1, Diarrhea Care (1) Evaluate related factors and eliminate the causes. The common causes of diarrhea are improper diet and intestinal infection. You should stop eating foods that may be contaminated and foods that may cause indigestion and allergies. Diarrhea caused by infection can be treated with anti-infective drugs according to the doctor's advice.
(2) Observe and record the frequency, characteristics and diarrhea of defecation, and collect feces for inspection.
(3) Do a good job in disinfection and isolation, and live separately from other children. Tableware, clothes and diapers should be used exclusively, and hands should be washed before and after feeding children. The feces and contaminated clothes of children with diarrhea should be disinfected to prevent cross infection.
2. Nursing care of body fluid deficiency
(1) By adjusting diet and taking medicine according to the doctor's advice, we can prevent the loss of body fluids and control infection; Patients with severe vomiting can apply antiemetic drugs according to the doctor's advice.
(2) according to the doctor's advice to supplement liquid to correct dehydration
1) oral 0RS solution: suitable for patients with mild to moderate dehydration and no severe vomiting. The cumulative loss was fed with mild dehydration of 50m 1/kg and moderate dehydration of 80 ~ 100m 1/kg, which was completed in 4 ~ 6h. The amount of continuous loss depends on the number and amount of defecation. Generally, feed 5ml (about 1 teaspoon) every 1 ~ 2 minutes. Older children can drink several times with a small number of cups. If you vomit, stop feeding 10min and feed 5ml every 2 ~ 3min. Precautions:
① Children should drink water as usual during taking 0RS solution to prevent hypernatremia;
(2) If children have eyelid edema, ORS solution should be stopped and boiled water should be used instead;
③ 0RS solution is not suitable for newborns or those with cardiac and renal insufficiency, shock and obvious abdominal distension.
2) Intravenous rehydration: suitable for children with moderate dehydration or above.
① Quantification: The total amount of rehydration includes three parts, namely, cumulative loss, continuous loss and daily physiological requirement. The total amount of liquid in the above three parts, in the case of fasting, the total amount of liquid to be supplied on the first day of admission is: moderate dehydration120 ~150m1/kg; Hypertonic dehydration150 ~180m1/kg, and the above rehydration is suitable for infants.
② Qualitative (infusion type): It depends on the nature of dehydration. 2/3 sheets of low-permeability dehydrated solution; 1/2 sheets of solution are used for isotonic dehydration; Hypertonic dehydration with 1/3 or 1/5 solution. For the preparation method of the above mixed solution, please refer to Section 5 Nursing of Children's Liquid Therapy.
③ Constant speed (infusion speed): It should depend on the degree and nature of dehydration. When hypertonic dehydration is accompanied by peripheral circulation failure, isotonic sodium solution should be dripped rapidly or directly intravenously to rapidly expand blood volume, correct shock, and then continue fluid replacement. The infusion speed should be slightly faster in hypotonic dehydration and slightly slower in hypertonic dehydration. The general cumulative loss (about 1/2 of the total fluid replenishment) should be replenished within 8 ~ 12h, and the dropping speed is about 8 ~ 10 1/kg per hour. The sustained loss and physiological requirement after replenishing the cumulative loss should be12 ~/kloc.
④ Precautions:
A, infusion too fast prone to heart failure and pulmonary edema, too slow dehydration can not be corrected in time.
B, children should be closely observed during fluid replacement, such as anterior fontanel, skin elasticity, sunken eye socket, urine output, etc. If the rehydration is reasonable, you should urinate for 3-4 hours, indicating that the blood volume has recovered. If the child's skin elasticity and eye socket depression recover within 24 hours, dehydration has been corrected. If the urine volume is large and dehydration is not corrected, it means that the proportion of glucose solution in the input liquid is too high; If eyelid edema occurs after infusion, it means that the proportion of electrolyte solution is too high.
C, timely observe whether the intravenous infusion is unobstructed, local leakage, redness and swelling.
D, accurately record the first urination time, 24 hours in and out, and adjust the fluid intake and speed according to the basic situation of children.
3. The nursing of children with mild diarrhea and malnutrition can continue to eat their daily diet and suspend the addition of complementary food; Severe diarrhea should be temporarily fasted according to the doctor's advice, and feeding should be resumed as soon as possible after the symptoms are relieved. Breastfeeding people continue breastfeeding and suspend complementary food; Artificial feeders can stop feeding milk and complementary food, and gradually resume eating after 4 to 6 hours, but pay attention to gradually increase from a small amount to multiple meals, and dilute milk, rice porridge or noodles with the same amount of rice soup and water. Children with viral enteritis lack disaccharidase, so they drink soy milk substitutes or fermented milk instead. After diarrhea stops, continue to give a nutritious diet and add meals once a day for 2 weeks, which can catch up with the normal growth level. Malnutrition and chronic diarrhea have a longer recovery period.
4. Care to prevent skin damage Choose clean and soft diapers, avoid using plastic sheets, and pay attention to timely replacement. Wash your ass with warm water after each defecation, dip it dry and oil it, keep the skin around the anus dry and prevent red ass. If there is local redness, exudation or potential ulcer, baking lamp and physical therapy can be used to promote wound drying and healing.
5. Nursing care of electrolyte disorder
(1) After rehydration, closely observe the changes of children's spirit, muscle tension and tendon reflex, and pay attention to whether there is hypokalemia or hypocalcemia; Draw blood in time for electrolyte analysis according to the doctor's advice.
(2) according to the doctor's advice, timely supplement electrolytes such as potassium, calcium and magnesium. Intravenous potassium supplementation can be started if there is urine after infusion. The concentration of potassium chloride should not exceed 0 or 3%, and the dropping acceleration should not be too fast. Intravenous injection is strictly prohibited to avoid cardiac arrest. If convulsion occurs during fluid replacement, calcium can be injected slowly intravenously for no less than 10min, and magnesium can be injected into deep muscles.
6. Nursing care of metabolic acidosis Closely observe the symptoms and signs of acidosis, collect arterial blood, and supplement alkaline solution according to the doctor's advice.
7. Symptomatic treatment
(1) Eye Care Children with hypertonic dehydration have less tears, dry conjunctiva, unable to close eyelids of comatose patients, and corneal exposure is easy to cause infection. Cornea can be infiltrated with normal saline and coated with eye ointment and eye mask.
(2) Monitoring of temperature changes in fever nursing. If the body temperature is too high, physical or drug cooling should be given. Dry the sweat in time, change wet clothes and quilts, drink plenty of water, and take good care of your mouth and skin.
(3) Abdominal pain nursing can gently massage the abdomen of children to keep warm or hot compress the abdomen to divert the attention of children. In severe cases, spasmolytic and analgesic drugs can be used according to the doctor's advice.
2. Model essay on nursing safety work plan
First, strengthen study, improve safety awareness, practice in strict accordance with the law, organize nursing staff to study nursing safety regularly, at least once a month, and conduct strict assessment. Enhance safety awareness. At the same time, we should strengthen the study of laws and regulations, practice in strict accordance with the regulations, and must not violate the operating procedures. It is forbidden to engage in nursing work independently by those who do not have the qualification of nurse practice and are not registered in this unit.
Second, according to the patient's top ten safety goals, strictly implement the nursing measures.
1. Establish patient identification system, especially in key departments such as emergency department, intensive care unit and electroconvulsive therapy room. There must be at least two methods (name and gender) to identify patients, and strict checks should be made to avoid mistakes and accidents.
2, strictly implement effective communication under special circumstances, to ensure the correct implementation of the doctor's advice. In particular, when rescuing patients, nurses must repeat the oral orders given by doctors, which can only be carried out after the two sides have confirmed it, and keep the empty ampoules after use. After the rescue, the doctor should be urged to fill in the doctor's advice. In general, verbal orders should not be carried out.
3. Strictly implement hand hygiene standards, implement the basic requirements of hospital infection control, and prevent cross infection. Nurses must be proficient in hand washing and know the evidence of hand washing.
4. Improve the safety of medication, strengthen drug management, strictly implement "three checks and eight pairs" in the implementation process to prevent errors, and closely observe the effects and reactions after medication to avoid incompatibility.
5. Prevent and reduce the occurrence of patients' falls and pressure ulcers, establish risk assessment and reporting systems and processes for falls and pressure ulcers, and take effective measures.
6. Actively report medical safety adverse events, establish a nursing adverse event reporting system, encourage active reporting, and severely punish those who conceal it. The nursing department organizes ward head nurses to discuss nursing adverse events every quarter, check the reasons and make rectification. Each department should organize the nursing staff of this department to discuss and analyze the incident and report the discussion results to the nursing department.
7. Encourage patients to participate in medical safety. In the corridors, bathrooms, washrooms, boiling water rooms and other places in the ward, there should be safety warning signs, and at the same time, patients should be educated on safety.
Third, strengthen ward management to prevent accidents.
1, according to the characteristics of psychiatric nursing, do a good job in patient management, hand over the number of patients, and keep the key of handover. Smoking is prohibited in the ward, especially in the warehouse, to prevent fire hazards.
2, the department should strengthen the collection of dangerous goods, patients admitted to hospital, or come back from outside activities, should be strictly checked to prevent dangerous goods from being brought in. Articles and food brought by family members must be checked by the nurse on duty before they can be handed over to patients.
3. The nursing department randomly checks the safety inspection conducted by the head nurse in each ward (check the records), and checks the patient's activity environment, ward environment, patient bed unit, etc. , timely pointed out that the security risks, require nursing staff to clear immediately, without delay.
4, require nursing staff to strictly implement the nursing work system, consciously regulate the nursing behavior, the head nurse should closely supervise the nursing staff to implement the system, often supervise and inspect, to ensure that the system is implemented in practical work, to avoid mistakes and accidents.
5, do a good job of "four prevention", for those who hurt people, destroy things, attempt to escape, new hospital, critically ill, banned from the compound. Strengthen the patrol, closely observe the changes of the condition, stop the patient's self-injury, injury and destruction in time, calmly analyze the patient's escape from danger, and take timely measures to make the patient recover. Avoid accidents.
3. Model essay on nursing safety work plan
First, general care: keep the ward fresh, sunny and well ventilated. In case of infectious diseases, digestive tract isolation or bedside isolation should be strictly implemented to prevent cross-infection. You should stay in bed in the acute stage. Pay attention to keep warm and massage the abdomen to avoid oppression and other mechanical stimulation that increases abdominal pressure. You can exercise properly in recovery period and chronic period, but you should pay attention to the combination of work and rest.
Second, emotional care:
Strengthen psychological counseling and keep a good mood.
Third, the condition observation:
Observe the color, smell, shape, quantity and mixing of diarrhea, and the relationship between defecation times, time and eating. Distinguish between cold and heat deficiency and excess of diarrhea. If the stool is thin or even watery, abdominal pain and bowel sounds are cold and wet, the stool is yellow-brown and smelly, and the urgency of diarrhea is damp and hot. If diarrhea in summer is like an egg failure, the pain after diarrhea will turn into food accumulation in the stomach, and when the mood fluctuates, the liver qi will attack the stomach, and diarrhea will be aggravated. Diarrhea will be kidney-yang deficiency before dawn, and diarrhea will not be reduced to spleen and stomach weakness. Observe and record the changes of body temperature, tongue coating, pulse condition and consciousness, whether there are dehydration symptoms such as thirst, dry oral mucosa, decreased skin elasticity and decreased urine output, and whether there are hypokalemia manifestations such as muscle weakness, abdominal distension, intestinal paralysis and arrhythmia, and report to the doctor in time and take active measures.
Fourth, diet care:
Diet should be light, less oily, digestible liquid or semi-liquid. It is advisable to eat vegetable soup, fruit juice, hot porridge and burnt rice soup. Ingesting a large number of foods that are cold, rich in fiber and difficult to digest will cause mechanical stimulation and should be avoided. Cold, sweet and greasy gas-producing beverages containing carbonic acid should be avoided.
Five, medication care:
Traditional Chinese medicine decoction is generally taken warm.
Six, dialectical nursing:
(1) Cold-dampness diarrhea syndrome is characterized by diarrhea, and the symptoms are sparse, acute onset, abdominal pain, anorexia, nausea, fever, head and body pain, thin and white tongue coating and slow pulse. Huoxiang Zhengqi Powder is selected, which can remove dampness by fragrance, relieve exterior symptoms and dispel cold, and is suitable for hot compress before meals. Lizhong decoction can be used for severe cold, and abdominal pain can be massaged by rubbing the abdomen or grinding Qi Hai, Guanyuan and Changqiang points, or applying hot water to the abdomen. It is advisable to have a mild diet, and avoid greasy and cold food.
(2) Pueraria lobata is selected as the medicine for damp-heat diarrhea, which should be taken cold before meals. Mowan, Tian Huan, Qihai, Pishu and Zusanli. Diet should be light and refreshing, give more fruit juice or melon soup, and avoid spicy, greasy, tobacco and alcohol and other products that help heat and dampness.
(3) Baohe Pill is selected for diarrhea due to food stagnation and should be taken after meals. Cut points such as Shangwan, Zhongwan, Tianwan, Qihai and Guanyuan. Diet according to the condition to give a light or semi-liquid diet, a small number of meals; People with severe diarrhea should control their diet. Avoid cold food, fatty liver and thick and greasy food.
(4) For the syndrome of liver-qi invading the spleen, the antidiarrheal prescription should be selected, and it should be taken warm after meals. In case of abdominal pain, patients can be instructed to push and grind Zhongwan, Tian Huan, Qihai and Guanyuan points. The diet should be vegetarian, light, eat less and eat more meals, and often eat radishes, spinach, tomatoes, yams, wax gourd, oranges and so on. Soothing the liver and regulating qi, avoid spicy, fried, greasy and greasy products, tobacco and alcohol and other products that help damp, sleepy spleen and generate heat.
(5) Spleen-stomach weakness syndrome, Shen Ling Bai Zhu powder for invigorating spleen and stopping diarrhea is suitable for taking hot food on an empty stomach. You can massage points such as Zhongwan, Tian Huan, Qihai and Guanyuan clockwise, and press Pishu, Shu Wei, Dachangshu, Changqiang, Zusanli and Pishu until they are warm. Moderate diet, regular quantitative, a small amount of meals, choose nutritious and digestible food, often eat Astragalus porridge or lotus seeds, yam, lentils, jujube, barley porridge, spleen and qi. Avoid cold, fat, sweet, fried and other products that hurt the spleen and hinder the stomach.
(6) Shen Si Pill is modified for kidney-yang deficiency, so as to warm the kidney and strengthen the spleen, astringe the intestine and stop diarrhea, which is suitable for hot taking on an empty stomach. You can massage Zhongwan, Tian Huan, Qihai and Guanyuan points clockwise, and press Roupishu, Dachangshu, Changqiang, Shenshu and Mingmen points. The diet is suitable for nutritious, tender and delicious Euryale ferox porridge. Often eat walnuts, yam, Euryale ferox and so on. And do not eat cold, greasy, greasy and sweet and fried food.
Seven, health education
(1) Pay attention to food hygiene, don't eat spoiled or unclean things, don't eat too much cold or greasy, sweet and greasy food, and don't drink too much to prevent damage to the spleen and stomach.
(2) Life is regular, and clothes and quilts are increased or decreased according to climate change. In summer or rainy season, don't sleep in the cold, don't wade in the rain, and don't lie in the wetland for a long time to prevent the invasion of dampness and damage the spleen and yang.
(3) Listen to light music at ordinary times to cultivate sentiment and eliminate troubles.
(4) Develop good eating habits. Diet is moderate, should be light and nutritious, and avoid cold food and indigestible food.
(5) Pay attention to environmental hygiene and personal hygiene, and exercise to enhance physical fitness.
4. Model essay on nursing safety work plan
First, the work goal is to take patient satisfaction as the overall goal, lay a solid foundation, consolidate the results, further deepen the quality nursing service, enhance the service connotation, and continuously improve the quality of nursing. Make children's family satisfaction ≥ 95%; The awareness rate of health education is ≥85%.
Second, the implementation measures
(a) continue to improve and revise the rules and regulations, workflow, continue to improve and revise the quality control standards, strengthen the supervision and rectification system of nursing adverse events, and strengthen the management of critically ill patients.
(2) Improve professional quality in an all-round way and optimize nursing service.
1, strengthen the training of basic theoretical knowledge and professional knowledge, improve the comprehensive quality and professional ability of nursing staff, strengthen the implementation of basic nursing and graded nursing and ensure the quality.
2, strengthen nursing professional technical operation training. According to the training plan of neonatology department, general nurses are trained in skills operation at different levels, so as to firmly master the basic nursing skills and consolidate the basic skills.
3. Take various forms of study and training, so as to improve the professional quality of hospital nurses and improve their ability to observe the condition, implement nursing measures and record nursing documents.
(three) strictly abide by the "neonatal safety management system" and standardize management according to its requirements.
1, neonatal nurses must hold relevant certificates, receive professional training for newborns, master the nursing skills of common diseases of newborns, and be familiar with the first-aid operation techniques of newborns and hospital infection control techniques in neonatal wards.
2. Strictly implement the identity confirmation system and check system. Children must wear identification wristbands during hospitalization. If it is damaged during bathing, examination and treatment, it should be worn in time to ensure the correct identity of the child.
3. Strictly restrict the entry of non-staff members. Staff should wear uniform clothes and wash their hands when going to work. All operations require washing hands and wearing masks. Anyone should wash their hands carefully or use quick hand disinfectant before and after contact with children.
4, ward equipment should be regularly checked and maintained, maintain good performance, strengthen fire safety management, safe use and safekeeping of flammable and explosive equipment and facilities, to prevent fire accidents.
5. Establish hospital infection monitoring and reporting system according to regulations, and conduct bacteriological monitoring on air, objects, hands of medical staff and disinfectants in use on a regular basis. The management of medical wastes in wards shall be classified in accordance with the Regulations on the Management of Medical Wastes and relevant regulations.
6. Formulate and effectively implement the safety procedures for neonatal examination, treatment, professional transfer and discharge. Formulate emergency plans and disposal procedures for all kinds of emergencies, improve the ability to prevent risks and respond to accidents quickly and effectively, and ensure medical safety.
(4) Consolidate basic nursing, conscientiously do all basic nursing work, and make nursing work more standardized. Keep the sickbed clean and tidy, free of peculiar smell and stains, the articles are placed neatly and regularly, and the number of infusion drops conforms to the doctor's advice. Visit children with infusion frequently to prevent or reduce extravasation of infusion, be good at observing patients and solve problems in time.
(5) Strictly implement the overall nursing responsibility system.
1, change the scheduling mode, implement the responsibility scheduling mode, and flexibly schedule.
2. Fully perform the duties of nurses, be responsible for all kinds of treatment and medication, condition observation, basic nursing and health education for nurses from admission to discharge, provide continuous and complete work for children, and earnestly do a good job in quality nursing services.
3. Deepen the graded use of nurses, assign responsible nurses according to the illness, nursing difficulty and technical requirements of children, and the nurses with high seniority and strong ability are responsible for critically ill patients, reflecting the corresponding energy level.
(6) Regular satisfaction survey
1. Children were given satisfaction surveys when they were discharged from hospital, and their family members' opinions and suggestions on quality nursing were listened to.
2, regularly adhere to the telephone follow-up of discharged children, do a good job of disease follow-up, health education, feedback.
5. Model essay on nursing safety work plan
First, strengthen nursing safety management, improve nursing risk prevention measures, effectively avoid nursing risks and provide high-quality, safe and orderly nursing services for sick children. 1. Constantly strengthen safety awareness education, promptly remind unsafe factors found in the work, and propose corrective measures. Taking the nursing errors inside and outside the hospital as an example, we can organize discussion and study for reference, so that nurses can fully understand the new situation and new characteristics of nursing error factors, learn from them, and make the safety alarm ring constantly.
2. Strengthen the management of key periods, such as night shift, middle shift and holidays. , the implementation of flexible scheduling system, reasonable collocation of old, middle-aged and young people on duty, and pay attention to cultivate nurses' cautious spirit when they are on duty independently.
3. Strengthen the management of key sick children, such as critically ill children in the intensive care unit and critically ill children in the general ward, and take these children as the focus of discussion at the morning meeting and the shift meeting, evaluate the existing and potential risks of patients, reach a * * * understanding, and attract the attention of each class.
4. Improve nursing records and reduce potential safety hazards. Standardize nursing records and conscientiously implement the "cross principle" in nursing records, that is, objectivity, truthfulness, accuracy, timeliness and completeness.
5. Improve the nursing emergency risk plan, pay attention to cultivating nurses' emergency ability in daily work, and make a retrospective evaluation of each emergency work, draw lessons from it, and improve nurses' ability to deal with emergencies.
Second, take patients as the center, advocate humanized service, strengthen nurse-patient communication, improve patient satisfaction and avoid nursing disputes.
1. The nurses in the office class sincerely receive the newly admitted children, send them to the bedside, and take the initiative to give admission education and health education to their families.
2. Ask the responsible nurse to communicate with the children's families every day, including health education, understanding the patient's condition, life needs, the effect and reaction after taking the medicine, etc. , and conscientiously implement the notification procedures of various nursing operations, respect parents' right to know, and relieve their concerns.
3. Hold a symposium on holidays every month, distribute patient satisfaction questionnaires, praise and encourage nurses with high service quality, and criticize and educate nurses with poor service quality.
Three, in-depth development of "people-oriented" holistic nursing work. Refine the workflow and clarify the job responsibilities.
1. Revise the duties of each class, change the shift arrangement mode, refine the work flow of each class, find out the weak links, clarify the division of nursing, and strive to make the new duties more reasonable and practical.
2. Pay special attention to basic nursing, specialist nursing and nurse responsibility system. Provide holistic nursing service for patients, closely observe patients' condition, communicate with patients at any time, do a good job in patients' life nursing and basic nursing, ensure patients' safety and embody humanized nursing.
3. Deepen the hierarchical use of nurses, assign responsible nurses according to the patient's condition, nursing difficulty and technical requirements, and the nurses with high seniority and strong ability are responsible for critically ill patients, reflecting the corresponding energy level.
Fourthly, nurses implement performance distribution.
Distribution principle: give priority to efficiency and quality, distribute according to work, and give consideration to fairness and justice.
Distribution basis: patient satisfaction, workload, existing risks, nursing quality and sense of responsibility.
Fifth, strengthen patient health education.
1. The nurse in charge will explain the patients in detail every day according to the treatment and nursing routine of common diseases in the department, special diet, self-prevention of diseases and matters needing attention in medication, provide health education and rehabilitation guidance to patients, and provide psychological care.
2. Hold a nursing meeting once a month, and each nurse reports her work and feelings. Conduct patient satisfaction survey every month, and listen carefully to patients' opinions and suggestions on quality care. Timely feedback the existing problems, put forward rectification measures, continuously improve the quality of nursing, and improve patient satisfaction.
Six, new business, new technology
1, focusing on the development of children's rehabilitation and health care, sent 1-2 nurses to pursue further studies in children's rehabilitation and health care.
2. Enhance scientific research awareness and strive to develop 1-2 new technologies during the year.