胸外科护理查房最终版课件

1、 Spontaneous Pneumothorax Thoracic surgery nursing ward roundThe speaker : Wuhan Polytechnic University自发性气胸Group division of laborCase - 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 edu

2、cation- 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 th

3、e 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% .Physi

4、cal 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 Etiology and classification病因及分类THE SPEAKE

5、R : 于广平The cause of spontaneous pneumothoraxClassification of one Spontaneous pneumothorax Trauma pneumothorax Artificial pneumothoraxClassification of two Closed pneumothorax Open pneumothorax Tension pneumothoraxThe cause of spontaneous pneumothoraxWhen a trigger causes alveolar pressure rise shar

6、ply, 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Signs（体征）： Fracheal shift to the contralateral（气管向健侧移位）。 Ipsilateral chest full（患

7、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）。 Auxiliary examination1.X-ray 2.CT 3. Pleural cavity angiography4. Thoracoscopic12Auxiliary examination2.CT Is more sensitive to the diagnosis of a small amount

8、of gas in the pleural cavityClearly 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

9、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。143.Pleural cavity angiographyThis 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

10、 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。154.Thoracos

11、copicThoracoscopy 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

12、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。16 Principles of treatment 治疗原则17Principles of treatment1. Conservative treatment2. Exhaust treatment3. Operation treatment182.Exhaust treatment1.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 condi

13、tion feasible emergency exhaust2 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,

14、 recurrent pneumothorax patients20Operation treatment Thoracoscopic and Thoracotomy21 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 p

15、leural adhesions, and to prevent the recurrence of pneumothorax.23Nursing diagnosis and measuresTHE SPEAKER : 王辉、毛雅琴、潘娟24impaired Gas exchangepain(1234pain at chest)The risk of infection56Activities without endurancenutrition alteredknowledge deficit护理措施Nursing measures1.Impaired Gas exchangeMeasure

16、s： 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.Obse

17、rve the fluctuation of the water column,color e.To change the thoracic regularity,and prevent retyograde infectionpositionpsychologicalnutritionenvironmentmedicinepain The risk of infection1.To keep respiratory tract unobstructed promptly eliminate sputum2.Do oral care, prevent secondary infection3.

18、Keep closed drainage system sterileActivities 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. Malnutrition1.Give high protein2.High vitamin3.Light easy to digest foodLack of knowledgea.Av

19、oid pressure shockb.Keep warmc.keep bowels open Nursing analysis 1.impaired Gas exchange 2.pain 3.The risk of infection 4.Activities without endurance 1.The nursing of breathing difficulties2.The nursing of Chest pain3.To prevent infection of nursing4.To strengthen the nursing of painproblemsNursing

20、 key pointsThoracic 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 positionThe location of the catheter: 1. The gas with side second intercostal clavicle middle2. Liquid with side 7, 8 rib clear

21、ance of axillary line and axillary line place after3. The pus by means of x line in the vomica lowest placeNursing key pointsTube drawingDrainage situation protect from infectionObservation conditionKeep pipeline closed and openThoracic closed drainage nursing胸腔闭式引流的护理Health EducationTHE PEAKER : 李飘

22、飘、赵娟381. The cause ,type and cure of Pneumothorax2. The purpose of thoracic closed drainage and attention3. the purpose of starting exercise early4. Lung function were exercise purpose and method5. diet for discovery6. Convalescence rehabilitation activities of the method and the matters needing att

23、ention7. discharge guidance39Early activities of the methods and significancepromote the whole body function recoveryPromote the blood circulationPromote gastrointestinal peristalsisPromote urination function recovery40Methods: 1.deep breath, sputum, assist keel over, take back, and smooth blood pre

24、ssure 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 fo

25、r a walk4.seriously ill weak and complications and activity restriction patients cant get up early, but still need to adhere to the bed activities.41Lung function were exercise purpose and method1).lung function exercise to let the lung lobe full expansion, to increase alveolar surface tension, increase the vital capacity, improve lung function2). cough training prevent pulmonary infection42Dietbefore: eat easy digestive less slag food (易消化少渣饮食)Early postoperative: easy to digest, less gas of food （易消化、少产气食物）Postoperative termin