equipment, "new N95, N99 masks, masks, goggles".
4. Common nursing occupational exposure and intervention measures in the new "bloodborne pathogens occupational exposure".
Chapter 6: patient hygiene
1. commonly used oral care solution in the new "new oral care solution", according to the patient's specific situation and the role of different oral care solution for a reasonable choice.
2. The requirement of water temperature in the care of hair washing in bed has been changed to "ensure that the water temperature is appropriate to the comfort of the patient"; the fifth edition of the textbook reads: "ensure that the water temperature is appropriate to 43-45 ℃, or in line with the patient's habits".
3. The head lice method was changed from large print to small print.
4. Skin care in the common causes of jaundice to add "increased carotene, long-term use of drugs containing yellow pigment"; new Article 6: "pigmentation deficiency" will be the fifth edition of the integrity of the skin, sensation, cleanliness of the sixth edition of the combination of "Other".
5. New "humidity" in skin care. Softness and thickness, integrity, sensation, cleanliness of the fifth edition of the textbook was merged into the fifth item "other".
6. New "bath time control in about 10 minutes, fasting, full stomach, alcohol and long time physical or mental activity immediately after the bath should not be, because the above conditions can cause insufficient blood supply to the brain, serious cases can trigger hypoglycemia, resulting in fainting and other accidents".
7. The correct choice of bath products in the alteration of the larger.
8. Shower and bath: environmental preparation, the fifth edition of the textbook for the water temperature requirements for: "the water temperature to maintain 41-46 ℃"; the sixth edition was changed to "the water temperature to the skin temperature shall prevail, the summer can be slightly lower than the body temperature, the winter can be slightly higher than the body temperature ". Deleted "conducive to evaluation" from the description of the main points of the operation steps.
9. bed bath: water temperature in the preparation of the fifth edition of the textbook for: "50-52 ℃ hot water, and according to age, season and personal habits of hot water increase or decrease", the sixth edition of the deletion of the specific value of the water temperature, changed to "hot water, according to age, season and personal habits of adjusting the water temperature ".
10. back massage preparation of materials in the sixth edition of the textbook deleted "50% ethanol", added "massage oil, massage cream, massage milk".
11. The causes of pressure ulcers in the sixth article of improper use of medical equipment: "due to medical equipment, such as cardiac monitoring, oxygen mask, ventilator, tracheotomy intubation, a variety of restraining devices and orthopedic appliances used improperly, can be used in the area of medical equipment to generate pressure and/or cause local temperature and humidity changes, which occurs to varying degrees of pressure ulcers. It is difficult to detect in time because the medical device fixation makes the skin breakage at the contact site hidden", there is a big gap between here and the fifth edition of the textbook.
12. Pressure ulcer treatment and care: the sixth edition of the textbook canceled the obvious staging of pressure ulcers and pressure ulcers in various stages of targeted care measures, summarized as the assessment of pressure ulcers and healing monitoring, pain assessment and management, the use of wound dressings, wound care, drug therapy, surgical treatment, other emerging treatments. (This chapter has been significantly altered).
13. Perineal cleansing care: the preparation of materials in the water temperature requirements, the sixth edition was changed to "warm water, temperature and body temperature close to the temperature, not more than 40 ℃ is appropriate", the fifth edition of the textbook for "50-52 ℃ water temperature.
Chapter 9: vital signs assessment and care
1. temperature measurement in the new "should be counted before measurement of the number of thermometers, and check for breakage. Check the accuracy of the thermometer periodically." In the Notes on Temperature Measurement, add "The thermometer should be counted and checked for breakage before taking the temperature."; "If the temperature is found to be inconsistent with the patient's condition, find out the reason for the discrepancy and repeat the measurement."; and "Emergency procedures for mercury leakage are described in Chapter 5, Patient Safety and Nurses' Occupational Safety". The new version of the textbook removes the phrase "unloading the table" from the oxygen delivery method of the oxygen cylinder. Knowledge development added "YYX type single-use oxygen tubing".
Chapter X: hot and cold therapy
1. cold and hot wet compresses with the preparation of the material deleted "2 ovoid pliers"; the sixth edition of the textbook of the operation steps changed to "wear gloves, the cloth will be immersed in ice water, hot water, and then wrung to half-dry", the fifth edition of the textbook for: "the cloth will be immersed in ice water, hot water, and then wrung to half-dry". The fifth edition of the textbook for: "dressings immersed in ice water, ovoid pliers twisted to half dry".
2. Increase the knowledge expansion "cold therapy in the field of sports applications", "paraffin therapy".
3. Contraindications to heat therapy in the new version of the addition of "paralysis, sensory abnormalities, infants and young children, the elderly should not be used heat therapy".
Chapter 11: Diet and Nutrition
1. Social factors in the assessment of nutritional status, add "lifestyle: modern high-efficiency, fast-paced lifestyle has led to an increase in the consumption of fast food, fast food."; biochemical indicators in the measurement of the human body. Deleted "serum protein levels, nitrogen balance tests and immune function measurements are summarized in a single sentence" from the biochemical indicators and immune function assessment in human body measurements.
2. "Diet for Occult Blood Test" was deleted from Hospital Test Diet; "Diet for Glucose Tolerance Test" was added.
3. In gastrointestinal nutrition, "other methods of checking the gastric tube in the stomach" has been added to expand knowledge.
Chapter XII: Excretion
1. Classification of urinary incontinence: the new version of the textbook for "persistent urinary incontinence, overflow incontinence, urge incontinence, stress incontinence"; the fifth version of the textbook for "true urinary incontinence, pseudo urinary incontinence, stress urinary incontinence ".
2. In the new edition of the preparation for catheterization, the new edition of the textbook has deleted "placing a bedpan and bedpan towel on the lower level of the treatment trolley"; the fifth edition of the textbook still retains it.
3. Oral solution bowel cleansing has been added to bowel cleansing with electrolyte isotonic solution in the nursing techniques related to defecation. In the large number of unretained enemas, add "record the time of enema, the type and amount of enema, and the patient's response".
Chapter 13: Drug Delivery
1. The new version of the textbook in the strict implementation of the checking system still requires "three checks, seven right".
2. The new precautions for aspirating medications include the following: "An empty ampoule or sealed bottle should not be discarded immediately. Vials or sealed bottles should not be immediately discarded, in order to be prepared for injection check".
3. In the procedure of intradermal injection, "If the patient is allergic to ethanol, 0.9% saline can be chosen for skin cleansing" is added. "If skin test results are inconclusive or false positives are suspected, a control test should be performed. The method is: replace the syringe as well as the needle, inject 0.1 ml of saline into the corresponding part of the other arm, and observe the reaction after 20 minutes of control".
4. In the intravenous method: cancel the small cotton pillow and replace it with a disposable padded towel.
5. ultrasonic nebulization inhalation of the purpose of the fourth, the new version of the textbook was changed to "expectorant cough to reduce respiratory mucosal edema, dilute sputum, help expectoration", the fifth edition of the textbook for "prevention of respiratory infections are commonly used in patients before and after thoracic surgery The fifth edition of the textbook reads "Preventing respiratory infections is commonly used in patients before and after chest surgery. Note in the new "need to add liquid during treatment, do not have to turn off the machine, directly from the cover of the small hole can be added; if you want to add water into the sink, you must turn off the operation"
6. The new version of the textbook deleted the "cytochrome C allergy test method", and added the insulin pen injection. Insulin pen injection was added.
7. plasma classification: the new version is divided into: fresh frozen plasma and frozen plasma, the fifth edition of the textbook for: "fresh plasma, preserved plasma, frozen plasma, dried plasma"; red blood cells in the classification of the addition of "leukocyte-concentrated red blood cells "; other blood products in the deletion of "fibrinogen", added "immunoglobulin preparations".
8. The method of intravenous blood transfusion will be "the patient's informed consent" in the first place, and explains that no family members to sign the emergency blood transfusion of patients without autonomy should be reported to the hospital department or the competent leadership to agree, for the record, and counted in the medical record; minors can be signed by the parents or a designated guardian.
9. Intravenous blood transfusion in the notes added "for emergency blood transfusion or a large number of transfusion of patients can be pressurized blood transfusion, blood transfusion can be directly squeezed blood bag, roll pressure blood bag transfusion or the application of pressurized transfusion device, etc.. Nurses need to be guarded at the bedside during pressurized blood transfusion, and the needle should be removed in time when the transfusion is completed to avoid the occurrence of air embolism".
10. New nursing care of component blood transfusion: such as "nursing care of red blood cell transfusion, platelet concentrate transfusion, plasma transfusion, plasma protein transfusion".
11. Common transfusion reactions and nursing care in the classification of hemolytic reaction, the new version of "1, acute hemolytic reaction; 2, delayed hemolytic reaction", the fifth edition of the textbook for: "1, intravascular hemolysis; 2, extravascular hemolysis".
12. Reactions related to massive transfusion of blood in the new "transfusion-related infectious diseases".
13. "Monitoring and Reporting of Transfusion Reactions and Accidents" has been added, which is divided into 1) the significance of monitoring and reporting; and 2) the working procedures of monitoring and reporting.
Chapter 14: specimen collection
1. Correct collection added: "choose the best sampling time, take a representative specimen". In the timely delivery of the test added "special specimens (such as arterial blood gas analysis, etc.) also need to specify the time of collection, should be timely delivery of the test".
2. In the capillary blood collection method, added "WHO recommends that the site of capillary blood collection should be the inner part of the tip of the middle finger and ring finger", and deleted "earlobe blood collection".
3. In the method of venous blood collection, the vacuum blood collection method is added, and the table form details the scope of application of different colors of blood collection tubes, the types of additives, the type of specimen and the requirements after blood collection.
4. New "biochemical tests commonly used anticoagulants and their uses, such as 1, potassium oxalate; 2, heparin; 3, calcium fluoride; 4, sodium citrate; 5, EDTA".
5. Venous blood collection in the precautions of the larger changes, will not be described in detail.
6. arterial blood collection procedures and precautions changed, such as the new version of the range of skin disinfection "diameter of at least 8cm", the fifth edition of the textbook for "more than 5cm", the disposable syringe blood injection angle of the new version for The new version of the blood collection angle of disposable syringe is "45°", and the fifth edition of the textbook is "40°"; in the blood collection of arterial blood gas needle, it is required that "after blood collection, invert the mixing for 5 times, and rub the sample tube by hand for 5 seconds in order to ensure that the anticoagulant is fully effective"; ">15min delivery requires ice bath"; "for PaCO2, PaO2, lactate and other tests, the specimen must be detected within 15 minutes" and so on.
7. urine specimen collection method of retaining urine in the new version of the textbook for "nurses wear gloves, assist adult men or women with soap and water or 1:5000 potassium permanganate solution to clean the urethral opening and vulva, and then rinse the urethral opening with antiseptic solution, sterile saline to flush away the antiseptic solution, and then urinate to discard the anterior part of the urine, collection of mid-urine 5-10 ml in a lid with a lid of sterile saline to collect. Then urinate and discard the anterior part of the urine, collect 5-10 ml of the middle part of the urine in a sterile container with a lid and send it for examination".
8. The collection of sputum specimens in the new "sputum culture specimens, should be Dobay's liquid and cold water rinse several times, try to exclude a large number of bacteria in the oral cavity.
9. In the collection of pharyngeal swab specimens for fungal culture, add "first use a swab to wipe off the superficial secretion of the ulcer or wound, and the second swab to collect the secretion from the edge or bottom of the ulcer".
Chapter XVI: pain patient care
1. Factors affecting pain in the new version is divided into "1, intrinsic factors; 2, external factors", the fifth edition of the textbook for "1, objective factors; 2, subjective factors,". Specific content has also changed.
Chapter XVII: Observation and Management of Critically Ill Patients
1. Critically ill patients in the care of a new "APACHE table"; cardiopulmonary resuscitation techniques changed to the 2015 version; gastric lavage method deleted "electric suction gastric lavage ". In the artificial respirator, "artificial respirator" was deleted; the frequency of squeezing the respiratory bag in the artificial respirator is "10 times/minute" in the new version, and "16-20 times/minute" in the fifth edition of the textbook. ".
2. Terminally ill patients and their families in the care of the new "good continuity of care after the patient is discharged from the hospital, nursing care still need to have been systematically in the outpatient clinic or at home to continue to carry out this practice is the continuity of care, but also one of the skills of end-of-life care. In home care, it is necessary to do a good job of disease control, that is, the patient may have insomnia, pain, nausea, vomiting, constipation, fantasies and other symptoms of medical and nursing control". The psychological care of terminal patients in the period of denial of the care of the new "the care of terminal patients, the focus of attention will no longer be whether the nursing skill is high, whether the gesture is beautiful, etc., but the quality of care will become the focus of attention, which is very important, to provide patients with thoughtful care, truly reflects the nursing is not just a natural science is also an art! ".
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