室间隔缺损医疗护理查房---副本课件.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,定义（definition）,室间隔缺损是指室间隔在胎儿时期因发育不全，在左右心室之间形成的异常通道。室间隔缺损引起血液自左向右分流，导致血流动力学异常。,Theventricular septumin the fetal period for dysplasia,abnormalpassage is formed in theleft and right ventricular.Ventricular septal defect caused by bloodfrom left to rightshunt,resulting in abnormal hemodynamics.,病因(,Pathogeny),心血管畸形的发生主要由遗传和环境因素以及相互作用所致,Thecongenitalmalformationrelatestogeneticfactor,environmentalfactorortheinteractionof bothfactors.,1.早期宫内感染(,early intrauterine infection,),2.孕母有放射线接触和服用药物(,a radiationexposure and medications,),3.孕妇代谢紊乱性疾病(,metabolicdisorder disease,),4.妊娠早期酗酒、吸食毒品等,分类（,classification,）,根据缺损的解剖位置不同，通长分为膜部缺损、漏斗部缺损和肌部缺损三大类。其中以膜部缺损最常见。绝大多数是单个缺损，偶见多个缺损。,According to the different anatomicaldefects usuallydivided intomembranedefect infundibular defect and muscular defectthree categories Themost common ismembranedefect.The vast majorityare singledefect,manydefects are rare.,病理生理（Pathophysiology）,室间隔缺损时，左心室血流向右分流，分流量取决于两侧心室间的压力阶差、缺损大小和肺血管阻力。肺动脉压力随右心负荷增大而逐渐增高。,When the ventricular septal defects,theleft ventricular flowshunt,flow depends onthe pressureorderdifference between thetwo ventricles,defect sizeand pulmonary vascular resistance.The pulmonary arterialpressure gradually increases withright heart load.,临床表现（clinical manifestation,）,症状（,symptom,）,呼吸道感染,respiratory,乏力、多汗,Fatigue,sweating,气促、心悸,Shortness,、,palpitation,辅助检查(,laboratoryexaminations,),1、心电图(electrocardiogram)：,小型,VSD,正常范围，大型,VSD,为左、右心室合并肥大。重度肺动脉高压时，显示双心室肥大、右心室肥大或伴劳损。,2、X线检查(,x-ray examination,),中度以上缺损时，心影轻到中度扩大，左心缘像左下延长，肺动脉段突出，重度梗阻性肺动脉高压时，肺门血管影明显增粗，甚至肺血管影呈残根征,3、,超声心动图(,echocardiogram,),示左心房、右心室内径增大。多普勒超声证实有左心室向右心室的分流。,治疗(treatment),1、缺损小、无血流动力学改变者，可暂观察，部分病例可自行闭合。,patient who defect is small or hemodynamic is not changeing,can temporarilyobservation,some cases canclose automatically.,治疗(treatment),2、缺损大、分流量大于50%或伴肺动脉高压的婴幼儿，应早期在低温体外循环下行心内直视修补术。,Defect ofinfants and young children,dividedflowis larger than 50%orwith pulmonary hypertension who should be earlyin the downlinkhypothermic cardiopulmonary bypass andopen heart surgery.,3、严重肺动脉高压、有右向左逆向分流者，禁忌手术。,patient who have a severe pulmonary hypertension,right to leftshuntoperationin reverse can not operate.,护理问题(Nursing problems,),术前(preoperative)：,1、心输出量减少(decreased cardiac output),2、活动无耐力(activity intolerance),3、恐惧(fear),4、有感染的危险(risk of infection),5、知识缺乏(Lack of knowledge),术后,(postoperative,),：,1,、有心输出量减少的危险,(risk of decreased cardiac output,),2,、清理呼吸道无效（,cleartheairways,invalid,）,3,、舒适度改变（,thechange of comfort,）,4,、有皮肤完整性受损的危险,(impaired skin integrityis invalid,),5,、潜在并发症（,the potential complications,）：肺高压危象、心律失常,护理措施nursing measures,术前（Preoperative）,1、根据患者心功能情况指导患者适量运动，避免激动，紧张，活动间隙给予充分休息，增加患者的营养。,According tothe cardiac function of the patients,we should instruct them exercise,avoid excited and tension,make sure sufficient rest andincrease their nutritions.,2、护士应该热情接待患者，做好入院宣教，消除患者的陌生感。,Thenurse shouldrecept warmly,do a goodadmission education so that they,eliminate the strangeness.,3、病房开窗通风，患者注意保暖,减少人员探视，避免呼吸道感染。,we should ventilat windows in the ward，patientspay attention to keep warm,reduce personnel visit to preventrespiratory infection.,4、向患者及家属讲述术前的注意事项置管情况，并介绍手术室及监护室的一些情况。,Tell patient and their families about the attention tothe woundand catheter or somecondition about operation room and intensive care unit,术后(postoperative)：,1、循环及意识的监测,密切观察患者生命体征,Monitoring of circulationandconsciousness,observe the vital signs closely,Heart rates,Blood pressure,Oxygensaturation,Respiration,2 保持呼吸道通畅,术后应用呼吸机辅助呼吸,保持患儿四肢温暖，促进末梢血液循环.,Keep airway clear,apply ventilator assisted breathing and keep warm to promote the blood circulation,3、采用体位引流，采取体疗促进痰液排出，遵医嘱用药，必要时进行吸痰。,take postural drainage and physical therapy topromotesputum discharge,sputum suctionif necessary.,ultrasonic nebulization,backslap,4,、观察疼痛的性质，持续时间，给予患儿舒适的体位，必要时遵医嘱给予药物止痛。,Observe thenature of pain,duration,and give patient a comfortable posture,when is necessary givedrug at the doctors advice,.,5,、预防发生肺高压危象,prevent pulmonaryhypertension crisis,HOW?,（1）适当延长呼吸机辅助时间，防止发生肺部并发症,Prolongingventilation time appropriately prevent the occurrence ofpulmonary complications,（2）维持适当的过度通气。,Maintainhyperventilationappropriately,（3）应用降低肺动脉压的血管活性药物 Apply the vasoactive drugsto reducethe pulmonary artery pressure,（4）充分镇静，减少刺激。,keep calm,reducethestimulus,5、饮食与活动(,diet andactivity,),患者拔除气管4小时可饮水，进食流质饮食，若无呛咳，可改为普食。,Patient can trydrink water and fluid food when tracheal intubation werepulled outwithin four hours,if there isno cough,Instead of common food.,6、术后注意观察引流液的颜色、量、有无凝血块等。,Observe color,volume of thedrainage fluid,7、护患之间采取有效沟通，做好阶段性健康指导，指导家属正确认识疾病及正确照护患者，提高患者及家属的合作和依从性。,Effectivecommunicationbetween nurse and patient,make stagehealth guidance,give thema correct understanding of the diseaseandthe correctfamilycare of patients,improvethem cooperation andcompliance.,健康指导（Health Guidance）,术前(,Preoperative),：,1、减少剧烈活动，活动量以不引起疲乏、呼吸困难、胸闷等不适为宜,Reduce violentactivity,stop activity when patient feel fatigue,difficulty breathing,chest painand so on,2、帮助患者及家属尽快认识和熟悉周围环境，寻找有效的支持系统.,Help the patients and their families are familiar with the surrounding environment.,3、指导患者 及家属开窗通风，防寒保暖，预防感染。,Guidepatients and their families open the windowventilation,prevent of infection.,4、指导患者及家属合理饮食，增强体质,讲解疾病知识，给予患者及家属心理支持,Guidepatients and their families have a reasonable diet,enhanced constitution andexplain theknowledge of disease and give psychological supportto patient and their families,术后(Postoperative),1、饮食与活动（diet andactivity）：早期下床活动，多食水果、蔬菜等纤维饮食，促进肠蠕动，保持大便通畅,Have morefruits,vegetablesand otherfiber diet which can promote intestinal peristalsis and maintain smooth stool.,2、教会患者及家属正确的咳嗽和排痰的方法，促进有效咳嗽,Teach patients and their family membersthe rightmethod of cough andexpectoration,promote effective cough,3、指导患者及家属保持床单元整洁，做好各种导管护理的配合注意事项,Guidepatients and their familiesto keep the bedunitclean,4、针对患者术后出现的并发症，给予积极的心理支持和健康指导,thepostoperativecomplications,givingpositive psychological supportand health guidance,THANK YOU,