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Specialist nursing routine_ant library

Updated: 2019-09-17

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1 Specialized Nursing Routine Revised I. Medical Nursing Routine Hypertension Nursing Routine I. Concept: Hypertension is a clinical analysis of secondary circulation with increased arterial pressure. Second, clinical characteristics: increased arterial blood pressure, late stage may be associated with vessel, heart net, brain and kidney net and other net damage. 3. Medical policy: reduce blood pressure, prevent complications, and reduce morbidity. 4. Nursing policy: (1) can adjust emotions (2) blood pressure control is in the right category (3) discomfort is relieved 5. care problems (1) program intolerance, related to permanent hypertension sincere function decline (2) changes in comfort Related to headache and dizziness to increase blood pressure 6. Specialist assessment (1) Whether the blood pressure can be maintained at a normal level, systolic blood pressure ≤18.6kpa, diastolic blood pressure ≤12kpa. (2) The patient's response to the program, whether palpitations can be presented after the program, increased systolic blood pressure, hard breathing, weakness, etc. (3) Whether physical strength can be easily restored after rest, and whether headache and dizziness can be reduced. 7. Nursing methods (1) Routine nursing 1. Psychological nursing cares for the patient, understands the patient's thinking, living and working environment, eliminates the patient's horror and indecent feelings about the disease, and assists the patient to find possible factors that cause hypertension In order to actively adopt control measures. 2. Program guidance determines the patient's program volume according to the stage of hypertension, but it must be based on a gradual and dynamic connection. (Basic classification of hypertension on page P161) Issue I Difficult physical programs, but you must avoid sinking physical programs. The second period is to rest properly and avoid more powerful programs. Phase III bed rest 3. Diet low in salt, light, low cholesterol and low animal fat food. (B) headache, dizziness care 1, connection quiet, try to reduce 2, as much as possible, raise the bedside to make the patient comfortable. 3. Give proper antihypertensive medicine and repressive agent according to doctor's advice. 4. Patients should be instructed not to get up too fast during the medication, and not to act too fast to prevent dizziness and increased sedimentation. 5. Be light when doing all kinds of exercises to avoid adding headaches. (3) Inspection of the condition 1. Observe the changes in blood pressure and heart rate, measure body sinking regularly, and recognize the line and closely check the environment such as headache, dizziness, and the presence of neurological symptoms such as convulsions and fainting. If so, notify the doctor in a timely manner. Eighth, health education (a) should be quiet and comfortable, mild light to avoid music stimulation, room temperature should not be too low. (B) dietary guidance 1. The diet is based on low salt and low fat, and eat less foods containing high cholesterol and the internal net and egg yolk of animals. 2. Obese people should reduce their daily calorie intake to reduce body sinking. 3. Eat more potassium-containing foods, such as vegetables and fruits. Do not exceed 5 grams of daily salt. 4. Quit smoking and drinking. (3) Daily programs 21. Avoid severe excessive work and fatigue, and get enough sleep. 2. Place rest and programs in a reasonable manner according to the blood pressure environment, and develop a planned moderate amount of activity, such as walking every night, playing Tai Chi, etc., to get a good rest. (4) Psychological guidance links are quiet, avoiding emotional impulses and excessive seriousness and anxiety. When you are in trouble, you should be relieved when there is a lot of pressure, such as talking to your partner and relatives to maintain a constant blood pressure. (V) Common medical treatment methods 1. Guide patients to take medicine for treatment and set up a long-term treatment plan. They can not increase or decrease or stop taking antihypertensive drugs according to their own feelings. Only treatment can control blood pressure and reduce complications. 2. Prompt the patient to pay attention to the adverse reaction of the drug and learn to observe and care. Nine, high-assistance emergency inspection and nursing of hypertension emergency 1, inspection (1) Closely observe the changes in the condition, if the patient shows a sharp rise in blood pressure, severe headache, nausea, restlessness, dizziness, dizziness, convulsions, fainting, etc. Symptoms, speak to the doctor immediately. (2) Closely observe the patient's pupils and cognitive changes, measure vital signs every 15-30 minutes and record. 2. Disposal: (1) Absolutely rest in bed, place the patient in a semi-recumbent position, raise the head slightly, and reduce movement and transfer of the patient. (2) Continuously inhale 4-5L / min. (3) Establish an intravenous line immediately, and give fast-acting antihypertensive drugs, anticoagulants and dehydrating agents, etc. according to the doctor's advice, such as intravenous drip of sodium nitroprusside, you should pay attention to avoid light and the speed of infusion. (4) Provisional care. Patients should add a bed rail to prevent falling when they are unclear. When convulsions occur, use a tooth pad to place between the upper and lower molars to prevent biting of the tongue, tongue, and coronary heart disease. Nursing routine 1. Concept refers to coronary arteries Atherosclerosis softens, narrows and occludes the vascular cavity, leading to myocardial ischemia and hypoxia, and even bad heart disease caused by coronary heart disease. It is known as coronary artery heart disease along with coronary functional changes (spasm). , Also known as ischemic heart disease. Second, the cause of atherosclerosis caused by a variety of reasons, it is currently believed that the secondary and the following factors are related 1. Disturbance of lipids and lipid metabolism is the main predictor of coronary heart disease. There is a close relationship between the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) and the nature of coronary heart disease affairs. For every 1% increase in the level of LDLC, 2-3% of patients with coronary heart disease are added. Triglyceride (TG) is a predictor of coronary heart disease, often accompanied by low HDLC and very high glucose tolerance, the latter two are also coronary heart disease. Elements. 2. Hypertension Hypertension is closely related to the composition and growth of coronary atherosclerosis. Systolic blood pressure is more predictive of coronary heart disease than diastolic blood pressure. 3. Diabetic coronary heart disease is the primary cause of juvenile diabetic patients. 4. Smoking and smoking can cause poor oxygen content in the arterial wall and promote the formation of atherosclerosis. 5. Obesity Obese people (10% are overweight, 20% are moderate, and 30% are moderately obese) are susceptible to the disease. 6. The incidence of coronary heart disease is higher in those with poor activities and poor programs, and the blood lipids of those who train are often lower. 7. Family history 8. Other three. Clinical indications 1. Angina pectoris type: expressed as a feeling of squeezing behind the sternum, constriction, and accompanied by anxiety, lasting 3 to 5 minutes, often diverging to the left arm, shoulder The lower arm, the lower jaw, the throat, and the back can also be radiated to the left arm. Sometimes these areas can be affected without affecting the posterior sternum. It is said to use three forces, emotional impulses, cold, full meals, etc. to add myocardial oxygen consumption. For labor angina pectoris, rest and relief. Sometimes angina pectoris is atypical and can be expressed as tightness, syncope, weakness, belching, especially in the elderly. 2. Myocardial infarction type: There are prodromal symptoms at the mercy of the week before the infarction, such as angina pectoris during resting and light physical exertion, accompanied by relatively discomfort and lassitude. When infarcted, it was expressed as persistent violent sensation, stuffiness, and even sorrow-like pain and sorrow. It was located behind the sternum, and often spread to the entire chest, with the left side as the sink. Departmental patients can radiate down the ulnar side of the left arm, causing tingling sensations in the left wrist, palms and fingers. Departmental patients can radiate to the upper limbs, shoulders, neck, and jaw, with the left side as the slave. The painful and sad parts are divided from the previous angina pectoris, but they last longer, the pain and sadness are deeper, and the rest and inability to ease can not be relieved. Sometimes expressed as pain in the upper abdomen, it is easy to take a mix of abdominal diseases. Accompanied by low fever, restlessness, sweating and night sweats, nausea, palpitations, dizziness, extreme fatigue, hard breathing, dysphoria, lasting more than 30 minutes, often up to several hours. Find out that this environment should be seen immediately. 3. Asymptomatic myocardial ischemia (current coronary heart disease): Many patients have a common coronary occlusion but have not experienced angina, and some patients have not felt angina when they are undergoing myocardial infarction. 4. Heart failure and heart rhythm abnormalities: Department of patients with angina pectoris, the current disease is common, myocardial fibrosis is widespread, angina pectoris is gradually reduced to disappear, but it shows a heart failure. 5. Sudden type: refers to the unpredictable suddenness caused by coronary heart disease, which is caused by sudden cardiac arrest within the current 6 hours of acute symptoms. Fourth, secondary care issues 1. Pain and sorrow related to myocardial ischemia. 2. The program's stamina and angina pectoris affect the program. 3. Myocardial ischemia in coronary heart disease is associated with arrhythmia due to myocardial disease. 4. Edema and hard breathing are related to heart failure at the late stage of coronary heart disease. V. Nursing methods 1. When you have angina pectoris, you must stay in bed absolutely, watch closely, and be quiet. 2. Understand the pathological morphology, eliminate bad emotions, avoid all kinds of inducements, and strengthen the care of subsistence. 3. The angina pectoris should be curbed immediately when it is done, and at the same time, it will be taken under the tongue. Look for adverse reactions to anti-angina drugs. Such as nitrous acid drugs often have headache, dizziness, flushing, dizziness and other signs of vasodilation. This drug is susceptible to orthostatic hypotension. 4. Give low-fat, low-cholesterol, high-vitamin, easy-to-digest light foods, small meals, and not over-satisfaction. No smoking. 5. The room temperature should not be too cold or too hot, because cold heat will add heart load, and angina pectoris is easy to happen. 6. Give oxygen inhalation, 3-4 liters / minute 7. Closely check the following items: (1) Heart rate, heart rate, painful and sad area, nature, duration, and whether it can be removed after medication. (2) Inspections should be strengthened at night, often due to angina pectoris at night and early in the morning. (3) The nature of pain or sorrow changes or the frequency, angina, and angina pectoris increase.

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