护理查房 鼻中隔偏曲ppt医学课件.ppt

护理查房鼻中隔偏曲,1,主要内容,病 例 导 入,相 关 专 业 知 识,护 理 诊 断 及 措 施,健 康 教 育,4,1,2,3,2,.,病史资料,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,3,.,现病史,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,4,相关病史,既往史 个人史 家族史,5,体格检查,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,6,专科检查,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,7,辅助检查,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,8,影像学检查,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,9,解剖,鼻中隔是指把鼻腔分成左右两部分的组织。 由骨、软骨和黏膜构成。 衬以粘膜和皮肤。鼻中隔分其为左右二腔，前方经鼻孔通外界，后方经鼻后孔通咽喉。每侧鼻腔可分为鼻前庭和固有鼻腔，二者以鼻阀为界，鼻前庭是指由鼻翼所围成的扩大的空间，内面衬以皮肤，生有鼻毛，有滞留吸附灰尘的作用。 鼻中隔由筛骨垂直板、犁骨和鼻中隔软骨共同构成，多偏向一侧，偏向左侧常见。其前下部的粘膜内有丰富的血管吻合从，约九成的鼻出血发生于此。临床上叫易出血区即Little区或 Kiesselbach区。,10,相关专业知识,鼻中隔偏曲：（deviation of nasal septum） 是指鼻中隔偏向一侧或两侧，或局部形成突起，并引起鼻腔功能障碍和临床症状者,11,Hot Tip,How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides., Image information in product Image : Note to customers : This image has been licensed to be used within this PowerPoint template only. You may not extract the image for any other use.,12,按偏曲的形状，鼻中隔偏曲可分为：,按偏曲的方向分类，有纵偏、横偏和斜偏。按偏曲的部位分类，可分为高位、低位、前段、后段偏曲。,“C”形偏曲：鼻中隔凸向一侧，常仅限于软骨部，也可为软骨和筛骨正中板同时向一侧偏曲。n here,“S”形偏曲：筛骨正中板偏向一侧，而中隔软骨偏向对侧,嵴突：鼻中隔上的长条形隆起，自前下向后上走行。多位于上颌骨鼻嵴或犁骨上缘。有的嵴突为软骨脱位重叠所造成。,棘突(距状突)：为局限性尖锐突起，常位于中隔软骨与骨部接合处。,A,B,C,D,13,.,14,病因,(1)肿瘤或异物压迫鼻中隔，也可发生本病。 (2)鼻中隔之骨和软骨发育不均衡以至畸形，畸形易发生于各部接合处。这也是本病发生的主要原因。 (3)外伤 当外伤发生鼻骨骨折时，常并发中隔软骨脱位变形，甚至软骨骨折，如不及时复位，可遗留中隔偏离。婴儿出生时产道狭窄、或因产钳挟持不当，亦可致鼻中隔软骨偏曲、脱位。外伤是引起鼻中隔偏曲的最常见病因。 (4)小儿腺样体肿大影响鼻通气，张口呼吸代偿，日久致颌面骨发育畸形，硬腭高拱，结果使鼻腔的底部上抬，渐使鼻中隔呈偏曲状态。,15,鼻阻塞造成长期张口呼吸和鼻内炎性分泌物积蓄，使患者容易继发上呼吸道感染,为主要症状。具有交替性或持续性，向一侧偏曲者，常为单侧鼻塞；向双侧偏曲者如S型偏曲，则鼻塞多为双侧。但一侧偏曲者如对侧出现了下鼻甲代偿性肥大，也可出现双侧鼻塞。,为常有症状。发生在偏曲的凸面、骨棘或骨嵴的顶尖部，此处粘膜薄，常受气流和尘埃刺激，易发生糜烂而出血。,偏曲的凸出部分压迫同侧鼻甲，而引起同侧反射性头痛。,鼻中隔偏曲，刺激腺体，使鼻分泌物增多，若继发感染刺激鼻粘膜，分泌亢进，多为粘液性或粘脓性分泌物，若伴鼻窦感染，则为脓性。,鼻塞,鼻出血,头痛,鼻分泌物增多,临床表现,16,.,治疗要点,对于明显鼻中隔偏曲的病人，手术矫正是唯一的治疗方法。 一般手术方法有两种：鼻中隔粘膜下切除术 鼻中隔鼻成形术,17,常见的护理诊断,与疾病本身和手术有关,伤口出血,缺乏有关鼻中隔偏曲治疗及自我保健的知识,有感染的危险,潜在并发症,知识缺乏,18,.,护理目标,（1）切口愈合好，无出血和感染发生。 （2）了解有关的治疗和护理措施，能进行自我护理。,19,护理措施,手术前后护理 （1）术前护理： 1 术前1日备皮，剪双侧鼻毛、刮胡须 2. 术前晚及术前1小时按医嘱给镇静剂 3. 术晨禁食 4.全麻者术前12小时禁食，术晨备全麻护理用物，铺麻醉床 5.鼻内有脓痂积存，可用消毒的温生理盐水冲洗,20,（2）术后护理 1 术后取半卧位，疼痛时给止痛剂，局部冷敷 2. 如病人头晕是由于手术时间长，病人精神紧张等原因，应给适量镇静剂，半卧位继续观察，进易于消化的半流食、软质饮食 3. 嘱病人张口呼吸将分泌物吐入容器内以观察出血情况，嘱病人勿打喷嚏 4. 随时观察病情，如患者出现双侧鼻塞，鼻梁有压迫感，额部头痛，考虑鼻中隔血肿的发生，应立即报告医师处理,21,5. 病室保持60%湿度，若发生张口呼吸，咽部干燥不适，可用纱布浸湿温开水遮掩口唇加以缓解 6. 术后3日抽出鼻内填塞的纱条。 7. 术后鼻腔内可喷以无菌生理盐水和复方薄荷油剂 8. 术后3-4日鼻背红肿压痛明显，头痛或伴低烧，则考虑是鼻中隔脓肿的发生，应立即报告医师及时处理 9. 术后1月内，禁止触动外鼻或用力擤鼻 10. 如是从内切口要特别注意口腔卫生，多饮水，必要时给止痛消炎药，防止术后并发症，尤其是扁桃体或中耳炎等,22,健康教育,1.改正不良的卫生习惯，勿用手挖鼻，指导病人正确擤鼻。 2.加强身体锻炼，防止感冒。 3.按医嘱继续按时用鼻滴药。需继续鼻腔者教会病人正确进行鼻腔冲洗的方法。 4.定期门诊随访。 5.近期内避免剧烈运动。 6.运动或工作时，注意保护鼻部免受外伤。,23,护理评价,通过治疗和护理计划的实施，评价病人是否能够达到： （1）积极配合治疗