腹部闭合性损伤病人的护理讲义课件

腹部闭合性损伤病人的护理NursingpatientswithBluntAbdominalTrauma第十六章外科护理学第4版1腹部闭合性损伤病人的护理Nursingpatientsw学习目标

LearningObjectivesTitleThemeGalleryisaDesignDigitalContent&ContentsmalldevelopedbyGuildDesignInc.TitleThemeGallery

isaDesignDigitalContent&ContentsmalldevelopedbyGuildDesignInc.四掌握其术前护理措施一了解腹部闭合性损伤的病因二掌握其临床表现、辅检三掌握其处理原则2学习目标LearningObjectivesTitleTOpentrauma急救原则

First-aidprinciples病因Etiology临床表现

clinicalmanifestationReview1.腹部伤口剧痛2.急性腹膜炎3.临近器官受损的临床表现4.休克征象腹部开放性损伤无菌包扎切忌回纳下肢半屈禁食禁水酌情止痛Opentrauma急救原则病因临床表现Review1.Case2011年4月荆州某学校体育课上张某

王某Collidewith右眼眉骨处外出血无外伤仅腹痛4Case2011年4月张某Colli作为接诊护士，我们要……?5作为接诊护士，我们要……?5一、病因Etiology钝性暴力bluntforceSpeedStrengthPartsDirection6一、病因Etiology钝性暴力bluntforce二、腹部闭合性损伤临床思维图ClinicalMindMap

判断1：有无内脏损伤无疑有对症处理严密观察相应处理必要检查判断2：？脏器

实质or空腔1、重视全身情况2、详细了解受伤史3、全面而重点的体格检查4、必要的化验1、早期休克（失血性）2、持续性腹剧痛3、明显的腹膜刺激征4、气腹5、移动性浊音6、便血、呕血、血尿7、直肠指诊三不：NomovingNoanalgesicsNPO

(NihilPerOs)

三要：

InfusionAntibioticsGIsuction

1、诊断性腹穿或腹腔灌洗术2、X线检查3、B超检查

……7二、腹部闭合性损伤临床思维图ClinicalMindMaCompareruptureof

Holloworgans

with

Parenchymaorgans

实质性脏器空腔性脏器刺激性ParenchymaorgansHolloworgans

Irritant脾spleen肾kidney肝liver小肠Smallintestine胃Stomach胃液Gastricjuice胆汁Choler胰液Pancreaticjuice肠液Intestinaljuice胰Pancreas膀胱Bladder血液Blood结肠Colon8CompareruptureofHolloworga99三、处理原则（TreatmentPrinciple)1、先救命、后治伤2、实质性：积极抗休克的同时手术治疗空腔性：先抗休克后手术治疗10三、处理原则（TreatmentPrinciple)10四、术前护理Pre-operativenursing

Relevantfactors:abdominal

hemorrhageseriousperitonealinflammationvomitingNPOFluiddeficit维持体液平衡11四、术前护理Pre-operativenursing四、术前护理Pre-operativenursingPain1.体位Positionpatient2.禁食NPO&禁灌肠Noclyster3.胃肠减压GIsuction4.观察Observation5.止痛RelievepainRelevantfactor:abdominaltraumadigestivejuicesirritateperitoneum12四、术前护理Pre-operativenursingPa四、术前护理Pre-operativenursingFeartheartofcommunicationRelevantfactors:

accidentalinjuryworryaboutprognosis13四、术前护理Pre-operativenursingFeSummaryBluntabdominaltrauma

EtiologyClinicalmanifestation&DiagnosticexaminationTreatmentprinciplePre-operativenursing14SummaryBluntabdominaltrauma1Assignment

农民贾某日凌晨5时偷渔被人殴打，猛踢右上腹，即感腹部剧痛当日上午9时急诊平车入院，患者上腹部疼痛，压痛及反跳痛（+），全腹肌紧张。B超检查示：腹腔内少量积液，内脏破裂？胆囊