先天性高肩胛症PPT课件.ppt

Postoperativenursingforsprengledeformity:acasereport,Manhui.HE2016-8-16Traumaandhandmicrosugery,1,Contents,1Sprengledeformity2Casereport3Nursingprocess4Nirsingexperience,2,Sprengledeformity,Thediseaseisgenetic,andmorewomenthanmenMostareunilateralandbilateralincidencewas10%-20%,3,Sprengledeformity,Definition:Itisararecongenitaldeformityoneorbothscapulatethatapearsatbirth.Characterizebyonesideshoulderjointis2cm-10cmhigherthannormalone.Anditcausesrestrictedmobilityoftheshoulderandcervicalspine,4,Sprengledeformity,ClassificationIdegrees:deformityisverylight,onbothsidesoftheshoulderjointinthesamelevel,appearanceisnotobviousdegrees:onbothsidesoftheshoulderjointisalmostthesamelevel,thedresscanbeseenwhenthedeformitydegrees:shoulderjointishigherthanthecontralateral25cm,deformity.IV:isveryserious,shoulderbladescanbeascendedtheoccipital,Diagnosis:X-rayexamination,5,Sprengledeformity,OperativetreamentAppropriateage:3-6yearsold；Idegreesdoesnotconsidersurgery,IVdegreesdemandthroughsurgeryunder5yearsold,detiodnuscle,subclavianarteryandvein,pectialismajor,pectoralisminor,brachialplexus,6,Commoncomplications,bleeding,hematoma,wound,surgery,Endotrachealintubation,Laryngealedema,Oppressionofthetrachea,Difficultyinbreathing,infection,Brachialplexusinjury,Themostseriouscomplications,7,Casereport,HuangXXfemale,3y,byfindingtheleftshoulderbladedeformity,3years,generallyingoodcondition,noshortnessofbreath,chesttightnessandotherdiscomforts;Childrenwithsmoothmood,goodappetite,sleepgood,normaltothetoilet.Culturaldegree:childrenkindergarten,socialpsychologicalreactionisgood,acompamywithparentsinthehospital,8,Casereport,Specializedexamination,Bonetissuepathologicalexamination,Bloodbiochemicaltest,hospitalexamination,Electrocardiogram(ecg),ChestRadiography,X-ray:Theshoulderbladepositiveside,Diagnosis:sprengledeformity,9,Casereport-Specializedexaminationandsurgery,degreeofdeformity,OntheleftshoulderbladeAngleplaceisrelativelyhigherthanthatoftherightshoulderbladeca.4cm,Limitedliftontheleftupperlimb,outreachactivities,leftarmadduction,rotation,Forwardbendsafterstretchnoobviouslimitations,fingersfeelnormal.,Operation:4/8inendotrachealhemponherleftshoulderbladeedge,Musclerelease+checkpointdownaroundtheexcisionreconstruction+bonebridge,10,Casedescription-postoperativecondition,Leftshoulderawounddrainagetube,drainageofthedarkredhemorrhagicfluid10ml,shoulderwounddressingsdryclean,Leftupperlimbactivitylimitedmild,goodbloodsupply,5%GS100mlbid.muscosolvan15mg+0.9%NS10mlbidoxygeninhalationlansoprazole15mg+0.9%NS100mlbid,Oftencried,emotionalinstability,familyfeltnervous.,Continuetoecgmonitoringandoxygen2l/min,stablevitalsigns,painscoressixpoints,11,Nursingprocess,assess,plan,evalaute,diagnosis,do,12,assess,Postoperativeevaluationofchildrenwithpain,Vitalsigns,especiallyrespiratoryandbloodoxygensaturation,Admissionassessmentandevaluationofpreoperativelimbsituation,术后评估患侧肢体的活动、血运患儿引流管及伤口局部情况,评估患儿与家属心理情况，及家属对术后注意事项掌握度,Postoperativeevaluationoflimbactivity,bloodsupplydrainagetubeandwoundlocalsituation,psychologicalsituation,andMasterdegreeoffamiliesofpostoperativeconsideratios,13,diagnosis,Potentialcomplications:brachialplexusinjury,acromegalybloodLoopobstacle,bleeding,infection,hematoma,Lackofknowledge:familieslackofpostoperativenursingknowledge,Anxiety:andthechildisnotadapttotheenvironment,pain:associatedwithpostoperativewound,14,EasethepainPsychologicalcareObservationPostoperativeguidance,ObservationTopreventinfection,Guidefunctionexercise,Plan,nearterm（1-3d）,mediumterm（4-10d）,lateperiod（10d后）,15,painnursing,Do,ListentothechiefcomplaintAssessmentofpainlocation,time,nature;Withsmilingfacepainassessmentscale,Bodypositionnursingcare:avoidlateralposition,recommendedthehypothesisorrightsidealittlebithigh(ontheleftsideofthepad10,15)inchildrenwithplacesandbagsfixedheadonbothsidesofthehead,Guidethenon-drugpainreliefmethodPrescribeddrugs,drugeffectandadversereactions.,16,Postoperativepainscores,17,observation,Do,Vitalsigns,especiallypayattentiontothechildstemperature,breathing,complexion,bloodoxygensaturation.,Limbbloodcirculation:color,swelling,skintemperature,theradialpulse.observeLimbactivity,musclestrengththroughinductionandthefingergrasping,andcomparedwithpreoperative.,Woundobservation:wounddressings;Wounddrainagesquantity,color,character;inflamedorhematoma,18,nursing,Do,Continuetoecgmonitoringandgiveoxygenfor24hWritethenursingrecord,Preventinfectionnursing:dressingwoundtemperaturemonitoring,Avoidshoulderjointactivitieswithin2weeks.startalimitedrangeofactiveandpassivejointtrainingafter2weeks.,19,psychologicalnursing,Do,ExplaintothefamilyabouttreatmentandnursingGivingmoreconcernandsympathy,toobtainthetrustandcooperation,keepancomfortableenvironmentThesameagechildrensencouragementandsupportDistraction:toys,anime,Listentochildrencomplained,understandthecauseofthecrying,20,Psychologicalchange,Childrenandfamilytensionsease,smoothmood,21,healtheducation(tothefamily),Do,postoperativepositionrequirements,turnanddrainagetubecareconsiderations,observationpoints：kidscomplexionandabnormalcrying,abnormallimbavtivity,highprotein,highquantityofheat,highvitamindiet;Guidefunctionexercise,suchastherecentmassagedistallimb,wrist,elbowflexionexercise;Thelate:monkeyclimbingtraining,weighttraining,22,theawarenessoffamillybeforeandafterhealtheducation,23,evaluate,Nocomplicationsoccurred,Familiescanbethefirstdayaftersurgerywithpostoperativeconsiderations,Beforedischargecangraspthefunctionalexercise,Postoperativepainreliefonthefirstday,Familymembersgraspthemethodofnon-drugpainrelief,andusethesmilingfacepainassessmentscalecorrectly,childr