口腔护理 ICU护士新认识.ppt

口腔护理,蚌医一附院重症医学科,ICU护士新认识,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,你、我、他每个人.每天.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,一般患者.,ICU患者.,口腔护理,口腔护理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,方法一样吗.?,达到效果一样吗.?,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,方法一样吗.?,达到效果一样吗.?,你懂得.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,皮肤护理气道护理口腔护理毛发护理眼部护理肠内营养护理胃肠功能护理个人卫生护理.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,皮肤护理气道护理口腔护理毛发护理眼部护理肠内营养护理胃肠功能护理个人卫生护理.,护士心中重要性,排序,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,JBrasPneumol.2008;34(9):707-714,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,口咽部分泌物的吸入是VAP发生的最主要途径,JBrasPneumol.2008;34(9):707-714,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,中华内科杂志2013年6月第52卷第6期,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,AJCCAMERICANJOURNALOFCRITICALCARE,March2010,Volume19,No.2,显示：50%的护士认为每2小时一次口腔护理，42%的护士认为每4小时一次口腔护理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,有报道：应用0.2%的氯己定葡萄酸糖溶液和安慰剂进行的前瞻性多中心双盲试验，每天3次应用，开始时没有统计学差异，第10天时，0.2%氯己定葡萄酸糖溶液组牙周致病菌29%，而对照组达66%（P0.05）。,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.,q12hq8hq6hq4hq2h,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,生理盐水稀释碘伏溶液稀释碳酸氢钠氯己定漱口液.,q12hq8hq6hq4hq2h,刷、冲、洗、冲洗、冲刷.,牙刷、棉球、纱布块.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,有研究显示：检查口腔卫生是应用呼吸机病人预防VAP发生的一种主要方法,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,研究显示：随着正规合格的口腔护理，VAP发生率在降低,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,ICU护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？,如何选择.？,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,ICU护士：口腔卫生评估？护理效果评价？口腔护理再培训？口腔护理执行管理？,如何选择.？,思考,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,背景：很多创伤患者入住ICU，通常需要机械通气，经口气管插管使口腔气道的天然防御机制受损，此类病人VAP发生几率比较高。证据显示：多关注机械通气患者口腔卫生非常有助于预防VAP发生。,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,目的：通过研究来评价ICU护士对于机械通气患者口腔护理的观点以及执行情况,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,53名,学历,ICU工作时间,雇佣形式,53名护士基本情况,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,每班次口腔评估次数，每班次每患者口腔护理次数，是否按规定的时间、规定的方法进行口腔护理（专用口腔护理表格）,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,机械通气患者提出护理频次,每班次检查口腔的次数,每班次每患者口腔护理的次数,应用专用口腔护理表格,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,关于列出的十个日常护理规程，每个护理规程进行1至10分打分，分值越高者就是优先倾向于做的护理规程,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,10项日常护理规程得分平均值和标准差,气管管理,口腔护理,皮肤护理,营养护理,导管维护,个人卫生,眼部护理,预防机体超负荷,记录单书写,肠道功能护理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,列举12种口腔护理材料和工具，并且对每种材料和工具1至100分打分，得分高者说明口腔护理时使用的频次越高,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,12种口腔护理材料和工具使用频次,纱布块,氯己定,生理盐水,口腔冲洗,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,列出口腔护理的10种障碍原因，然后对其1至10分打分，分值越高者口腔护理障碍原因越常见,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,护士进行口腔护理障碍原因,人员不足,时间缺乏,担负书写任务,害怕感染转移,缺乏设备,气管插管存在,不重要,缺乏知识和能力,害怕吸引,不愉快,和我没关系,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,53名,学历,ICU工作时间,雇佣形式,53名护士基本情况,理学士,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,机械通气患者提出护理频次,每班次检查口腔的次数,每班次每患者口腔护理的次数,应用专用口腔护理表格,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,10项日常护理规程得分平均值和标准差,气管管理,口腔护理,皮肤护理,营养护理,导管维护,个人卫生,眼部护理,预防机体超负荷,记录单书写,肠道功能护理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,12种口腔护理材料和工具使用频次,纱布块,氯己定,生理盐水,口腔冲洗,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,护士进行口腔护理障碍原因,人员不足,时间缺乏,担负书写任务,害怕感染转移,缺乏设备,气管插管存在,不重要,缺乏知识和能力,害怕吸引,不愉快,和我没关系,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,口腔护理虽说排名第二，但其分值和其他皮肤护理，导管维护，营养护理，个人卫生分值差不多，并且远远落后于气道管理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,结果显示很有必要为护士开设口腔护理再培训课程,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,47%的护士认为口腔护理不是非常重要,GrapMJ,MunroCL,AshtianiB,BryantS.Oralcareinterventionsincriticalcare:frequencyanddocumentation.AmJCritCare.2003;12(2):1138.discussion119.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,有必要进行护士口腔护理再培训以及在预防呼吸道感染中担当一定的角色,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,这篇研究中85%的参与者培训过应用机械通气患者口腔护理而另外一篇报道70%的护士没有培训过应用机械通气患者口腔护理,Adib-HajbagheryM,AnsariA,Azizi-FiniI.Intensivecarenursesopinionsandpracticefororalcareofmechanicallyventilatedpatients.IndianJCritCareMed.2013;17(1):237.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,又有研究报道：在英国，62%的护士说在这个领域内接受过培训,JonesH,NewtonJT,BowerEJ.Asurveyoftheoralcarepracticesofintensivecarenurses.IntensiveCritCareNurs.2004;20(2):6976.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,另外在一篇研究：在欧洲的ICU显示，77%的ICU护士接受过相关的培训,RelloJ,KoulentiD,BlotS,SierraR,DiazE,DeWaeleJJ,etal.Oralcarepracticesinintensivecareunits:asurveyof59EuropeanICUs.IntensiveCareMed.2007;33(6):106670.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,在这篇研究中，尽管大多数护士都接受过此类口腔护理培训，但是在口腔护理方面并没有给出高的优先分数,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,此研究提到：缺乏时间和人员不足是忽视机械通气患者口腔护理的最主要因素,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,另外研究发现：担负书写任务以及时间、人员不足是ICU口腔护理的最大障碍,Adib-HajbagheryM,AnsariA,Azizi-FiniI.Intensivecarenursesopinionsandpracticefororalcareofmechanicallyventilatedpatients.IndianJCritCareMed.2013;17(1):237.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,又有研究发现：在欧洲59个ICU调查显示，三分之一的护士认为口腔护理令人不愉快，三分之二的护士认为口腔护理很难去执行,RelloJ,KoulentiD,BlotS,SierraR,DiazE,DeWaeleJJ,etal.Oralcarepracticesinintensivecareunits:asurveyof59EuropeanICUs.IntensiveCareMed.2007;33(6):106670,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,本文调查：口腔冲洗是最常用的方法用于口腔护理,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,另外一篇研究不一致：强调牙刷刷洗最有助于清除口腔的菌斑和微生物对于ICU患者,PedreiraML,KusaharaDM,deCarvalhoWB,NunezSC,Peter-liniMA.Oralcareinterventionsandoropharyngealcoloniza-tioninchildrenreceivingmechanicalventilation.AmJCritCare.2009;18(4):31928.,TheFirstAffiliatedHospitalofBengbuMedicalCollegeinintensivemedicine,有研究显示：用氯己定口腔冲洗比牙刷刷洗更能减少VAP。,MunroCL,GrapMJ,JonesDJ,McClishDK,SesslerCN.Chlorhexi-dine,toothbrushing,andpreventingventilator-associatedpneu-moniaincriticallyilladults.AmJCritCare.2009;18(5):42837.,TheFirstAffiliatedHospitalofBeng