Nursing case analysis model article 1: blood saved the patient's life.
Patient, female, 28 years old, married. Because? Gastric ulcer? Hospitalization. After a meal, the patient went out for a walk and returned to the ward for about 1 hour. After that, he felt pain in his lower abdomen, with symptoms getting worse, nausea, vomiting of coffee-like stomach contents and profuse sweating. The nurse asked the cause many times, and the patient must have replied that he had eaten it? Ice cream? The doctor's physical examination found tenderness in the upper abdomen. Think about it? Stomach cramp? No abnormal phenomena such as free gas in abdominal cavity were found by X-ray fluoroscopy and B-ultrasound examination. However, the patient's condition gradually worsened, with abdominal pain and groaning. Pale face, rapid pulse, blood pressure has a downward trend. When the nurse checked the patient again, she found that the patient was obviously anemic, so she asked her menstrual history carefully and took off her underwear to check. Sure enough, she found blood in her underwear. Preliminary judgment? Officially pregnant? O immediately told the doctor on duty about his judgment and reminded him to ask for gynecological consultation as soon as possible. Consultation results: ectopic pregnancy, hemorrhagic shock, immediate emergency surgical treatment. The operation proved that the nurse's judgment was correct. This patient is in an emergency because the nurse can? Take off your underwear and check it? Turn the corner.
case analysis
1. This case shows that the results of nursing observation were found in extremely subtle places. If every nurse, like this nurse, can use professional knowledge to think and associate when the patient complains of deviation from the condition, never let go of any possible details in nursing observation, and actively look for relevant signs that are helpful to disease diagnosis, such as? When I took off my underwear, I found that there was blood in it, which provided an important reference for doctors to diagnose. After years of unremitting efforts, such nurses will accumulate endless experience and become clinical elites who save patients' lives.
2. Pregnant eggs are implanted outside the official cavity, which is called ectopic pregnancy, and it is customary to call ectopic pregnancy. Tubal pregnancy is the most common, accounting for about 95%. Ampulla is the most common part of tubal pregnancy, accounting for about 55%. 60%, is one of the most common acute abdomen in obstetrics, if not diagnosed and treated in time, it can often be life-threatening due to hemorrhagic shock. It can be seen that the careful observation of nurses has won valuable time for saving patients' lives.
3. The typical clinical manifestations of ectopic pregnancy are: 1. Menopause: There are 6 patients on average? Early pregnancy reaction after 8 weeks of menopause, but a few patients did not respond, mistaking vaginal bleeding as menstruation. Abdominal pain: About 90% of patients show dull pain or soreness in the affected lower abdomen. When the embryo in the fallopian tube grows up gradually, which leads to abortion or internal bleeding due to fallopian tube expansion, it shows a sudden tearing pain on one side of the lower abdomen, accompanied by vomiting, which quickly spreads to the whole abdomen. Third, vaginal bleeding: after the death of the embryo, the uterine decidua degenerates and necrosis with the change of estrogen level in the body, and irregular vaginal bleeding often occurs. 4. Syncope and shock: Due to intra-abdominal bleeding, patients often have syncope, and in severe cases, hemorrhagic shock occurs, which is out of proportion to extravaginal bleeding. This important sign is often easily overlooked and misdiagnosed. The nurse grasped this key detail and played an important role in nursing observation in the medical process.
Nursing case analysis model Part II: Keen observation comes from years of accumulation.
Patient, male, 3 6 years old, police. After fighting with a gangster in a mission, I suddenly felt chest tightness and shortness of breath, feeling oppressed in my chest and unable to walk with my legs. He was carried into the emergency room, conscious but pale. His blood pressure is 60/30mmHg, his pulse is weak 128 times, and he breathes 32 times/minute. His heart rhythm is neat, and a comprehensive physical examination found no signs of trauma. Preliminary diagnosis: myocardial ischemia? Coronary heart disease? Nutritional myocardial support therapy, ECG monitoring and oxygen inhalation were given. The emergency nurse found blood on the patient's mouth and hands during infusion, thinking that he was probably hiding a wound. O ask in detail about the incident and the process of fighting with the gangsters. According to years of clinical experience, nurse a initially judged as? Chest trauma? He decisively reported his thoughts to the doctor. The doctor carefully examined the patient's chest and back again, and sure enough, a small closed wound about 1cm was found between the left breast nipple and xiphoid process, which confirmed the nurse's judgment. Emergency cardiac color Doppler examination suggests pericardial effusion. After active surgical treatment, the patient turned to safety.
case analysis
1. At the critical moment when the police were in danger, the nurse observed the condition while operating. With years of clinical experience, they are keen to learn from patients? Blood on the corners of the mouth and hands? This appearance thought of the essence of the problem, helped the doctor find the wound shot by the chest bullet at once, and won valuable time for making correct diagnosis and implementing correct treatment in time.
2. Pericardial tamponade is the accumulation of a certain amount of blood in the pericardial cavity, which oppresses the heart, prevents venous blood from flowing back to the human heart, and affects the blood discharge of the systolic heart, thus causing serious circulatory disorders. Thoracic penetrating injury can lead to heart and coronary artery rupture and bleeding. If acute bleeding squeezes the heart, it will die in a short time without timely treatment. The patient has symptoms such as pale face, dysphoria, dyspnea, distant and weak heart sounds, decreased blood pressure and decreased pulse pressure difference. In this case, diagnosis should be made immediately, pericardiocentesis should be done quickly, and the blood accumulated in the pericardial cavity should be pumped out to relieve the pressure on the heart, so as to save lives.
3. Emergency nurses should have rich first aid knowledge and be familiar with the clinical manifestations of pericardial tamponade, such as decreased arterial pressure, increased central venous pressure, decreased pulse pressure difference, strange pulse, jugular vein bulging, weak heartbeat, distant and weak heart sounds, and severe cardiac arrest. Therefore, once the above-mentioned critical illness occurs, emergency treatment should be carried out immediately. Carefully record the changes of the disease, prepare puncture needles and syringes, and prepare for thoracotomy in the ward in case of emergency. When there is active bleeding in the heart and blood clots accumulate in the pericardial cavity, surgery is needed to stop bleeding and clear the blood clots in the pericardial cavity. Strictly control the infusion speed and total volume, use intravenous infusion pump to control infusion when necessary, and monitor blood volume with central venous pressure.
Nursing case analysis model Part III: Nursing inquiry embodies nursing value
The patient is a 6 6-year-old male who has been suffering from hypertension for more than 1 0 years. He takes antihypertensive drugs all the year round, and his blood pressure is controlled smoothly without any abnormal feeling. Ever used it because of a stuffy nose? Nasal drops? . Although the symptoms of nose have improved, I feel dizzy, my head is swollen and I am unconscious after getting up every day. My blood pressure fluctuated between170 ~180/10 ~120mmhg for several days. I feel very puzzled that taking antihypertensive drugs has no effect. Go to the hospital to see a doctor for further examination. So the doctor had to adjust the medication plan for the patient, and the effect was still not obvious. When I came to the clinic again, I talked about my situation carefully with a nurse. The keen nurse immediately understood the patient's meaning, patiently asked about the recent drug use and the incidence, and then suddenly realized. It turns out that the reason for this patient's high blood pressure is not that antihypertensive drugs are ineffective, but that the patient has allergic rhinitis. Nasal drops? Three times a day, 2~3 drops each time? Drug induced hypertension. Stop using it under the correct guidance of the nurse? Nasal drops? After taking the original dose of antihypertensive drugs, symptoms such as dizziness and headache gradually disappeared, and blood pressure was controlled at the original level.
case analysis
1. The main component of Didi Jing is oxymetazoline, which is a vasoconstrictor. It can contract the blood vessels of nasal mucosa, reduce the secretion of mucosal glands, and relieve local tissue congestion, thus achieving the purpose of improving nasal ventilation. However, if these drugs are not used properly, some drugs will flow to the pharynx after reaching the nasal cavity and being absorbed by the nasal mucosa, and then enter the blood circulation after being absorbed by the pharynx, causing peripheral blood vessels to contract, thus increasing peripheral blood vessel resistance. For ordinary people, normal blood vessels have a certain regulatory ability, and their influence on blood pressure will not be too great. However, for hypertensive patients, due to the effect of antihypertensive drugs, their blood pressure will rise, which will lead to hypertensive crisis, heart failure or myocardial infarction and other life-threatening situations. Therefore, we must pay attention to teaching patients how to use nasal drops correctly in clinic.
2. There are two ways to use nasal drops correctly in clinic:
First, the head is tilted back to drop medicine: the patient lies on his back on the bed, with a soft pillow under his shoulders, and his head is tilted back as far as possible, so that his chin is knocked up and then drops medicine. After dropping the medicine, he gently pinched his nose a few times to make the medicine evenly spread all over the nasal cavity. Keep the original posture unchanged after dropping the medicine, get up after 5 ~ 10 minutes, and let the medicine fully contact and absorb the nasal mucosa. This method is suitable for local treatment of rhinitis and sinusitis, which can make the liquid medicine enter the opening of eustachian tube at the back of nasal cavity.
2. Head-down dripping method: the patient lies on his side, removes the pillow, leans the affected ear against the bed surface, hangs his head over his shoulder, rotates his nose in the shoulder direction, keeps it in the same plane with his shoulder, makes the nasal cavity side wall horizontal and slightly inclined to the nasal root, and sits up after dripping medicine for 5- 10 minutes. This can make the liquid medicine stay in the nasal cavity for a longer time and reduce the irritation symptoms caused by the liquid medicine flowing to the throat.
3. The nurse in the case solved the problem that the doctor did not solve with extensive medical knowledge through consultation, relieved the pain for the patient, and more importantly, put an end to the development of serious complications, which reflected the value of nursing work. This practice of being good at communication is advocated by the current nursing service model and is eager to be popularized. When a nurse comes into contact with every patient, if she can play the role of nursing like this nurse, she will actively popularize health knowledge and improve the health quality of the whole people.
4. This case reminds the medical staff that when giving medication guidance to patients, they must tell them that any drug must be used under the guidance of a doctor and cannot be used blindly to avoid adverse consequences. For example, long-term use of nasal drops without authorization to improve nasal symptoms will lead to drug-induced rhinitis; When epistaxis occurs after nasal trauma, if nasal drops are used to stop bleeding casually, because some patients with nasal trauma will cause intracranial infection and lead to serious complications.
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