带状疱疹三区终极版概要课件

护理临床查房 Clinical nursing ward round 国际住院部二科三区 I.M.C Inpatient Dept.2 Ward.3 人员介绍 会诊医师 consulting staff 查房目的查房目的 Round GoalsRound Goals 掌握带状疱疹的护理。 熟悉带状疱疹的病因、临 床表现及治疗方法。 Acquire the nursingAcquire the nursing ofof VZV VZV. . Be familiar with the the risk factors,clinical manifestation and treatment of VZV. VZV. 查房目的查房目的 Round GoalsRound Goals l提升护理人员的英文水平 和学习兴趣 Promote the English level and enhance the interest of nurses in English learning. Part 1Part 1 inquiryinquiry 问诊问诊 病例报告病例报告 Case ReportCase Report 阳吉菊 女 69岁 D: Hello ,Mrs Yang, my name is Dr Du,I am a doctor of Internal Medicine.I will be looking after you,how can I help you? P: Yes please! D: How old are you? P: 69 病例报告病例报告 Case ReportCase Report 现病史 l患者主因阵发头痛 1年，加重2天。 l于4月10日为进一步 检 查收入我科。 Present History D: Please tell me whats wrong with you? P: I have had bad headache for 2 days. D: Have you had this pain before? P: Come in waves for a year. 病例报告病例报告 Case ReportCase Report 现病史 l无明显诱因阵发右侧 头痛，为针刺样。 l无头晕、呕吐、视物 模糊等伴随症状,睡 眠不佳。 Present History D: Please point to where you feel pain? P: On my right side. D: Tell me what the pain is like? P: stabbing，it kept me awake. D: Do you have dizziness or vomit? P: No. D: Do you have blurring of vision? P: No. 病例报告病例报告 Case ReportCase Report 现病史 l头颅CT无出血灶。 Present History D: Have you had any tests recently? P: I had a head CT and no hemorrhage. 病例报告病例报告 Case ReportCase Report 既往史 l 有腔隙性脑梗死病史 l 否认冠心病、高血压、 糖尿病史 l 否认药物过敏史 l 预防接种史不详 Previous History D: Do you have any existing medical health problem? P: Lacunar infarction. D: Do you have any allergies? P: No,not that I know of D: Are your vaccinations current? P: I am not sure. 病例报告病例报告 Case ReportCase Report 家族史 l家族中无类似病史， 否认家族遗传病史。 Family History D: Do you have a family history of health problems? P: No 病例报告病例报告 Case ReportCase Report 个人史 l生于原籍 l否认疫区居住史 l否认毒物接触史, l无烟酒等不良嗜好 Personal History D: Where are you lived in? P: Where I was born. D: Is there anything you need to tell me that you think will be useful? P: No. 病例报告病例报告 Case ReportCase Report D：你还有什么问题需要 问我吗？ P：现在没有。 D：如果你有什么问题， 你可以问护士，如果 她不知道怎么办，她 会找知道的人来帮助 你。 D: Are there any questions you would like to ask me? P: No,not right now. D: If you have any problems,please ask the nurse,if she cant help you,she will find someone who can. 病例报告病例报告 Case ReportCase Report P：好的，非常感谢。 D：不客气，再见。 P: Ok,thanks very much. D: Youre welcome,see you later. 经查阅病历、详细询问 病史及查体后指示：患者 目前头痛部位以右侧头皮 皮疹处为著，无颅内高压 症状及体征，建议联系皮 肤科专家会诊进一步明确 ，密切观察病情。 Reviewing the case, detailed inquiring medical history and examing , it is indicated that the patient headache location mainly at the right scalp rash, havet symptoms and signs of intracranial hypertension. Recommended contact dermatologist to diagose and obseve patients condition. 病例报告病例报告 Case ReportCase Report Part 2Part 2 group consultation group consultation 会诊会诊 会诊 group consultationgroup consultation 查体：右侧头皮、耳后、颈 部散在小片片状红斑、丘疹 ，其上散在水疱，部分破溃 渗出，触痛。诊断为带状疱 疹。 l外用 青鹏软膏 l口服 盐酸伐昔洛韦1g 3/日 维生素B1片20mg3/日 甲钴胺片500mg3/日 普瑞巴林胶囊75mg2/日 Dermatology consultation: cluster red papules on examination found that left back, a diagnosis of herpes zoster. External use: Qing peng ointment. Take orally: Three times a day galloway hydrochloric acid; Three times a day vitamin B1; Three times a day a piece of cobalt amine; Two times a day lyrica capsule. Part 3Part 3 Group discussion Group discussion 小组讨论小组讨论 带状疱疹是由水痘-带状疱疹病毒(varicella-zoster virus,VZV)引起的一种沿某一脊神经或颅神经单侧分布的 簇集性水疱和神经痛为特征的病毒性皮肤病。 Herpes zoster is caused by the varicella-zoster virus a along a spinal nerve or the distribution of the cranial nerve unilateral cluster blister and neuralgia of the viral skin diseases. 定义 Definition 诊断 Diagnosis 病变皮肤出现簇集成群水 疱，沿一侧周围神经呈带 状分布。 有明显的神经痛，伴局部 淋巴结肿大。 中间皮肤正常。 the blister along one side of the peripheral never on the attached skin. Has obvious neuralgia, with local lymph node enlargement. Middle normal skin. 诊断 Diagnosis 从水疱液中分离chu病毒或 检测VZV，HSV抗原或DNA是 鉴别诊断唯一可靠的方法。 Find the vzv、the HSV antigen or DNA is the only reliable reason for the diagnoise. 病因及发病机制 Etiology and pathogenesis VZV 呼吸道黏膜respiratory mucosa 血 液blood 颅神经的感觉神经 水痘 varicella 隐性感染inapparent infection 脊髓后根神经节 机体抵抗力下降 VZV被激活 沿感觉神经下行 支配区域的皮肤复制 水疱 blister 神经炎neuritis 典型表现General manifestation 前驱症状：轻度乏力、低热 、纳差等全身症状，患处皮 肤自觉灼热感或者神经痛， 触之有明显的痛觉敏感，持 续13天，亦可无前驱症状 即发疹。 Weak,low-grade fever,poor appetite,loucal burning heat sensation or neuralgia,obvious sense of pain last 1-3 days, before blister,also blister with no formanifestation. 典型表现General manifestation 好发部位：肋间神经、颈神 经、三叉神经和腰骶神经支 配区域。 Predilection:the skin govened by intercostal nerve,cervial nerve,trigeminal,lumbosacr al nerve. 典型表现General manifestation 出疹特点：首先出现潮红斑 ，很快出现粟粒至黄豆大小 的丘疹，簇状分布而不融合 ，继之迅速变为水疱，疱壁 紧张发亮，疱液澄清，外周 绕以红晕，各簇水疱群间皮 肤正常。 Red spot firstly, papule soon,and then the blister with circumambient flush. 典型表现General manifestation 皮损特点：沿某一周围神 经呈带状排列，多发生在 身体的一侧，一般不超过 正中线。 Zonation Injury along some of peripheral nerve, always one of the side of the body ,not cross the midline. 典型表现General manifestation 神经痛，可在发病前或伴随 皮损出现，老年患者常较为 剧烈。 病程一般23周，水疱干涸 、结痂脱落后留有暂时性淡 红斑或色素沉着。 Neuralgia before the blister or following the skin injury,especially the older. Course of the diease always 2-3 weeks, temporary erythema. 特殊表现 Special manifestation 眼带状疱疹 三叉神经眼支受累，眼睑红 肿，结膜充血，可累及角 膜形成溃疡性角膜炎，疼 痛剧烈。 herpes zoster ophthalmicus Eyelids red swollen、 conjunctival congestion and maybe the ulcerative keratitis with severe pain by suffering from the eye branch of trigeminal. 特殊表现 Special manifestation 耳带状疱疹 病毒侵犯面神经及听神经所 致，表现为外耳道或鼓膜疱 疹。可出现面瘫、耳痛及外 耳道疱疹三联症，称为 RamsayHunt综合征。 herpes zoster oticus 此患者即为此特殊类型！ 特殊表现 Special manifestation 带状疱疹后遗神经痛 带状疱疹常伴有神经痛， 在发疹前、发疹时以及皮 损痊愈后均可发生，但多 在皮损完全消退后或者1个 月内消失，少数患者神经 痛可持续超过1个月以上。 minority Neuralgia lasts more than 1 month. 特殊表现 Special manifestation 其他不典型带状疱疹 顿挫型；不全型； 大疱型 、出血性、坏疽型和泛发 型 ；播散型带状疱疹。 Others Forme fruste(only neuralgia);incomplete(red spot,papule);big blister;bleeding,gangrenous ,generalized and disseminated. 全身治疗 Systemic treatment 抗病毒治疗（尽早应用伐 昔洛韦） 止痛药 干扰素 皮质醇类激素 Antiviral therapy (use valaciclovir as early as possible) Painkiller Interferon Cortisol hormone 局部治疗 Local treatment 复方锌铜溶液或3%硼酸溶液作 局部湿敷，外用3%5%阿昔洛 韦霜，1%喷昔洛韦霜，干扰素 -2b涂布剂，0.5%酞丁安搽 剂等。 眼部带状疱疹可用3%阿昔洛韦 眼药水，0.5%碘苷液，干扰素 眼药水点眼，34次/d。 Wet packing with compound zinc copper solution, 3%5% Acyclovir 、1% Penciclovir、 -2b interferon 、 0.5% Ftibamzone applecations 3% Acyclovin eyedrop、 0.5% lodine glycosides liquid、interferon 3-4 times every day for the herpes zoster ophthalmicus 局部治疗 Local treatment 物理疗法：可用紫外线局 部照射，音频电疗法和氦 氖激光照射消炎止痛，缩 短病。 针刺疗法。 Naturopathy:irrradiate with ultraviolet rays,helium and nitrogen laster； audioferquency current therapy Acupuncture therapy 护理诊断 Nursing diagnosis 1.疼痛 2.舒适的改变 3.皮肤完整性受损 4.焦虑 Pain Comfort , altered Skin integrity , impaired Anxiety 护理措施 Nursing Intervention 诊断1:疼痛 -与疾病引起的神经痛 有关 护理措施 -遵医嘱给予镇痛剂 -做好心理护理，充分发挥 心理镇痛效应。 Pain related to the neuralgia Implementation -Give the analgesic as the doctors older -Psychological nursing 护理措施 Nursing Intervention 诊断2:舒适的改变 -与所患疾病引起疼痛及 体位受限有关 护理措施 1. 密切观察病情变化，取 舒适卧位。 2. 尽量保持病房安静，减 少不良刺激。 Comfort , altered -related to the pain and limited position Implementation -Observe the changes of illness closely, get the comfortable lying position -Reduce the pessimal stimulation 护理措施 Nursing Intervention 诊断3:皮肤完整性受损 -与疾病引起的水疱破裂 有关 Skin integrity , impaired - related to the blisters rupture 护理措施 Nursing Intervention Implementation -Antiphlogosis、arefaction mainly -No scratching,improve patient training,to prevent the spread of lesions. 护理措施 1.疱疹处以消炎、干燥为 主。 2.不要搔抓患处，加强患者 宣教，避免病灶扩散。 改英文部分 护理措施 Nursing Intervention 护理措施 3.泡液未破：阿昔洛韦乳 膏涂抹。 4.疱疹破溃后：双氧水、生 理盐水清洗，再用0.5%甲 硝唑液局部湿敷。 Implementation -Acyclovir applecations with the whole blister -Douche with hydrogen peroxide and normal saline、local wet packing with 0.5% metronidazole when rupture. 护理措施 Nursing Intervention 诊断4:焦虑 - 与担心疾病预后有 关。 Activity Intolerance - related to the illness prognosis 护理措施 Nursing Intervention 护理措施 1. 向病人及家属讲解 疾病相关知识、成功 治疗经验，增强战胜 疾病的信心。 2.宣传重视预防颈椎病 ，避免情绪波动，及 时开导患者，缓解颈 椎病的症状和预防复 发。 Implementation - introduce the information about the VZV and the successful treatment experiences to the patiences and the relatives. -diss