Formation of nursing: early humanistic care - doctors, witches, both medieval nursing - hospitals run by nuns in the service of the noble profession of the Renaissance - became independent, the Reformation - the Dark Ages, the basic tasks of nursing: alleviate pain, prevent disease, restore health, promote health in the physical environment of the hospital, the space, the temperature, humidity, ventilation, light, sound, decoration, should not be beds beds are less than one meter apart from the last place of residence is surrounded by curtains necessary. It is necessary that the beds should not be beds beds with a distance of less than one meter between the curtains that surround the last place of residence. The general temperature of the ward is 18? 22 for the elderly, the temperature of the neonatal ward should be maintained at 22? 24. Ward humidity of 50% to 60% is appropriate. A 30-minute window is to be achieved for the purpose of replacing the circulation of air in the room. Ideal noise intensity in day hospitals should be maintained at 35-45 decibels Nurses should do four light in their work, i.e., speak softly, walk very softly, operate lights and open and close doors softly. Operating rooms use green or blue decorations for patients to feel confident of quietness! Relationship with the hospital: the relationship between the nurse and the patient, the relationship between the doctor and the patient, the relationship between the patient and other staff. In the course of hospitalization, furniture and equipment to provide patients with medical institutions bed unit, the patient's excretory activity at rest and treatment sleep and food, it is the most basic unit of life. Operation of spare beds, beds for legal temporary empty beds, beds for anesthesia, bed rest for patients, beds, bedside tables about 20 cm, 15 cm bedside chairs. Admission procedures: care of patients admitted to the hospital and disinfection, escorting the patient to the ward. In general, the patient is admitted to the hospital care: in preparation of the bed unit to meet the new patient, measuring blood pressure and weight of the patient's body temperature pulse respiration, height measurements and records, inform your doctor advises the patient's needs and, if necessary, assists in the timing of medical examinations or treatments, fills out the ticket, nursing (page by page with a blue pen filled hospital, eyebrow strip, and various forms, date of admission and Time fields are vertically oriented to the written fill in the entry registration card for a good introduction and physician's treatment, nursing measures, admission nursing assessment under the guidance of the first hospitalization time record vital signs, height and weight between the temperatures of a single diagnosis with a card with a red pen at the head of the bed). Emergency patients are attended separately in the intensive care unit, preparing the bed unit, preparing the first aid items and medicines for rescue, lasting escort graded care; divided into 4 main categories of prioritized illnesses and the patient's ability to self-care level of care, special care, nursing care, secondary care and tertiary care. Critically ill patients are the object of special care in situations that require constant observation in order to carry out rescue. (e.g., severe trauma, complex and difficult surgeries, organ transplants, extensive burns, severe medical conditions.) Nursing care; arrange 24-hour nursing care, closely observe the patient's condition and changes in vital signs, develop nursing care plan, clinic and nursing care measures, strictly implement, timely and accurately fill out special nursing care records, prepare first aid medicines and medications for basic nursing care, prevent complications from occurring to ensure the patient's safety. Applicable object level of care, critically ill patients need absolute rest. (Such as all kinds of major surgery, shock, coma, paralysis, high fever, hemorrhage, liver, renal failure and preterm infants) Nursing care content; round once, each time 15? 30 minutes, in order to observe the condition and vital signs of the changes in the development of nursing care plan? Procedures, strict implementation of clinic and nursing measures, timely and accurate completion of special care and good tracking records of basic care, to prevent complications, and can meet the physical and psychological needs of patients. Secondary care applicable objects; patients with severe, life can not take care of their own people, (such as major surgery situation stability, old and frail, chronic diseases is not easy for activists, children's health care, etc.), the content of the care, once every 1? 2 hours for check-in procedures, observe the daily care of patients with life and cardiac diseases to meet the patient's physiological and psychological needs of the necessary technical support. Tertiary care applicable object; lighter patient's condition, life can basically take care of themselves. (Such as chronic diseases, disease recovery and selection of the preparatory stage before surgery) health status: two visits a day to observe the condition of the patient, daily care, guidance, supervision of the provisions of the hospital, the patient's compliance with the provision of medical services to meet the patient's physiological and psychological needs. Chapter Comfort, Safety, Comfort; The individual's state of self-perception in a state of ease, satisfaction, comfort, no anxiety, no pain, health, serenity. Discomfort; the individual's physical and mental incapacity or defect, physiological, mental inability to meet all the needs of the self sense of discomfort, pain is the most serious manifestation. Uncomfortable patient care, prevention-oriented approach, promote patient comfort, strengthen monitoring, detect discomfort and take effective measures to eliminate or relieve discomfort, mutual trust, and give psychological support. Side-lying position, supine position classification, supine active, passive side-lying position, and forced supine position. Change position at least every two hours. Used supine, supine position (anesthetized patients concave supine shock patients pillow supine, supine abdominal examination, catheterization of patients;), lateral position (enema, anal examination and gastroscopy and enteroscopy, intramuscular injections, prevention of pressure ulcers) semirecumbent position (face and neck surgery patients with respiratory distress patients with cardiac and pulmonary diseases, thoracic, abdominal and pelvic surgery, patients with inflammatory diseases, and convalescence of physically weakened patients) sitting (heart failure, pericardial effusion bronchial asthma). Pericardial effusion bronchial asthma patients), easy (lower back, examination or with cholangiopancreatography, spinal surgery, abdominal pain, flatulence) head down and feet up. (drainage of pulmonary secretions duodenal drainage, pregnancy, premature rupture of membranes film, heel bone, tibial tubercle traction), students with low (reverse traction cranial traction cervical spine fracture patients to prevent cerebral edema, patients with brain surgery) knee membrane thoracic position (anus, proctoscope, sigmoidoscopy, correction of malposition of the fetus or to promote the recovery of the uterus in the postpartum period of the anterior tilt), truncus (perineal-anal examination, the concept of fertility) of pain Pain is a subjective feeling associated with existing or potential tissue damage, a defense response to a painful stimulus that is harmful to the body) and personal violation of danger warnings Pain, uncomfortable sensation, physical and mental suffering, pain is often accompanied by physiological, behavioral, and emotional responses. Nursing assessment of pain assessment, site of pain, duration of pain, quality of pain, degree of pain, expression of pain World Health Organization pain is divided into four categories, namely, 0 pain-free 1 (mild), painful, but not severe, but intolerable, will not be affected by sleep. 2 (moderate), significant pain, inability to stand, sleep disruption, sedation: 3 (severe), severe pain, inability to stand, serious disruption of sleep, you need to use painkillers. Nursing measures to reduce or eliminate the cause of pain, relieve or alleviate pain, psychological care is a safe, comfortable environment, peace is no danger, no harm to the environment. Common unsafe factors in hospitals; mechanical injury, thermal injury, chemical injury, biological injury, psychological injury, medically induced injury. Protection; bed stalls AIDS branch of the frame restraints with crutches (minus 40 centimeters high), cane. Chapter Hospital Infections Prevention and Control of Hospital Infections, Hospital Infections Broad Concepts and Narrow Concepts The concept of hospital infections generally refers to a narrow concept of hospital infections, including infections that occur during hospitalization and post-discharge nosocomial infections. Classification; exogenous and endogenous infections. Basic conditions of formation; source of infection, route of transmission, susceptible host. Cleaning; Physical method of removing dirt, dust, and organic matter from surfaces with the purpose of eliminating and minimizing the body's ability to kill microorganisms. Sterilization; the physical or chemical removal or killing of all microbial spores. Sterilization to kill all microorganisms by physical or chemical methods. Selection of disinfection methods based on sterile, natural high temperature, humidity members preferably autoclave; fear of heat, avoid humidity and valuables should be selected formaldehyde or ethylene oxide gas disinfection corrosive metal disinfectants of choice. Surface disinfection, should consider natural surfaces, smooth surfaces, ultraviolet disinfection, you can choose or disinfectant wipe, wipe spray disinfectant, long-term and short-term surface. Aseptic technique, a series of operational techniques and management methods to maintain aseptic contamination during medical care operations and prevent the invasion or spread of microorganisms to others. Sterile: Uncontaminated articles that have been sterilized by physical or chemical means. Sterile area: chemically sterilized shopping resort of contaminated areas. Non-sterile area: a contaminated area that has not been sterilized or disinfected. Aseptic technique: the environment is clean, spacious environment, spacious, and regularly disinfected, and should stop business half an hour before sweeping linen works to reduce the walking walk to avoid unnecessary crowds, textile dust emissions. Staff dress in line with the aseptic requirements: before the aseptic staff is a good hat, wash hands, wear masks, masks should be replaced once, replaced once the bacteria can easily penetrate the moist 4-8 hours. 3, material management, orderly, sterile and non-sterile materials are placed separately, and there are obvious signs of sterilization not exposed to air, should be stored in sterile packages or sterile containers, sterile package crooked should be marked with the name of the item valid order, date of sterilization, placed in sterile packages are valid for 7 days, access? A sterile aseptic grasping forceps, once removed cannot be restored to a sterile container, suspected or contaminated items should be replaced and re-sterilized. 4 Clear the sterile field from the non-sterile area, the operator's body should be kept at a distance from the sterile area, and the sterile area in which the items are picked up and placed. Arm can not cross the sterile field hand can not touch the sterilization to avoid facing the sterile area, laughing, coughing, sneezing, touching may not be items without high temperature disinfection, sterile or across the sterile area. 5 sterile workers, a group of patients to prevent cross infection. Sterile holding forceps class: oval (reckless) trident (use with caution) soaked in disinfectant size forceps (trivia question) 2? 3 cm hand-sterilized pliers with articulated shaft fixed in the last third. Sterile items? Usually valid for seven days, but only for 24 hours, sterile cartons open for 4 hours. Isolation: measures to prevent the spread of infection control, microbial sources, cut off the means of transmission, protection of susceptible people to be achieved. Classification: two types of isolation for infectious diseases and protective isolation. Types of isolation: (cholera, plague) strict isolation, respiratory isolation (tuberculous meningitis), (typhoid fever, dysentery, hepatitis A) intestinal isolation, contact isolation (tetanus, gas gangrene), isolation in blood and body fluids (hepatitis B, AIDS, syphilis), insect isolation protective isolation (encephalitis, epidemiological hemorrhagic fever, scarlet typhoid, malaria, etc.), reverse isolation (severe burns, preterm infants leukemia, organ transplantation, patients with immunodeficiency) are used to avoid the matter without tearing the paper to scratch. Gowns and gowns belonging to the inner surface of the clean area. Carefully comb hair care for knots by applying 30% alcohol penetration! Close the bathtub more than 7 months pregnant. Pressure ulcers: also known as pressure ulcers, a long period of time under pressure, the local tissues of the blood circulation is impaired, sustained ischemia, lack of oxygen,, malnutrition caused by tissue ulcers and bad. Mechanical factors, pressure ulcer pressure, shear force, friction.
Limited by local moisture and fecal irritation, malnutrition or edema in patients. Classification and clinical manifestations of decubitus ulcers are: congestive erythematous phase, inflammatory infiltration phase, ulcer stage. Product characteristics: 1 degree pressure ulcer manifested as dark red skin. Redness, swelling, heat, pain, numbness and so on. These two characteristics of the trauma, the skin is blue-purple subcutaneous sclerosis, edema thinning of the skin, oozing and inflammatory reaction, such as moist wound-sized blisters, blisters rupture after the formation of flushing. Third-degree pressure ulcers: shallow tissue infection, pus, pus out, formation of ulcers, bad ulcers infection extends to the periphery and deep, often does not reach the surface of the bone, black bad tissue, purulent secretions increase, there is a foul smell! Effective rest conditions: adequate sleep, physical comfort and mental relaxation! Musculoskeletal state of complete paralysis: 0
Muscle circumference slightly contracted, but no physical movement two limbs can be moved in position, but can not be lifted. Three limbs can be lifted off the bed surface, but cannot resist resistance;
4 levels of resistance to movement, but weakness; muscle strength classified as normal physical activity; 0 degrees of complete independence and freedom of movement. Requires use of equipment or devices. 3 degrees, 2 degrees, requires supervision, help and education, assistance, and equipment and machinery. 4 degrees of complete independence. Isometric contraction of muscles for training maneuvers and straining vital signs such as temperature, pulse, respiration, blood pressure, general condition. Temperature: oxidation and breakdown of sugars, fats, and proteins. Thermoregulation: self-regulation of body temperature and thermoregulatory behavior. Changes in physiologic body temperature: day and night, age, activity, medications Fever sector (e.g., environment, diet, mood, etc.): low fever 37.3 to 38.0 38.1 to 39.0, at high temperatures, fever 39.1 to 41 0; ultrahigh fever ascending phase of the thermal process Temperature higher than 41 degrees, duration of fever, types of fever: persistent fever (persistent 39-40), pneumonia, typhoid fever, flaccid fever (over 39 degrees and fluctuates widely) read sepsis, rheumatic fever, intermittent fever (sudden rise in temperature above 39 degrees) malaria is a common form: despite the sweltering weather thermotherapy care: cooling (physical hypothermia, such as whole-body cryotherapy), rest, diet, maintain a clean, comfortable, safe care, cardiac care: care: increased observation, health education.