弹力袜与充气加压装置

1、弹力袜与充气加压装置(Elastic Stockings and Sequential Compression Devices) 弹力袜与充气加压装置 (Elastic Stockings and Sequential Compression Devices)1. 患者有糖尿病，处于昏迷状态，且每2个小时需要翻身一次。入院时，护士发现患者的腿部发绀并且发凉，两只小腿上各有一处硬币大小的压疮。护士意识到该名患者：A. 可能患有DVT并经过霍曼斯征评估B. 与弹力袜相比，能从SCD中受益更多C. 可能不适合使用弹力袜或SCDD. 有发生静脉淤血的风险，需要使用弹力袜正确答案 C. 可能不适合使用弹

2、力袜或SCD题解该名患者不适合使用弹力袜或SCD。使用弹力袜或SCD的禁忌情况包括皮炎或开放性损伤（如压疮），近期植皮，表现为肢体发绀、发凉的下肢血液循环降低，和 /或影响到下肢的坏疽。霍曼斯征不可靠。尽管研究显示大多数患者从SCD中的收益比弹力袜多，但该名患者两种都不适用。因为腿部的压疮，这名有静脉淤血风险的患者不适合使用弹力袜。2. 一名患者将弹力袜卷下“凉快一下”，因为弹力袜让腿变得“热且出汗“。护士应该指导患者：A. 弹力袜在使用前可以浸泡在水中来使腿部感到凉爽B. 如果不舒适，患者应该直接将袜子脱下C. 如果卷下袜子能让患者觉得更舒适，那就可以这样做D. 弹力袜在每次轮班中可以脱下一

3、小段时间正确答案 D. 弹力袜在每次轮班中可以脱下一小段时间题解弹力袜可以脱下一小段时间以进行评估和/或清洁措施，但需要尽早更换。将袜子部分卷下会产生压迫的效果并影响静脉回流。长时间脱下弹力袜会使患者处于栓塞的危险中。不建议浸泡弹力袜The patient is diabetic and comatose and needs to be turned every 2 hours. On admission, the nurse notices that the patients legs are cyanotic and cool, with two dime-size ulcers on e

4、ach calf. The nurse recognizes that the patient:A. May have a DVT and needs to be evaluated using Homans procedureB. Benefits more from SCDs than elastic stockingsC. May not be a candidate for elastic stockings or SCDD. Is at risk for venous stasis and needs elastic stockingsC. May not be a candidat

5、e for elastic stockings or SCDCorrect AnswerRationaleThe patient is not a candidate for elastic stockings or SCD. Conditions that might contraindicate use of elastic stockings or SCDs include dermatitis or an open skin lesion (such as an ulcer), recent skin graft, decreased circulation in lower extr

6、emities as evidenced by cyanotic, cool extremities, and/or gangrenous conditions affecting the lower limb(s). Homans sign is not reliable. While research suggests that the most patients would benefit more from the use of SCDs over elastic stockings, in this case the patient is not a candidate for ei

7、ther. The patient at risk for venous stasis is not a candidate for elastic stockings because of the leg ulcer.A patient rolls down the elastic stockings to cool down because the stockings make the legs hot and sweaty. The nurse should instruct the patient that:A. Elastic stockings can be soaked in w

8、ater before application to keep the legs coolB.If uncomfortable, the patient should just take the stockings offC.It is okay to keep the stockings rolled if the patient is more comfortable D. Elastic stockings can be removed for a short period once a shiftCorrect AnswerRationaleThe elastic stockings

9、can be removed for a short period to perform an assessment and/or hygiene measures but need to be replaced as soon as possible. Rolling socks partially down has a constricting effect and can impede venous return. Removing elastic hose for long periods places the patient at risk for embolism. Soaking

10、 elastic stockings is not recommended.3. 充气加压装置可以：A. 用于患者夜间睡觉时B. 一天24小时/一周7天使用C. 单独使用或与弹力袜合并使用D. 在白天使用，因为夜间其噪音会影响患者睡眠正确答案 A. 用于患者夜间睡觉时题解根据医生的偏好，充气加压装置可以单独使用或者与弹力袜合并使用。SCD在白天和夜间均可使用，但需要在每次轮班时至少脱下一次。4. 一名患者在髋关节置换术后卧床休息，护士评估患者的血液循环和凝血功能检查是为了检查患者是否存在：A. 出血倾向增加B. 感染征象C. 血小板减少D. Virchow三要素正确答案 D. Virchow三

11、要素题解有3个因素（通常称为Virchow三要素）促进了DVT的发展：血液高凝状态，静脉壁损伤和血流淤滞。感染征象最好通过查看白细胞计数和分类以及生命体征和临床表现来评估。出血倾向增加可以通过凝血功能检查发现，但是不能了解卧床休息患者因为静止和血液淤滞导致DVT的风险。血小板减少提示血小板计数偏低和出血倾向。5. 一名患者因“疑似DVT”入院。护士评估患者时发现其腿部温热，伴有轻度水肿。护士不应当进行霍曼斯征测试，因为：A. 它不可靠B. 它很痛苦C. 伴有轻度水肿，可以排除静脉血栓形成D. 按压腿部可能导致脑卒中正确答案 A. 它不可靠题解不到20%的DVT患者会表现出霍曼斯征阳Sequen

12、tial compression devices are used:A. At night when the patient is sleepingB. 24 hours a day/7 days a weekC. Alone or with elastic stockingsD.In the daytime, because the noise keeps patients awake at nightA. At night when the patient is sleepingCorrect AnswerRationaleSequential compression devices ca

13、n be used alone or in conjunction with elastic stockings, depending on the practitioners preference. SCDs are worn both day and night but need to be removed at least once per shift.When a patient is on bed rest following hip replacement, the nurse should assess the patients circulation and coagulati

14、on studies in an attempt to check the patient for:A. Increased bleeding tendencyB. Signs of infectionC. ThrombocytopeniaD. Virchows triad D. Virchows triadCorrect AnswerThree elements (commonly referred to as Virchows triad) contribute to the development of DVT: hypercoagulability of the blood, veno

15、us wall damage, and stasis of blood flow. Signs of infection are best assessed by looking at the white blood cell count and differential as well as vital signs and the clinical picture. Increased bleeding tendencies may be recognized in the coagulation studies, but the risk for a patient on bed rest

16、 is DVT caused by inactivity and blood stasis. Thrombocytopenia is an indicator of a low platelet count and possible risk for bleeding.A patient is admitted with a diagnosis of “possible DVT.” The nurse assesses the patient and finds that the leg is slightly warm, with minimal edema. The nurse shoul

17、d not pursue testing for Homans sign because:A. It is not reliableB. It is extremely painfulC. With minimal edema, venous thrombosis is excludedD. Manipulation of the leg could lead to stroke A. It is not reliableCorrect AnswerRationale性。霍曼斯征阳性表现为足背屈时出现小腿不适。霍曼斯征测试会造成疼痛并不是不进行这项测试的原因。水肿出现与否并不能排除DVT的诊断

18、。按压腿部会导致血栓运行到肺部，而不是脑部6. 护士为有发生DVT风险的患者腿部使用弹力袜的目的是：A. 减少通过腿部的血流B. 增加静脉扩张并防止静脉撕裂C. 对损伤的静脉加压使血液凝固D. 促进静脉回流并防止静脉扩张正确答案 D. 促进静脉回流并防止静脉扩张题解弹力袜有助于降低与DVT形成相关的2个因素。能够通过维持浅表静脉压力来防止静脉淤滞，促进静脉回流，从而减少下肢血栓形成的风险；还能防止静脉的被动扩张，从而减少发生内皮撕裂的风险。弹力袜不会减少通过腿部的血流，不会增加静脉扩张或对损伤的静脉加压使血液凝固。使用弹力袜的目的是为了防止血栓形成，而不是促使其形成。7. 在为一名老年患者预定

19、弹力袜时，护士应该记得：A. 老年人可能出现肌肉消瘦，因此需要对他们进行仔细测量B. 老年人同时需要弹力袜和SCDC. 老年人因为脂肪储存量减少，通常静脉回流会增加D. 老年患者的弹力袜几乎不可能不出现褶皱正确答案 A. 老年人可能出现肌肉消瘦，因此需要对他们进行仔细测量题解老年人因为衰老的过程会出现肌肉消瘦；因此，仔细测量这类患者以得到合适的尺寸尤为重要。正常的生理衰老会掩盖静脉功能不全的症状和体征。将弹力袜上的所有皱褶抚平十分关键，因为皱褶会导致压力增加和循Fewer that 20% of patients with a DVT exhibit a positive Homans sig

20、n. A positive Homans sign is indicated by leg discomfort when the foot is dorsiflexed. The fact that the Homans test can be painful is not the reason for not pursuing the test. The presence or absence of edema does not exclude the diagnosis of DVT. Manipulation of the legs can result in clots travel

21、ing to the lungs but not the brain.The nurse should apply elastic stockings to the legs of a patient at risk for DVT for the purpose of:A. Decreasing blood flow through the legsB. Enhancing venous dilation and reducing the risk of venous tearsC. Applying pressure to damaged vessels and causing clott

22、ingD. Promoting venous return and preventing venous dilationD. Promoting venous return and preventing venous dilationElastic stockings help reduce two of the elements related to DVT formation. They promote venous return by maintaining pressure on superficial veins to prevent venous pooling, thereby

23、reducing the risk of clot formation in the lower extremities; and they prevent passive dilation of the veins, thereby decreasing the risk of endothelial tears. Elastic stockings do not decrease blood flow through the legs, increase venous dilation, or apply pressure to damaged vessels resulting in c

24、lotting. The purpose of elastic stockings is to prevent clots not cause them.When ordering elastic stockings for an elderly patient, the nurse should remember that:A. Older adults may experience muscle wasting, so they need careful measurementB. Older adults require SCDs along with elastic stockings

25、C. Older adults usually have enhanced venous return because of loss of fat storesD. It is almost impossible to get wrinkles out of the stockings of older patients A. Older adults may experience muscle wasting, so they need careful measurementCorrect AnswerRationaleOlder adults may experience muscle

26、wasting because of the aging process; therefore, it is essential to measure these patients carefully to ensure proper fit. Normal physiologic aging can mask the signs and symptoms of venous insufficiency. It is essential that all wrinkles be smoothed out of elastic stockings 环改变。根据医生的喜好，弹力袜可以单独使用，也可

27、以与SCD联合使用。8. 下列哪一项是使用弹力袜和SCD时准确测量患者气囊套尺寸最重要的理由？A. 准确测量才能达到最佳的袜子压力B. 身高和体重会影响小腿的周长C. 合适的尺寸有助于使用D. 合适的尺寸确保血液循环评估时脚趾没有被覆盖正确答案 A. 准确测量才能达到最佳的袜子压力题解将患者的测量结果与生产厂家的尺寸表对照。最佳的弹力袜压力是脚踝处20到30mmHg，大腿的中上段降低到8mmHg。这种压力变化能在安全和实用的基础上，最大限度增加静脉回流速率。在使用弹力袜和SCD时，不需要测量身高和体重。合适的尺寸能够保证装置的轻松使用，但这不是主要的治疗目的。如果脚趾没有被覆盖，他们会被压迫，影响到血液循环。because wrinkles lead to increased pressure and alter circulation. Elastic hose may be used alone or with SCDs, according to the practitioners preference.Which of the following is the most important reason to accurately determine sleeve size when measuring a patient for