课件：胸外科护理查房最终版.ppt

Spontaneous Pneumothorax,Thoracic surgery nursing ward round,The speaker : Wuhan Polytechnic University,自发性气胸,Group division of labor,Case - 甄媛媛 Etiology and classification - 于广平 马莹 Clinical manifestations - 蒋娟 Auxiliary examination and- 桓秀山 刘严逸夫 Therapeutic principles Nursing measures - 毛雅琴 潘娟 王辉 Health education - 李飘飘 赵娟,CASE,Patient YuWeicheng male 17 years With pain at left chest and difficulty breathing , chest distress 10 days. Past medical history: Always body health , deny history of other serious diseases and drug allergy . History of present disease : Without any obvious cause , he felt pain at the left chest and difficulty breathing , chest distress 10 days ago . No fever , low head , cough , haemoptysis , lack of power , night sweat and so on . At first did not pay attention to these , but symptoms for no ease . A chest radiography showed that the left lung tissue compression by 85% . Physical examination : T 37.3 , P 96/min , R 20/min , BP 140/80 mmHg Intelligence clear , tracheal at the center of neck .The left breath sounds a little weak . Diagnostic examination : WBC 11.4 109 , N 8.05 , L 18.1 Admission diagnosis : Spontaneous Pneumothorax,病例,患者： 余炜成，男，17岁 左侧胸痛、胸闷伴呼吸困难10天。 既往史：既往体健，否认其他重大疾病病史及药物过敏史。 现病史：患者于10天前无明显诱因，自感左侧胸痛、胸闷，偶有呼吸困难，无发热、咳嗽、咳痰、咯血、心慌、乏力、盗汗、声嘶等不适。起初未予注意，症状持续无明显缓解，胸片检查，提示：左侧肺组织压缩85%左右。 体格检查： T 37.3 , P 96次/分 , R 20次/分 ,BP 140/83mmHg ,神智清楚，皮肤巩膜无黄染，气管居中，左侧呼吸音稍弱，未明显干湿罗音。 辅助检查： WBC 11.4 109 , N 8.05 , L 18.1 入院诊断： 左侧自发性气胸,Etiology and classification,病因及分类,THE SPEAKER : 于广平,The cause of spontaneous pneumothorax,Classification of one Spontaneous pneumothorax Trauma pneumothorax Artificial pneumothorax Classification of two Closed pneumothorax Open pneumothorax Tension pneumothorax,The cause of spontaneous pneumothorax,When a trigger causes alveolar pressure rise sharply, lesions of the lung and pleural rupture occurs, the pleural cavity is communicated with the air, airflow will flow into the thorax lead to the formation of spontaneous pneumothorax.,Clinical manifestations,临床表现与体征蒋娟,Clmical manifestations （临床表现）：,Sudden chest pain（突然发生胸痛），difficulty in breathing（呼吸困难），chest tightness(胸闷)， in severe cases irritability、profusely、cyanosis（严重者烦躁不安、大汗、紫绀）accelerated respiration（呼吸加快），pulse breakdown and even death（脉搏细数甚至死亡）。,Signs（体征）：,Fracheal shift to the contralateral（气管向健侧移位）。 Ipsilateral chest full（患侧胸部饱满）weakening or disappearance of resiratory motion（呼吸运动减弱或消失）。Percussion drum sound（叩诊呈鼓音），fremitus and decreased breath sound（语颤呼吸音减弱）。,11,Auxiliary examination,辅助检查,THE SPEAKER : 桓秀山,12,Auxiliary examination,1.X-ray 2.CT 3. Pleural cavity angiography 4. Thoracoscopic,13,Auxiliary examination,1. X-ray examination is the most reliable method of diagnosis of pneumothora Typical pneumothorax X-ray findings of the pneumothorax part through the brightness increase, no markings, the pulmonary hilar atrophy, higher density, and the edge of the visible hairline-like visceral pleura shadow; Contralateral lung compensatory emphysema, lung markings; Trachea with Concurrent pleural fluid or blood, fluid levels can be seen. mediastinal shift to the contralateral;,X线检查是诊断气胸最可靠的方法。 典型的气胸X线表现为气胸部分透亮度增加，无肺纹理，肺向肺门萎缩，密度增高，其边缘可见发线样脏层胸膜阴影； 健侧肺可有代偿性肺气肿，肺纹理增粗； 气管与纵隔可向健侧移位； 并发胸水或血液时，可见到液平面。,14,Auxiliary examination,2.CT Is more sensitive to the diagnosis of a small amount of gas in the pleural cavity Clearly shows a small amount of pneumothorax and lung tissue overlapping parts of the pneumothorax; Location, extent determine the pleural product gas; May found emphysema blister; Easy to identify the limitations of pneumothorax and lung bullae.,2.CT 对胸腔内少量气体的诊断较为敏感 可清晰地显示少量气胸和与肺组织重叠部位的气胸； 确定胸腔积气的位置、程度； 有可能发现肺气肿疱； 易于鉴别局限性气胸和肺大疱。,15,3.Pleural cavity angiography,This method can clear the pleural surface, easy to clear the cause of pneumothorax.When the lung compression area in 30% 40% when the contrast is appropriate, bulla is lobe profile within a single or multiple cystic low density shadow; a bubble spray performance for pleural phenomenon, especially when patients with cough, due to intrapulmonary pressure increases, this phenomenon is more obvious.,此方法可以明了胸膜表面的情况，易于明确气胸的病因。当肺压缩面积在30%40%时行造影为宜，肺大泡表现为肺叶轮廓之内单个或多个囊状低密度影；胸膜裂口表现为冒泡喷雾现象，特别是当患者咳嗽时，由于肺内压增高，此征象更为明显。,16,4.Thoracoscopic,Thoracoscopy can easily detect pneumothorax etiology, flexible operation, can reach the interlobar fissure, apex, hilar, almost no blind spots, observe the visceral pleura with no rips, pleura without bullae of lung and chest cavity with no adhesive joint.,胸腔镜可以较容易地发现气胸的病因，操作灵活，可达叶间裂、肺尖、肺门，几乎没有盲区，观察脏层胸膜有无裂口、胸膜下有无肺大泡及胸腔内有无粘连带。,17,Principles of treatment,治疗原则,18,Principles of treatment,1. Conservative treatment 2. Exhaust treatment 3. Operation treatment,19,1.Conservative treatment,Mainly applicable to the stability of a small amount of closed pneumothorax Specific methods: strict bedresanalgesic drugs. t ,oxygen ,bronchodilator .bronchospasm, granting the sedative and,主要适用稳定型小量闭合性气胸 具体方法：严格卧床休息、给氧，支气 管痉挛者使用支气管扩张剂，酌情给予镇静镇痛等药物。,20,2.Exhaust treatment,1.张力性气胸病情危急可行紧急排气 2. 胸腔穿刺抽气适用小量气胸，呼困较轻，心肺功能尚好的闭合性气胸。 3.胸腔闭式引流适用不稳定气胸，呼困明显，交货张气胸，反复发生气胸的病人,Tension pneumothorax in critical condition feasible emergency exhaust 2 pleural puncture exhaust apply a small amount of pneumothorax, respiratory difficulties lighter, the closed pneumothorax heart and lung function is still good. Closed thoracic drainage unstable pneumothorax applicable call trapped obvious, delivery Zhang pneumothorax, recurrent pneumothorax patients,21,Operation treatment,Thoracoscopic and Thoracotomy,22,胸腔镜 通过二至三个“钥匙孔”，在电视影像监视辅助下完成过去由传统开胸进行的操作手术。其本质是用“腔镜”做手术，相对于传统的开刀手术具有创伤小、恢复快、住院时间短等技术特点,Thoracoscopic Complete operating traditional thoracotomy surgery in the past two to three “key hole“ in the TV image monitoring aid. By its very nature is laparoscopic“ surgery, relative to traditional open surgery with less trauma, recovery faster, shorter hospital stay andother technical features,23,外科手术治疗 手术的目的是结扎或切除肺大疱、或胸膜修补、或对壁层胸膜切除或摩擦促使其与脏层胸膜粘连，防止气胸复发。,Surgical treatment The purpose of surgical ligation or resection of bullae, or pleural repair or resection or friction parietal pleura procure its visceral pleural adhesions, and to prevent the recurrence of pneumothorax.,24,Nursing diagnosis and measures,THE SPEAKER : 王辉、毛雅琴、潘娟,2019/9/1,25,可编辑,护理诊断,Nursing diagnosis,pain at chest),The risk of infection,Activities without endurance,nutrition altered,knowledge deficit,护理措施,Nursing measures,1.Impaired Gas exchange,Measures ： a.Observe patients Temperature， breathing， pulse ， blood pressure b.Observe patients bony thorax movement and the rang of the respiratory notion,and auscultation patients breathing sound c.Keep the thoracic closed drainage system fixed,be closed tightly and be unobstructed.(保持闭式引流装置固定、密闭等） d.Observe the fluctuation of the water column,color e.To change the thoracic regularity,and prevent retyograde infection,1 .Positive pressure continuous exhaust method.,2.Continues the negative pressure exhaust method.,Drainage bottle,The risk of infection,1.To keep respiratory tract unobstructed promptly eliminate sputum 2.Do oral care, prevent secondary infection 3.Keep closed drainage system sterile,Activities without endurance,a. Complete bed rest,take half-clinostatism. b. Ask the patient to avoid to hold his breath and to cough intensity. c. Giving low flow oxygen.,Malnutrition,1.Give high protein 2.High vitamin 3.Light easy to digest food,Nursing analysis,problems,Nursing key points,Thoracic closed drainage of nursing （胸腔闭式引流的护理）,purpose：1. The discharge pneumatosis, effusion, hemorrhage 2. Promote lung complex zhang 3. Keep mediastinal normal position The location of the catheter: 1. The gas with side second intercostal clavicle middle 2. Liquid with side 7, 8 rib clearance of axillary line and axillary line place after 3. The pus by means of x line in the vomica lowest place Nursing key points,胸腔闭式引流的护理,39,Health Education,THE PEAKER : 李飘飘、赵娟,40,1. The cause ,type and cure of Pneumothorax 2. The purpose of thoracic closed drainage and attention 3. the purpose of starting exercise early 4. Lung function were exercise purpose and method 5. diet for discovery 6. Convalescence rehabilitation activities of the method and the matters needing attention 7. discharge guidance,41,Early activities of the methods and significance,promote the whole body function recovery Promote the blood circulation Promote gastrointestinal peristalsis Promote urination function recovery,42,Methods:,1.deep breath, sputum, assist keel over, take back, and smooth blood pressure after take half decubitus; 2. The next day helped by the sides of the bed, on the bed can be activities during the upper limbs, and flexion and exercise; 3. 4 days later gradually off the bed activities, first in bedside stand, and gradually in the indoor walk slowly, and discretionary go out for a walk 4.seriously ill weak and complications and activity restriction patients cant get up early, but still need to adhere to the bed activities.,Lung function were exercise purpose and method,1).lung function exercise to let the lung lobe full expansion, to increase alveolar surface tension, increase the vital capacity, improve lung function 2). cough training prevent pulmonary infection,Diet,be