ICU fundamental nursing ppt courseware ppt
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* Hello! Fundamental Nursing for ICU Patients ** Fundamental Nursing Condition Looking at the quality of nursing care for critical nursing health education? * The main importance of ICU basic care for patients with physical and mental comfort * According to the theory of need, ICU patients need to be frustrated because they need to be frustrated and low needs need to be responded. Fundamental care is just a secondary way to ensure the patient's low organizational needs. ①②④⑤③ * CU patients should give active and comfortable care regardless of whether their disease can be cured. * Comfortable Nursing is the study of nursing programs. The ultimate goal of research is to make patients physically and mentally in the best form. Its connotation will improve the quality of ICU fundamental nursing and spur the growth of nursing discipline. Therefore, it is emphasized that in addition to the current nursing programs, nurses should strengthen the research on comfortable nursing so that the basic nursing research takes more care of the infection and the patient's stiffness. * Patients praise for reducing the physical and mental comfort of their family members to avoid some of the key features of ICU's basic nursing care, which is an excellent medical system. * Contents of basic care. Nursing care of the ward, diet, urination, and defecation. Nursing of various pipes. * I. Temperature of the ward: ~ C Humidity: ~ * I. Air in the ward: Fresh and clean. Carry out the object profile and air cultivation on a regular basis to strictly control the number of bacterial colonies air cfum. * 1. Ward room () Indoor air purification: natural ventilation: open window for ventilation. Ventilate daily ~ times every time ~ minutes. Laminar flow chamber: It can make the indoor connection completely sterile. * 1. Ward room () Indoor air disinfection: UV: Ozone: Ozone is colorless, no residue, and has a light and fine gas. It has strong disinfection. The fungus function is called ldquo green disinfectant rdquo. Some people who are prone to allergies who have been suffering from ozone levels over cubic meters for a long time will experience symptoms such as skin itching, poor breathing, cough and rhinitis. Chemical agent: Peroxyacetic acid fumigation (in the absence of people in the room), chlorhexidine (chlorhexidine) aqueous solution is sprayed twice a day. * I. Light in the ward: When the light in the room is controlled to minimize the irritation of the light to the patient, the light is closed at night to allow the patient to have good sleep during the day and at night. * 1. Ward room sound: Try to reduce the quietness of the music room. Inquiries and visits revealed that ICU is the most noisy premises in the hospital as a result of hearing overload infection. The origin of noise? The sound of machinery running, the sound of alarms, the sound of tracheal suction, the wording of workers. * According to the International Music and Music Association's ICU Day Music, it is best not to span Dubai, Dusk, Decibel at night, Decibel at night. * I. The ward Walder et al. Conceived some ways to control the light and noise of the ICU: there are plans to close all the doors to minimize the alarm sound of various monitors: ~: between: try to harmonize with nursing care and do not whisper words Can not use telephony, radio can not use indirect lighting to use earplugs or use a cotton ball to plug the patient's ears. * I. Screen or screen in the ward: When we are in emergency, we should pull up the screen or cover it with screen to avoid unpleasant reactions in other patients. * Second, hair care, eye care, nasal cavity care, oral care, skin care * Hair care goals: make hair uniform, clean the patient's pride and pride. Evaluation: The patient's condition and psychology reflect the length of the patient's hair and the sanitary environment. Method: Shampoo or cut your hair on the comb bed. * Eye care assesses whether the eyes have shit, bulbar conjunctiva with edema, or infection. For patients whose eyelids cannot be closed on their own: You can clean your eyes with psychological saline and apply ointment. Then cover with Vaseline gauze or a ventilated flap to avoid corneal ulcers and conjunctivitis due to blinking and corneal dryness. * The nasal cavity care association helps patients to cut off the nasal cavity excreta in time to maintain the nasal cavity clean and maintain the general function of the nose and provide comfort. Patients with long-term nasal cannula oxygenation should be connected to the nasal cavity to prevent bleeding due to dryness. For patients with head and brain surgery, excretion cannot be sucked from the nasal cavity. * Nasal cavity care Patients who have an indwelling nasogastric tube should always change the position of the nasogastric tube to the nasal mucosa. Patients with epistaxis should use a hemostatic gauze to stop bleeding, and the doctor should be informed to take it out after 72 hours. * Oral Care Objectives: To keep the mouth clean and moist to prevent complications such as oral infections. Prevent oral inflammation, oral ulcers, mumps, otitis media, etc. Deodorizing patients is comfortable. Observe the changes in the oral cavity to provide news of changes in the condition. * Oral Care Oral Care Assessment Table Site Score Mucosa wet, intact, dry, mucous membranes or ulcers without bleeding gums and atrophy mild atrophic bleeding gums atrophy easy bleeding, swelling in the amount of saliva, clear small amount or Excessive amount of bright or thin tongue is moist, a small amount of tongue coating is dry, there is a moderate amount of tongue coating drying, there is a large amount of tongue coating or cover tongue coating, the smell is odorless or smelly, the smell is pungent, the lips are smooth, soft, dry, with a small amount of dry skin with cracks There are a large number of clefts, no clefts, clefts, bleeding tendencies, skin discharges, bleeding damage, no lips, and the presence of a foreign tooth score in the mouth. * Commonly used in oral care Solution name Concentration Psychological saline cleansing The mouth prevents the transmission of hydrogen peroxide solution ~ Preservative, deodorant Combined for oral infections Sore bicarbonate solution with ulcers and bad tissues ~ Combined for bacterial infection chlorhexidine solution to clean the mouth Spectral antibacterial furacicillin solution cleansing oral broad-spectrum antibacterial acetic acid solution for Pseudomonas aeruginosa and metronidazole solution for anaerobic infections * Oral care Note: The tooth opener should be placed in the molar from the molar and the closed one should not be used to prevent the mouth from opening Those who develop antibiotics for long-term use should check whether there is mold infection in their mouth. They should be gentle during scrubbing. For patients with poor coagulation function, they should prevent damage to mucous membranes and gums. Be careful not to leave cotton balls in the mouth. * Special oral care Nursing care of all oral mucosa ulcers: Set up equipment Special mouthwash: Lidocaine Vitamin B or C Psychological saline resuscitation spray Oral trachea intubation Oral care for patients: For patients who are not in common Do * skin care ldquo Liu Qin Yi pay attention to rdquo Qin Qin turn over Qin Qin scrub wash Qin massage Qin Qin change pay attention to pay attention * Third, dietary care to assess the patient's cognition and swallowing function. Motivate patients to make up for body depletion and need to help patients with self-care defects. Nasal feeding or intravenous high nutrient can be given to those who cannot pass the oral route. Patients who have fluid problems (such as a large amount of drainage fluid or extra fluid) should make up enough fluid to maintain fluid balance. * Three, defecation and urination nursing assistance to help patients with urination, such as indwelling urinary catheters should be connected to drainage Lida to prevent urinary system infection constipation can give laxative medicine or enema incontinence patients to do skin care to prevent local complications * IV. Nursing of all kinds of pipes Nursing of endovascular catheters Nursing of nasal gastrointestinal tubes Nursing of urinary catheters Nursing of artificial airways Nursing of ventricle drainage tube Nursing of hematoma drainage tube Nursing of thoracic drainage tube Nursing of abdominal drainage tube The guideline tube is firmly fixed to prevent unintended decoupling or the patient to pull the tube out of the way. To prevent the sterility of the connected sterile tube to prevent infection. Intravascular catheter care. Intravascular catheter use. Infusion, blood transfusion products, intravenous drug nutrients. Supporting veins with high nutrient hemodynamic monitoring for hemodialysis * (I) Classification of catheters There are many ways to classify catheters into the types of blood vessels: peripheral veins, middle veins, and arteries. Veins, internal jugular veins, peripheral vessels, and peripherally inserted mid-catheter catheters (PICC) follow the skin-to-vessel diameter: authentic and non-vascular Authentic type. * (II) Catheter-related infection (CRI) Local infection of phlebitis, suppurative thrombosis, infection at the outlet of the infection channel (infection around cm outside the outlet), infection, perfusion, related: primary bacteremia, intubation, related: catheter-related Sexual bloodstream infection (CRBSI) * The risk of CRBSI CRBSI is a type of infection associated with the removal of intravascular catheters. It ranks fourth among hospital infections. This infection occurs in about 10,000 to 10,000 patients in the United States each year. Such infections occur in the UK at most every year. CRBSI (United States) is being presented approximately 10,000 times in 10,000 uses of CVC. * Approximately% of infectious infection of intubation. Intubation patients are shocked, intubated patients have fever, cold and redness of the skin of the intubation area, and exudate potential is positive for infection of bacteria in the infectious duct wall. * The pathogenesis of CRBSI, intubation site and The outer wall of the catheter, the general situation in the catheter, the bacteria in the cycle are colonizing at the catheter, the diagnosis of indirect input of bacteria * CRI, the diagnosis of catheterization () with bacteriology and no clinical symptoms and signs. Non-bacteriology said that the local CRI () has a clinical indication (the origin does not have to be determined). Bacteriology () has a clinical indication (the origin does not have to be determined). The latter two are called CRBSI * catheter samples for bacteriological incubation and can be considered the gold standard for diagnosing CRBSI. * Semi-quantitative method or quantitative method semi-quantitative method (rolling plate method) is recommended for the eradication of catheters for bacteriological use: used to detect bacteria outside the catheter. (High diagnostic value for intubated W) Judgment of results: gecfu catheters have clinical significance. CRBSI can be diagnosed if it is accompanied by local and symptoms. Quantitative method: detection of external appearance of the catheter and bacteria in the lumen. Judgment of the results: The gecfu catheter segment is used in an environment where the catheter can be eradicated, especially if the intubation time is longer than W *. When it is difficult to extubate, ldquo paired rdquo blood is used to cultivate blood samples: ① blood collection from CVC tube and ② blood collection from peripheral veins. Judgment of the results: () Obtaining one pathogenic bacteria (variety, antibacterial spectrum) () Specific force colonies (CFU): Catheter> more than four weeks of veins () Specific positive time difference: Catheter positive time> Four weeks of early veins can diagnose CRBSI . * The United States CDC does not guarantee that bacteriological cultivation of conventional catheters is only carried out when CRBSI is suspected. * (3) Catheter care Changing the catheter and dressing at the intubation site, changing the drug delivery equipment, changing the liquid hanging time, and sealing the tube * (3) education and training of the nursing medical staff of the catheter Selection of bacteria disinfectant skin disinfectant Preventive use of antibiotics monitoring * change catheters and catheters * change of intubation site dressing Use sterile gauze or sterile, semi-transparent dressing to cover the catheter site. Gauze is more suitable than a bright or semi-bright dressing if the patient is sweating more frequently or has local bleeding or exudation. Change the dressing when it becomes moist, loose, or noticeable. For adolescents and adolescents, changing dressings at most once a week depends on the specific circumstances of each patient. * Specific force of Tongming dressings and gauze dressings Bacterial colonization rate of Tongming dressing ducts-Bacterial colonization rate of gauze dressing ducts-No statistical difference * The specific force of Tongming dressings and gauze dressings or gauze dressings are easily contaminated and cannot be inspected Invalid palpation hour change-Huaxu's human and material gauze pads are non-sticky-adding extravasation, catheter displacement and phlebitis opportunities. * The specific force of Tongming dressing and gauze dressing. Tongming dressing does not affect the patient's bathing and programs. It is beneficial to continuously observe the puncture site and change the dressing once a day: throttling time and labor are sticky-the catheter is not easy to displace. * Change of dressings Avoid touching the puncture site with your hands when changing dressings. Wear sterile or clean gloves when changing dressings. * Replacement of drug delivery equipment. Replacement of intravenous catheters includes the frequency of replacement of additional equipment. Change the tube for blood transfusion or blood products or fat milk within hours. The delay tube adjacent to the duct is considered to be a part of the relocation when the relocation is changed. * Liquid Hanging Time No popular liquid hanging time. Fat-soluble parenteral infusions should be infused within an hour. If only zero fat is given, the fat emulsion should be lost within hours after use. Blood products should be transfused by the hour. * The goal of the flushing tube is to flush the remaining irritating liquid into the bloodstream to avoid irritation of local blood vessels and reduce the contraindications between drugs. The goal of sealing the tube is to give a smooth venous connection to the positive pressure. Rinse the tube and take the tube sealing tube variety: the amount of isotonic saline is ml, and the tube is sealed once and the diluted heparin solution is used in ml per ml. The anticoagulant effect lasts for more than one hour. Flush the tube and take the tube. Flush the tube: isotonic saline ml * pulsed tube and positive pressure sealed tube. Scouring method * Method Pull out the needle while injecting the liquid medicine. Pull out the needle of the needle to seal the tube-Positive pressure Rate and disease rate uarr. Educate medical staff on the use of compliance with intravascular catheters, accurate placement and manipulation, and ways to prevent infection. Promote the establishment of a professional and fixed medical care team. Evaluate the academically controlled environment of medical staff on a regular basis. * Hand hygiene and aseptic techniques follow exact hand hygiene regulations. The use of gloves cannot replace hand washing. Aseptic technique during intubation and care. Use a maximum of sterile isolation fences (sterile gloves, sterile gowns, towels, masks, and hats) for mid-venous catheterization. As far as possible, non-contact aseptic technique should be used in catheter puncture placement and daily care. * Skin Disinfectant Choice Preferred chlorhexidine alternative to iodine tincture, iodine or alcohol. Chlorhexidine has a broad antibacterial spectrum and low skin irritation. Allow the disinfectant to air dry before intubation or manipulation. Disinfection category: larger than dressing size (CVC: * cm). * Using preventive antibiotics It is not necessary to give preventive antibiotics before intubation and during catheter use. * Monitoring The environment of the dressing at the intubation site is monitored by inspection or palpation. If the patient presents with local pain and sadness of the intubation, fever, or other signs that indicate local or bloodstream infections should be removed and the intubation site should be checked. Inspire the patient to speak to the doctor or nurse about any changes or discomfort in the catheter site. Record the date when the operator inserted and removed the catheter and change it according to the standard. Incubation of the catheter tip is not routine. * (1) Peripheral venous catheters (2) Mid-pulse catheters (including PICC and hemodialysis tubes) (3) Nursing of peripheral arterial catheters with divergent intravascular catheters * (1) Peripheral venous catheters a: Placed through the back of the hand or forearm. For lengths <inches, use upper limb blood vessels as much as possible and rarely use lower limb blood vessels for catheterization. The lower extremity blood vessels have been moved to the upper extremity blood vessels as soon as possible. b Hematogenous staining is rare in venous catheters around short-term intubation. Pay attention to local phlebitis. * (1) Change of peripheral venous catheter c: Change the short peripheral venous catheter at most once every hour to reduce the degree of phlebitis. (If the site of venous communication is unlimited and there are no signs of infection and phlebitis, the peripheral venous catheter can delay the indwelling time. The patient and the environment of the catheterized site should be closely monitored.) Pediatric patients: The peripheral venous catheter is being properly indwelled until the venous treatment is completed. Nothing needs to be changed unless complications such as phlebitis or exudation occur. d. Gauze and dressings have no significant infection and do not need to be changed. * (II) Mid-pulse catheters The highest infection rate of mid-pulse catheters is CRBSI. Multi-lumen catheters are more contagious than single-lumen catheters. When using, separate the special cavity mouth marked with high nutrients and administration. a Insertion: The jugular and femoral veins should be avoided as much as possible with the subclavian vein. Aseptic techniques (sterile clothing, caps, gloves, masks, large orders) should be used in the operating room. * (2) The mid-pulse catheter b does not guarantee to change the catheter regularly. Even those who have mild or moderate fever but no local inflammation and no migrating lesions or septicemia are not anxious to change tubes. c. Dressing change of the catheter site: Change the gauze dressing once a day and change the bright dressing once a day. Change the dressing when it becomes moist, loose, or contaminated. * (2) The scale of the mid-vein catheter d eradication or replacement of the catheter: () redness and swelling at the insertion site of the catheter indicates inflammation; () clinical sepsis indicates () positive blood culture; **** (C) Peripheral artery catheters can be placed in the radial artery, but also in the femoral, axillary, brachial, and posterior carotid arteries. ﹤ inches in length. Low risk of infection Rarely related bloodstream infections. aDo not routinely change the catheter to prevent catheter-related staining. The frequency of catheter changes in children is not. b. Change the dressing when changing the catheter or when the dressing becomes wet, loose, or contaminated, or when the intubation site needs to be inspected. * (3) The peripheral arterial catheter c pressure monitoring equipment uses the disposable pressure sensor as much as possible. Change the sensor for reuse or single use every hour. When the sensor is changed, other components of the system (including pipes, continuous flushing equipment, flushing fluid, etc.) are also changed at the same time. * (4) Surgically implanted CVC (authentic CVC) and fully implanted intravascular devices: Surgically implanted CVC can be linked to a longer-term use of blood source infection rates lower than non-authentic CVC. * Should be as ducted as possible. If in doubt, CRBSI is made to blood culture and determine the clinical significance of bacterial cultivation results. Remind CRBSI that the target () blood culture multiple positives () from the catheter blood sample quantitative incubation gecfuml () paired blood culture positive () positive results time difference> h. * Elimination of the catheter indication () Purification of the channel mouth () There are severe complications such as endocarditis () Escherichia coli infection () Catheter results are not obvious or worse * The dialysis catheter is better placed in the jugular femoral vein than the subclavian to avoid veins narrow. Hemodialysis catheters are used for hemodialysis only, and no other alternatives are available for infusion of liquids, blood products or nutrient solutions (requires simultaneous hemodialysis infusion). Each hemodialysis requires multiple channels to contiguously store the high-risk elements. Catheter colonization rate is high and blood flow infection is characterized by severe deep infections such as infective endocarditis and sepsis. (5) Hemodialysis catheter-related staining * Nursing and prevention of local infection ① Strict aseptic operation Wash hands before and after operation. Cover the exposed end of the tube with a sterile medical towel and wrap the sandbag for tube placement on the same day for more than local hours of routine compression, and check for local bleeding. ② Check the puncture site for swelling and puncture. Use iodine disinfection to change the dressing once a day. The film dressing should be punctured at the core and cover up to four centimeters around the puncture site if there is pollution at any time. ③ The infusion pipeline system should be changed all the time when heparin locks, tee joints and infusion delay tubes are changed. * Nursing and connecting catheters are accessible: ① After each infusion, use a mlNS flushing tube and then seal the tube with uml heparin solution (psychological saline ml heparin stock solution ml). Withdraw the anterior heparin saline before each infusion and discard it, then use the mlNS flushing tube to connect the infusion. ② Try to collect blood with deep venous catheter as far as possible. The first is to prevent the tube from being blocked and the second to avoid affecting the inspection results. ③ Pay attention to prevent mechanical obstruction caused by twisting the catheter. ④ Control the accurate use of the three-lumen tube. Check the exposed scale of the tube to prevent the tube from coming out. * Care, accurate use of the lumen brown of the three-lumen tube, because the proximal cavity (proximal) cavity is the cavity for monitoring the pulse pressure. 2. When a thrombus occlusion occurs, try to suck the hemorrhoids outward without causing a hard inward injection to avoid vascular embolism. 2. Prevent unintentional extubation and fixation. Ensure that patients with anxiety properly restrain their hands with restraints. 2. Find out that the cause outside the pipe is relieved by the fever and the doctor is related to the catheter. * Nursing of indwelling gastric tube * The goal of indwelling gastric tube is to provide nutrients and heat for patients who are fainted or unable to pass the mouth. The conventional indwelling gastric tube is used for gastrointestinal decompression. Gastrointestinal decompression can reduce the pain during surgery and help the anastomosis return, reduce the suffering of patients, restore gastrointestinal function, and observe the nature of gastrointestinal contents to assist diagnosis and treatment. * The goal of gastrointestinal decompression is gastrointestinal perforation who reduces the content of gastrointestinal tract into the abdominal cavity and intestinal obstruction to reduce abdominal contraction and withdraw gas and liquid from the proximal end of the obstruction to reduce the pressure on the intestinal wall After bowel preparation, the tension of the anastomosis can be reduced to promote healing and relieve gastrointestinal gas contraction, which is conducive to the exposure of the surgical field during abdominal surgery. * Nursing sink point control intubation indications (note for patients with increased intracranial pressure) Insert appropriate and fixed to prevent disengagement, connection, ineffective drainage, and gastric tube access to do a good job of disease observation and documentation * Change of gastric tube Permanent placement of gastric tube The popular tube is replaced once a week with a silicone tube for ~ days * causing the elements of nasal feeding aspiration. Extracranial, unrecognized, cerebrovascular accident or tracheotomy cough may cause gastric tube changes and add the possibility of aspiration. Nasal feeding may cause too fast Large amount of gastric residual intestinal dysfunction, delayed gastric emptying *, aspiration of nursing bed head, withdrawing the gastric tube on time to check for retention patients, and response to gastrointestinal decompression. Pulmonary infection, gastrointestinal bleeding, electrolyte, acid-base balance disorders Poor drainage * Extubation indicates gastrointestinal drainage, reduces bowel crawling, restores drainage, and does not require intestinal nutrients. * After extubation, clean the nostril and cut the facial tape traces to see if there are signs of the abdomen and the environment of the abdomen. How can Fuerkai stomach tubes be placed in special patients? Patients with deep fainting Unclear, anxious patients Indwelling intubation or tracheostomy tube depth of gastric tube insertion? * Nursing gastrointestinal tube care After inserting the gastric tube, the doctor auscultates the gastric tube and inserts it into the stomach. The gastric tube is fixed and secured to prevent prolapse. Those with gastrointestinal decompression should observe and record the amount and color of the drainage fluid. Nasal feeders who are connected to the pipeline can withdraw the stomach contents on time to assess the patient's digestive ability. * Care catheter indwelling catheter replacement time? Bladder scour? How to prevent the problem of urinary infection? * Research on catheter replacement time for indwelling patients. Clinical question: What is the best interval between catheter changes? In the literature, the life expectancy of the silicone tube is at most weekly, and there is a large difference in the time when the urinary catheter is blocked. The pH of the patient's urine is the main factor that affects the proliferation of microorganisms and the precipitation of urine. The probability is higher than those whose urine pH is less than that. * Research on catheter replacement time for indwelling patients. Clinical question: What is the best interval between catheter changes? Found: Patients with indwelling catheters can be divided into two types of high-risk obstructed (PH) and non-obstructed (PH) patients according to the pH of their urine. The optimal interval for changing catheters is weekly non-obstructed patients. The optimal interval between catheters is week. * Research on catheter replacement time for indwelling patients. Clinical question: What is the best interval between catheter changes? Promote to clinical practice: During the clinical nursing process, the pH value of urine of indwelling catheter patients should be dynamically monitored, and the patients should be classified according to the urine pH value. The time to change the catheter for high-risk obstructed patients is weekly for non-blocked patients. The interval between urinary tubes is weekly or longer. * Care of Indwelling Catheter After indwelling the catheter, if there is no urination, check the reason first and then inform the doctor. Check and record the hourly urine output and color, and inform the doctor if there is any. Prevent urine infection. * Urine output: urinary volume: reflects renal net perfusion flow (target of excellent renal net perfusion: mdash urine volume: mlkgh) One of the goals of shock correction: gemlkgh or urine volume mlhmlhr: ① higher than the Shen mdash declares renal vasoconstriction, blood Insufficient capacity ② Lighter than mdash may have acute renal failure * Methods to prevent urine infection) Strict control of urinary catheterization compliance: The urine output must be measured on time and accurately to closely observe the urine of incontinent patients with cardiorenal and renal dysfunction or fainting in patients with fainting Obstruction of neurogenic bladder function obstruction and urinary retention are urgent urological procedures. ) Strict adherence to the aseptic technique of catheterization: Female patients who use a disposable sterile catheter for urethral catheterization should perform a severe aseptic procedure before flushing the vulva during the catheterization. * Methods to prevent urinary infection) Avoid damage to the urethral mucosa during urinary catheterization: The indwelling catheter should be properly fixed to prevent the urethral mucosa from being damaged due to sliding. ) Sterile form of indwelling urinary catheter drainage: the urine storage bag is lower than the bladder to prevent urine from flowing backward and the urine infection urine storage bag is changed once a day. * Methods to prevent urinary infection) Remove the indwelling urinary catheter as soon as possible when the condition is agreed. Once urinary infection (when the number of bacteria> cfuml) occurs, the urinary catheter should be removed immediately to avoid further infection. * UTI diagnosis standard (foreign) Urinary tract infection ①Mid-term urinary culture positive (type of bacteria) ②Bacterial count: cfu ml ③Clinical symptoms are not importantPrevention ofhospitalacquiredinfectionsApracticalguide, ndedition * UTI diagnosis standard (domestic) ①symptomatic urinary tract infection Road infection ② Asymptomatic bacteriuria ③ Other urinary infections (including kidney, peri-kidney, ureter, bladder, and urinary tract infections) () Department of Medical Affairs, Ministry of Health () Institute of Infectious Disease Management, Chinese Hospital * Bacteriuria indwelling catheterization patients The incidence of bacteriuria per day is ~. Common urinary pathogens are Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. Yuan Tao ’s bacterial membrane composition is taken from the Urinary System Infections Foreign Medical Urology Volume, (): * Bacteriuria urethral catheter-induced bacteriuria has a history ① bacteria around the urethra and perineum ② contaminated urine collection bag or urine collection Dismantled bacteria ③ Bacterial infection caused by urinary system when scouring, draining or emptying the urine collection bag. Yuan Tao's bacterial membrane constitutes a urinary system infection. Foreign medical urinary system volume, (): * Catheter-related urinary tract infection (CRUTI) occurs The rate of single short-term catheterization is ~% indwelling catheterization days or more.% Closed catheterization% In short, the longer the indwelling time, the greater the incidence of CRUTI. * Types of components into which the catheter is placed. The duration of the catheter should be eliminated once the clinical environment has eased. The quality of sterile catheters, closed drainage systems, drainage bags, etc. Weak, postpartum * EtiologyEscherichia coli, Klebsiella, Proteus, Enterococcus, Pseudomonas, Enterobacter, Serratia Candida (now known as Candida) * For recent (every week ) Those who have history of endoscopic examination or indwelling catheterization: urine cultured gram-positive cocci concentration gecfuml, urine cultured gram-positive bacteria concentration gecfuml, should be regarded as urinary tract infection. (Ministry of Health) Urine cultivation * The endogenous source of infection is mostly the intestine. The general flora is asymptomatic bacteriuria as exogenous ① ~ pathogenic bacteria come from the urine collection system and urine bag. This infection is happening within ~ h. ② Reproductive tract and surgical infection of menstrual blood caused urinary tract infections. ③ Use of incompletely sterilized cystoscope, urinary catheter, scouring fluid and disinfectant. ④ The hands of medical staff. * The urinary catheter system prevents the addition of urine specimen bottles in the drainage tube. Catheter and urine collection system contaminated urine backflow stomatal drip cavity one-way valve * CRUTI prognosis in most cases of CRUTI clinically benign. All patients can be cured naturally after the catheter is removed without any clinical symptoms. Continuous CRUTI in high-risk patients can cause prostatitis, epididymitis, cystitis, pyelonephritis, and Gram-positive bacteremia. In addition to indwelling catheterization, patients who need catheterization can choose other catheterization methods. Drainage: Urinary incontinence in male patients with impaired urination reflex and no urinary obstruction. Intrapubic catheterization: Interventional catheterization in patients with urology and gynecological surgery: Patients with impaired bladder emptying * Prevent catheter correlation The urine infection method (WHO) proves invalid, proves the invalid catheter duration, prevents the use of antibiotics, uses sterile technique to intubate psychological saline or antibiotics to flush the bladder, maintains a sterile closed drainage drainage bag, and inserts antibiotics into the urinary catheter. The antibiotics are applied daily. Agent cleaning perineal PreventionofhospitalacquiredinfectionsApracticalguide, ndedition * Choice of indwelling urinary tube selection of urinary tube materialSilicone, latex and the size of the lumens of the two inclusions should be selected as small as possible and the catheter suitable for patients can be coated with silver Silver oxide catheter can delay the occurrence of bacteriuria in patients with short-term use. The result is a silveralloy-coated catheter. It is best to use a latex or single-lumen silicone catheter for indwelling. Urinary patients often use dual-lumen balloon catheters for bladder flushing or dripping drugs. Catheter infection control measures and links a closed sterile drainage system () catheter system cuts and at the adjacent drainage bag. If it is necessary to open and wash the hands before and after opening and disinfect the adjoining place with alcohol cotton balls () The urine collection bag is generally changed with the urinary tube, or it is being changed in the following environment: Damaged or leaking urine deposits, accumulated urine bag smells * prevent and control catheterization The method of tube infection is connected to the closed sterile drainage system (). Urine tube replacement Do not change the indwelling urinary tube blockage or sediment when there is a period of time. Change the popular urinary tube once a week. If the urine pH is less than once a month, change the silicone urine tube. If the urine pH is greater than once every two weeks, change it. * To prevent and control the infection of urinary catheters, connect the closed sterile drainage system (), empty the urine bag, wash your hands before and after emptying, wear disposable gloves, and change the gloves before and after emptying. Dry retention * Methods to prevent and control urinary tract infections. Scouring should be performed strictly in accordance with aseptic technique. Unless obstruction is foreseen or suspected, avoid scouring (eg, bleeding may occur after prostate or bladder surgery). If it is possible that the ureter itself may cause blockages, then Changing the urinary tube and continuous bladder flushing should not be used as a conventional infection prevention method. * Methods to prevent and control urinary catheter infection. Connect urine flow. Lida avoid urinary tubes and collection pipes. Knot urine bags. * Methods for preventing and controlling urinary catheter infection Specimen collection () Collection of a small number of novel urine specimens First empty the urine bag, then clamp the urine bag tube for half an hour to sterilize the urine tube, and then use a sterile needle and needle to extract the urine ( ) Collection of a large number of urine specimens collected from a drainage bag using a sterile technique * Prevention and control of urinary catheter infection Daily care Strengthen perineal care And after washing and scrubbing perineal urethra extubation communicable and non-infected patients with indwelling catheter should not be placed as soon as possible so as not to burst is adjacent beds infection. * Category I: Required (Article) Class II: Best Adopted (Article) Class III: Considerable (Article) US CDC Prevents Restraint CRUTI * Class I Required () requires operators to be accurate Control of urinary catheterization and nursing techniques () Place the catheter when needed () Emphasize hand washing and disinfection () Place the catheter with sterile techniques and instruments () Properly fix the catheter () Maintain a closed sterile drainage system () Aseptic technique to obtain urine specimens () Linked to urinary Lida * Ⅱ Best to adopt () Urinary catheter care for medical personnel on schedule () Use the smallest caliber and suitable urinary catheter () Avoid guide Urinary scouring (unless it is necessary to prevent or relieve urinary catheter obstruction) () Do not take care of the urethral opening daily with polyvinylpyrrolidone iodine sterilization or panyu water cleaning () Do not change catheters casually * Class III should be considered ( ) Other indwelling techniques should be considered before indwelling the catheter. () Closed sterile drainage system should be changed in time. () Indwelling catheters should be properly isolated from infected patients and non-infectious patients. () Avoid unnecessary Routine bacteriological monitoring of urine * Thankyou! * Nursing guide for artificial airways Prevent fixed secure link detached airway smooth to prevent plugging seasonal adjustment to prevent respiratory tract infection bladder pressure strengthen psychological care. * Nursing of ventricle drainage tube: The tooth opening of the drainage tube needs to be higher than the plane of the lateral ventricle ~ cm. Drainage speed and volume: In the late postoperative period, the drainage bottle should be properly elevated to control the drainage speed to prevent excessive and excessive drainage from causing a sudden drop in intracranial pressure. It is advisable not to exceed ml per day. * The care of the ventricle drainage tube connects the drainage Lida. Observe and record the color, quantity and character of cerebrospinal fluid. Strictly adhere to aseptic standards. Change the drainage bottle on time every day. Extubation: Ventricular drainage generally does not span ~ days. The closed tube was tried on the day before extubation. * After the nursing of the subdural hematoma drainage tube, the patient should be placed in the supine position or the head-to-foot position. The drainage bag should be cm below the wound cavity. The powerful dehydrating agent for postoperative qi is not harsh for water intake. The drainage tube was removed on the third day after surgery. * Nursing of the pleural cavity closed drainage tube is tightly closed. Care of aseptic operation of the connected drainage tube is close to observe the changes in the condition. * Care of the closed drainage tube of the thoracic cavity is closed at any time. No drop water sealed bottle, long glass tube is submerged in the water ~ cm, and it is always connected to the curved drainage tube. It is covered with oil gauze and tightly moved to transfer the patient or change the drainage bottle. Double-sink clamped drainage tube is needed. Pinch the skin around the mouth with Vaseline gauze to seal the mouth. * Care of closed chest drainage tube. Strict aseptic operation to prevent infectious drainage. Disassembly should be connected to the sterile dressing at the chest drainage port. The liquid level of the clean and dry water seal bottle is lower than the drainage tube chest outlet plane cm. The drainage bottle is changed on time every day. And strictly aseptic operation. * Content on the label :: The pole of the arrow should be flush with the liquid level when labeling. * The nursing connection of the closed chest drainage tube drains Lida. If the patient's blood pressure is stable, the patient should adopt a semi-recumbent position to facilitate drainage and the patient should encourage his cough and Deep breathing activity promotes the discharge of gas and fluid in the chest cavity to prevent the lung from expanding, preventing the drainage tube from folding, twisting, or being compressed. Squeeze the drainage tube close to the dark place on time every hour to prevent the lumen from being blocked by clots or pus. Squeeze it once. * Nursing of closed drainage tube of chest Thoroughly observe the condition of the vital signs. When patients with hemothorax are drained, they should closely observe the changes of vital signs, observe the fluctuation of the water column, and observe the color, characteristics and quantity of the drainage fluid. *
The National Nurse Qualification Test is a test that evaluates whether applicants for nursing qualifications have the necessary nursing professional knowledge and work ability to practice, and implements the same national test track system. Passing the nurse qualification test is a prerequisite for the employment of skill positions in the unit. The annual nurse qualification test is coming. Are you ready?