外科创伤患者的护理.ppt
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1、Nursing Care of Client Experiencing Trauma,创伤病人的护理,Definition of TraumaTrauma morbidity(发病率)and mortality(死亡率)constitute a major health care challenge.创伤的发病率和死亡率构成了健康的最大挑战。Although significant strides have been made in combating heart disease and selected cancers,traumatic injury continues to be the
2、 number-one killer of the young.,Section 1 Overview,Trauma,traumatic injury,heart disease,cancer,The number-one killer of the young,It is estimated that traumatic injury causes about 140,000 deaths per year.An additional 57 million people suffer nonfatal(不致命的)injuries each year.,当肯尼迪乘坐敞蓬轿车驶过德克萨斯州达拉斯
3、的迪利广场(Dealey Plaza)时,遭到枪击身亡。约翰肯尼迪是美国历史上第四位遇刺身亡的总统,也是第八位在任期内去世的总统。assassination 遇刺,暗杀,John Fitzgerald Kennedy,肯尼迪诅咒 curse,11941年,约瑟夫的残疾女儿死于失败的脑叶切除手术;21944年,约瑟夫长子小约瑟夫肯尼迪战时死于飞机失事;31948年,约瑟夫二女儿凯瑟琳死于飞机失事;41963年,肯尼迪总统的第三个儿子出生两天后夭折;51963年,约瑟夫二子肯尼迪总统遇刺身亡;61968年,约瑟夫三子罗伯特遇刺身亡;71983年,罗伯特之子博比因吸毒被判刑;81984年,罗伯特之子
4、戴维因过量吸服海洛因死亡;91997年,罗伯特之子迈克尔死于滑雪事故;101999年,约翰之子小约翰肯尼迪死于飞机失事;112009年,约瑟夫四子爱德华死于脑癌;,Traumatic injury usually occurs suddenly,leaving both the client and family with little time to prepare for its consequences.创伤发生得太突然,没有任何时间留给病人和家庭来准备承受后果。Nurse provide a vital link in both the physical(生理的)and psychos
5、ocial(心理社会)care for the injured client and family.护士要提供给护士伤员及家庭一个关健的护理不仅是生理上的还包括心理社会的。,traffic accident,In caring for the client who has experienced trauma,nurses must consider not only the initial physical injury,but also its long-term consequences,including rehabilitation and the clients return to
6、 his or her previous way of life.护士护理创伤人员时,不仅必须考虑最原先的生理创伤,而且也要考虑长期的后序治疗,包括康复和伤员能回归原来的生活轨道。,Types of Trauma 创伤类型,Severity 严重程度分类Whether intentional or accidental,trauma causes injury to one or more parts of the body.,1 Minor trauma,2 Major or multiple trauma,1 Minor trauma 轻伤,Minor trauma causes inju
7、ry to a single part or system of the body and is usually treated in the hospital or emergency department.轻伤导致身体一个部分或一个系统的损伤,通通都会在医院或急诊科被治疗。A fracture of the collarbone,a small second-degree burn,and a cut requiring stitches are all considered minor trauma.锁骨的骨折,二度烧伤和一个需要缝合的伤口都被认为是轻伤。,2 Major or mult
8、iple trauma 重伤及多发伤,Major or multiple trauma involves serious single-system injury(such as the traumatic amputation of a leg)or multiple-system injuries.Multiple trauma requires immediate intervention(立即干预)that is specifically focused on ensuring the survival of the client.多发伤需要立即干预,尤其重心是保证病人的生命。,Cli
9、ents who suffer multiple trauma receive immediate emergency care and often require long periods of intensive nursing care.多发创需要立即接受急救治疗,并且经常需要常长时间的护理。,Types of Trauma,Skin Integrality 按皮肤的完整性来分1 Blunt trauma 闭合性损伤 Blunt trauma occurs when there is no communication from the damaged tissues to the out
10、side environment.2 Penetrating trauma 开放性损伤 Penetrating trauma occurs as the result of foreign objects set in motion.Penetration of tissues causes damage to body structures,most commonly the intestines(肠道),liver(肝脏),spleen(脾脏),and vascular system(血管系统).,Types of Trauma,Organ and location 创伤器官和部位分tra
11、uma of abdomen 腹部创伤trauma of bladder 膀胱损伤;膀胱外伤trauma of limbs 四肢损伤Trauma of chest 胸部损伤trauma of breast 乳腺外伤trauma of gastrointestinal tract 胃肠道创伤trauma of nose 鼻外伤trauma of brain 脑外伤trauma of spinal cord 脊髓外伤,Effects of Traumatic Injury 创伤的影响,Causes and Initial Management 创伤原因和处理Airway obstruction 气
12、道阻塞Tension pneumothorax 张力性气胸 Hemorrhage 出血 Integumentary effects 皮肤损伤 Hypovolemic shock 低血容量性休克 Neurologic effect 对神经系统的影响 Effect on the family 对家庭的影响,1 Causes and Initial Management 创伤原因和处理,(1)Natural DisastersEarthquake 地震Mudslide;mudflow 泥石流volcano 火山vlkeinu lahar 火山泥流l:h:avalanche 雪崩v,lntBlizza
13、rd 暴风雪 blzdHurricane 飓风Typhoon taifu:n台风Flood 洪水 ice storm 冰雹,1 Causes and Initial Management 创伤原因和处理,Man-made disastersDerail 火车出轨Traffic crash;traffic accident 交通事故Plane crash 飞机失事attack;slaughter;fight 袭击;屠杀;打架terrorist attack 恐怖袭击Shooting 枪击War;battle 战争;战斗Sport activity,Initial Management,A men
14、tioned as the opening of this chapter,death is a common result of serious traumatic injury.Death from trauma may be immediate,early,or late.创伤引起的死亡可以是立即的,早期的或是晚期的。Immediate death is death is death at the scene from such injuries as a torn thoracic aorta(主动脉撕裂伤).Early death is death occurring within
15、several hours of the injury from,for example,shock(休克)or lack of treatment for unrecognized injuries(无法诊断的损伤).,Late death generally occurs one or more days after the injury and results from multiple organ failure(器官衰竭).Because of the serious consequences of a traumatic injury,it is important to iden
16、tify rapidly and take interventions appropriately.因为创伤的严重后果,对于迅速确定并且适当地采取措施非常重要。,EP 10 mins 急救白金十分钟,platinumpltnm,CRASH PLAN检查顺序,C cardic 心脏R respiratory 呼吸A abdomen 腹部S spine 脊柱H head 头颅P Pelvic 骨盆L 1imb 四肢 A artery 血管N nerve 神经,2 Airway obstruction 气道阻塞,The trauma clients airway may become obstruc
17、ted by the presence of blood,teeth,the tongue,and vomitus(呕吐).Airway interventions may include:1 Clearing the airway by suctioning(吸引)。2 Use of airway adjuncts,such as an oropharyngeal(口咽的)airway3 Intubation with an oral endotracheal airway(气管插管).4 Needle or surgical circothyroidotomy.(气管切开)This pro
18、cedure is performed only after other methods are ineffective in opening and maintaining an open airway.,开放气道 Airway,Clearing the airway by suctioning,an oropharyngeal airway,口咽管,Intubation with an oral endotracheal airway,circothyroidotomy,3 Tension pneumothorax 张力性气胸,A pneumothorax results from air
19、 in the pleural space from blunt and penetrating injuries to the chest.When a one way valve(阀门)is created so that air can enter the pleural space but not exit,a tension pneumothorax may develop.,4 Hemorrhage 出血,1 External Hemorrhage(外出血)When the client has suffered an injury that causes external hem
20、orrhage,such as severing of an artery,the bleeding must be controlled immediately methods to achieve this include:(1)Applying direct pressure over the wound(2)Applying pressure over arterial pressure points 压迫伤口上方动脉(3)Elevating the injured limb 抬高(4)Clamping the bleeding vessel.(固定,夹紧)(5)Applying a
21、tourniquet.(止血带),压迫止血Applying direct pressure over the wound,包扎止血Clamping the bleeding vessel,Applying pressure over arterial pressure points 压迫伤口上方动脉,4 Hemorrhage 出血,2 Internal Hemorrhage 内出血Internal hemorrhage may result from either blunt or penetrating traumatic injury.Discovering the cause of,lo
22、cation of,and extent of blood loss related to the injury is the most important concerns.Methods to discover the presence and location of internal hemorrhage include:Diagnostic peritoneal lavage(诊断性腹腔清洗)CT scans of the head,chest,and abdomen,Diagnostic peritoneal lavage,The body has several potential
23、 spaces that can accommodate(容纳)large amount of blood that may accumulate(集聚)follow injury.在身体中有几个潜在的腔隙可以容纳大量的血液。Fox example,bleeding into the pleural space(胸膜腔)may occur with chest trauma,and bleeding into the abdominal cavity(腹腔)may occur with abdominal trauma.Pelvic fracture(骨盆骨折)may cause massiv
24、e hemorrhage in the retroperitoneal(腹膜后)region.,Once the source of internal hemorrhage has been recognized,interventions are initiated,including:Operative control of bleeding 手术控制出血Continual assessment of the client,including physical assessment,vital signs,and serial laboratory work.评估患者通过身体检查,生命体征
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