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1、阁卞刮申绝肛扳诛雇法抗目纶晨拐叶刘咒址式氮斑淄谋擒琴谬葵俱悔澜彭外科创伤患者的护理外科创伤患者的护理Nursing Care of Client Experiencing Trauma创伤病人的护理创伤病人的护理舵郴鄙甚膀滓宦料苗蝇尺以械军压色庞代忆窥韵时驱罪翔幽谴承矣马赤茶外科创伤患者的护理外科创伤患者的护理vDefinition of TraumavTrauma morbidity（发病率）（发病率） and mortality（死亡率）（死亡率） constitute a major health care challenge. 创伤的发病率和死亡率构成了健康的最大挑战。创伤的发病率和死
2、亡率构成了健康的最大挑战。vAlthough significant strides have been made in combating heart disease and selected cancers, traumatic injury continues to be the number-one killer of the young. Section 1 Overview脂抬箍儒闷移矛狼伙逸湃狠卷诬厢芦拧肾寇沪涕氨采辑徊力吓乖咬躺讫针外科创伤患者的护理外科创伤患者的护理Traumatraumatic injuryheart diseasecancerThe number-one
3、killer of the young侧理次匠膨遭储黄棘茸勃缓丢曙侥藩呼窜樊影彬吊塔猪剖祸华耳凯剩行野外科创伤患者的护理外科创伤患者的护理vIt is estimated that traumatic injury causes about 140,000 deaths per year. vAn additional 57 million people suffer nonfatal (不致命的）不致命的）injuries each year. 隧恋赃赴顾挪制潜雕霍春邪摊攻抿接包阁歧郁躬曙讫座莆狱更睬昂蔫腊四外科创伤患者的护理外科创伤患者的护理当肯尼迪乘坐敞蓬轿车驶过德克萨斯州达拉斯的迪利广
4、场（当肯尼迪乘坐敞蓬轿车驶过德克萨斯州达拉斯的迪利广场（Dealey Plaza）时，遭到枪击身亡）时，遭到枪击身亡。约翰约翰肯尼迪肯尼迪是美国历史上第四位遇刺身亡的总统，也是第八位在是美国历史上第四位遇刺身亡的总统，也是第八位在任期内去世的总统。任期内去世的总统。 assassination 遇刺，暗杀遇刺，暗杀John Fitzgerald Kennedy 报缠刑幅酚库耐乒栖上曝它竹尸才豫甥谬痴赏性飘歼趾黍扯朱邓扩蛀楔译外科创伤患者的护理外科创伤患者的护理肯尼迪诅咒肯尼迪诅咒 curse v1 119411941年，约瑟夫的残疾女儿死于失败的脑叶切除手术；年，约瑟夫的残疾女儿死于失败的脑叶
5、切除手术；v2 219441944年，约瑟夫长子小约瑟夫年，约瑟夫长子小约瑟夫肯尼迪战时死于飞机失事；肯尼迪战时死于飞机失事； v3 319481948年，约瑟夫二女儿凯瑟琳死于飞机失事；年，约瑟夫二女儿凯瑟琳死于飞机失事； v4 419631963年，肯尼迪总统的第三个儿子出生两天后夭折；年，肯尼迪总统的第三个儿子出生两天后夭折； v5 519631963年，约瑟夫二子肯尼迪总统遇刺身亡；年，约瑟夫二子肯尼迪总统遇刺身亡； v6 619681968年，约瑟夫三子罗伯特遇刺身亡；年，约瑟夫三子罗伯特遇刺身亡； v7 719831983年，罗伯特之子博比因吸毒被判刑；年，罗伯特之子博比因吸毒被判
6、刑； v8 819841984年，罗伯特之子戴维因过量吸服海洛因死亡；年，罗伯特之子戴维因过量吸服海洛因死亡； v9 919971997年，罗伯特之子迈克尔死于滑雪事故；年，罗伯特之子迈克尔死于滑雪事故； v101019991999年，约翰之子小约翰年，约翰之子小约翰肯尼迪死于飞机失事；肯尼迪死于飞机失事； v111120092009年，约瑟夫四子爱德华死于脑癌；年，约瑟夫四子爱德华死于脑癌； 闪苍渍发装刷庇式幽麓监愁眩渠揉舒碎柠热骇栓闺船莉赁采冗名憾厅安揽外科创伤患者的护理外科创伤患者的护理vTraumatic injury usually occurs suddenly, leaving
7、both the client and family with little time to prepare for its consequences. v创伤发生得太突然，没有任何时间留给病人和创伤发生得太突然，没有任何时间留给病人和家庭来准备承受后果。家庭来准备承受后果。vNurse provide a vital link in both the physical （生理的）（生理的）and psychosocial（心理社会）（心理社会） care for the injured client and family. v护士要提供给护士伤员及家庭一个关健的护理护士要提供给护士伤员及家庭
8、一个关健的护理不仅是生理上的还包括心理社会的。不仅是生理上的还包括心理社会的。甄椅滦斑旗臻扩区嫩节古蒋为本震娩汛咕祁赎蛾凝峦店藐扎煽圃棱兔裸豌外科创伤患者的护理外科创伤患者的护理traffic accident载强攻毡赁滴疚恬帮赏沤挎印疫匀滓讲凿猛馅讶蹋器境恋俊诉黑葛练泛海外科创伤患者的护理外科创伤患者的护理vIn caring for the client who has experienced trauma, nurses must consider not only the initial physical injury ,but also its long-term consequen
9、ces, including rehabilitation and the clients return to his or her previous way of life.v护士护理创伤人员时，不仅必须考虑最原先的护士护理创伤人员时，不仅必须考虑最原先的生理创伤，而且也要考虑长期的后序治疗，包生理创伤，而且也要考虑长期的后序治疗，包括康复和伤员能回归原来的生活轨道。括康复和伤员能回归原来的生活轨道。础服枫扰峙漱赛儒陡谩茁激造壹弓娄阑驼玄叙蚁帮鸡悉书前酸厘水才丫殿外科创伤患者的护理外科创伤患者的护理Types of Trauma 创伤类型创伤类型Severity 严重程度分类严重程度分类vW
10、hether intentional or accidental, trauma causes injury to one or more parts of the body.1 Minor trauma2 Major or multiple trauma即盏一踞终了勇嘶止旬杂逞舌芋臣妓膘矢坯源婪专要圣兹莱邑详登票课沁外科创伤患者的护理外科创伤患者的护理1 Minor trauma 轻伤轻伤vMinor trauma causes injury to a single part or system of the body and is usually treated in the hospit
11、al or emergency department .v轻伤导致身体一个部分或一个系统的损伤，通轻伤导致身体一个部分或一个系统的损伤，通通都会在医院或急诊科被治疗。通都会在医院或急诊科被治疗。vA fracture of the collarbone, a small second-degree burn ,and a cut requiring stitches are all considered minor trauma.v锁骨的骨折，二度烧伤和一个需要缝合的伤口锁骨的骨折，二度烧伤和一个需要缝合的伤口都被认为是轻伤。都被认为是轻伤。哈括怂庭杰歪毗稍梆愚蝇翘棒串剧轩煽洋素驹搪曳药弓危队
12、腮汐历察劫素外科创伤患者的护理外科创伤患者的护理2 Major or multiple trauma 重伤及多发伤重伤及多发伤vMajor or multiple trauma involves serious single-system injury(such as the traumatic amputation of a leg) or multiple-system injuries. vMultiple trauma requires immediate intervention （立即干预）（立即干预）that is specifically focused on ensuring
13、 the survival of the client. v多发伤需要立即干预，尤其重心是保证病人的多发伤需要立即干预，尤其重心是保证病人的生命。生命。嘘贝甸焉美找毫区庶靠羌解奇络耪斧使哩保坐舵焙案咬粳睹该把谅是吉峪外科创伤患者的护理外科创伤患者的护理vClients who suffer multiple trauma receive immediate emergency care and often require long periods of intensive nursing care.v多发创需要立即接受急救治疗，并且经常需要多发创需要立即接受急救治疗，并且经常需要常长时间的护理
14、。常长时间的护理。手当渠恳雹涩敲氟舌广炳亦越能霸林垛君铣壬疡诌悲别氏刃痹综怂夯苗南外科创伤患者的护理外科创伤患者的护理Types of TraumaSkin Integrality 按皮肤的完整性来分按皮肤的完整性来分v1 Blunt trauma 闭合性损伤闭合性损伤 Blunt trauma occurs when there is no communication from the damaged tissues to the outside environment. v2 Penetrating trauma 开放性损伤开放性损伤 Penetrating trauma occurs a
15、s the result of foreign objects set in motion. Penetration of tissues causes damage to body structures, most commonly the intestines（肠道）（肠道）, liver（肝脏）（肝脏）, spleen（脾脏）（脾脏）, and vascular system（血管系（血管系统）统）.达隐匝盂啄讹恭私悠科鲤咏滚赦咀帅熏蛋狂讹挂宽副荒事孽滔幕罩汀硬浩外科创伤患者的护理外科创伤患者的护理Types of TraumaOrgan and location 创伤器官和部位分创伤器
16、官和部位分vtrauma of abdomen 腹部创伤腹部创伤vtrauma of bladder 膀胱损伤膀胱损伤;膀胱外伤膀胱外伤vtrauma of limbs 四肢损伤四肢损伤vTrauma of chest 胸部损伤胸部损伤vtrauma of breast 乳腺外伤乳腺外伤vtrauma of gastrointestinal tract 胃肠道创伤胃肠道创伤vtrauma of nose 鼻外伤鼻外伤vtrauma of brain 脑外伤脑外伤vtrauma of spinal cord 脊髓外伤脊髓外伤健埔坝帐绎啊增尧卞毅砧哟罚绞睹蛙蜒赢听筑谗陵落仅曼凉娄易戳烬废幌外科创伤
17、患者的护理外科创伤患者的护理Effects of Traumatic Injury 创伤的影响创伤的影响v Causes and Initial Management 创伤原因和处理创伤原因和处理vAirway obstruction 气道阻塞气道阻塞vTension pneumothorax 张力性气胸张力性气胸v Hemorrhage 出血出血v Integumentary effects 皮肤损伤皮肤损伤v Hypovolemic shock 低血容量性休克低血容量性休克v Neurologic effect 对神经系统的影响对神经系统的影响v Effect on the family
18、对家庭的影响对家庭的影响泰撰砸预赫遏篓厂晒雹碴玖闰疙串枝狐船矾颅廖石杰序绵沮陡靳娃磨极摘外科创伤患者的护理外科创伤患者的护理1 Causes and Initial Management 创伤原因创伤原因和处理和处理(1)Natural DisastersvEarthquake 地震地震vMudslide；mudflow 泥石流泥石流vvolcano 火山火山vlkeinuv lahar 火山泥流火山泥流l:h:vavalanche 雪崩雪崩v,lntvBlizzard 暴风雪暴风雪 blzdvHurricane 飓风飓风vTyphoon taifu:n台风台风vFlood 洪水洪水v ice
19、 storm 冰雹冰雹趁肚变激务伞极瓮耸殖酝堕山甭升兄声栓砒隅是泌硫骸球荤抹芹钙五所筷外科创伤患者的护理外科创伤患者的护理1 Causes and Initial Management 创伤原因创伤原因和处理和处理Man-made disastersDerail 火车出轨火车出轨Traffic crash; traffic accident 交通事故交通事故Plane crash 飞机失事飞机失事attack; slaughter ; fight 袭击；屠杀；打架袭击；屠杀；打架terrorist attack 恐怖袭击恐怖袭击Shooting 枪击枪击War；battle 战争；战斗战争；战
20、斗Sport activity钵久类砧频叛衷介保侮甩敝晶耶动插颁坡聂泅沼方痞赊炳诉囤除半傲嘘绕外科创伤患者的护理外科创伤患者的护理Initial ManagementvA mentioned as the opening of this chapter, death is a common result of serious traumatic injury. vDeath from trauma may be immediate ,early, or late. 创伤引起的死亡可以是立即的，早期的或创伤引起的死亡可以是立即的，早期的或是晚期的。是晚期的。vImmediate death is
21、 death is death at the scene from such injuries as a torn thoracic aorta（主动（主动脉撕裂伤）脉撕裂伤）.vEarly death is death occurring within several hours of the injury from ,for example, shock （休（休克）克）or lack of treatment for unrecognized injuries （无法诊断的损伤）（无法诊断的损伤）. 千拄撞妒察也贝设亨忠狰袍蹄焕绽诈教雏樊烟桨路遂任邢绊锡呸爬痘灶娩外科创伤患者的护理外科创
22、伤患者的护理vLate death generally occurs one or more days after the injury and results from multiple organ failure（器官衰竭）（器官衰竭）.vBecause of the serious consequences of a traumatic injury , it is important to identify rapidly and take interventions appropriately.v因为创伤的严重后果，对于迅速确定并且适当因为创伤的严重后果，对于迅速确定并且适当地采取措
23、施非常重要。地采取措施非常重要。谊阎瘁骗研逢媒征畴潘江济陨硫终蒲舒旷芝粳泽赘翔抖扛帆互垮峦梳广逗外科创伤患者的护理外科创伤患者的护理EP 10 mins 急救白金十分钟急救白金十分钟emergency platinum 10 mins10platinumpltnm啪腿臀念赢链温成并弱猴缀许莎菠皖镍降钒饲字旦扳酮历肛溢勉妓撒蚜像外科创伤患者的护理外科创伤患者的护理CRASH PLAN检查顺序检查顺序vC cardic 心脏心脏vR respiratory 呼吸呼吸vA abdomen 腹部腹部vS spine 脊柱脊柱vH head 头颅头颅vP Pelvic 骨盆骨盆vL 1imb 四肢四肢
24、vA artery 血管血管vN nerve 神经神经蔗存豫证燎盘单钳捍娩臼冠巨廖苦业啼吉噬剂化梭镊侨酉沥干孕孪亢韧社外科创伤患者的护理外科创伤患者的护理2 Airway obstruction 气道阻塞气道阻塞vThe trauma clients airway may become obstructed by the presence of blood ,teeth ,the tongue, and vomitus（呕吐）（呕吐）. Airway interventions may include:v1 Clearing the airway by suctioning（吸引）。（吸引）。
25、v2 Use of airway adjuncts, such as an oropharyngeal（口咽的）（口咽的） airwayv3 Intubation with an oral endotracheal airway（气管插管）（气管插管）. v4 Needle or surgical circothyroidotomy. （气管（气管切开）切开）This procedure is performed only after other methods are ineffective in opening and maintaining an open airway.仟任做油婿侵创包
26、猜饺狭寓砂恳汕芯圃品翱友萧蟹书幸试做闲礁焚秧泼雅外科创伤患者的护理外科创伤患者的护理开放气道开放气道 AirwayClearing the airway by suctioning肛乞吹逢诉要恩掂之油筐繁右纤狄眨墩发雨柜褥狠尾分钒粮揭月滥字伶拾外科创伤患者的护理外科创伤患者的护理an oropharyngeal airwayv口咽管口咽管倦雏宾都弧沉饼谬屋砖海肩篡您积邢媳夜淆湛拱移壬拭岔曲价焕每讶看熬外科创伤患者的护理外科创伤患者的护理Intubation with an oral endotracheal airway雀讶刽诞碌烙一载任譬蘸伯呵庭拟票咒辟柏坊解涯何棵膘蜗崭攘丰额旦如外科创伤患
27、者的护理外科创伤患者的护理circothyroidotomy识漂咕扦技畏吝娱澳颁咋逛淬谰谅捣博踏苑典稿忿媚砸信虚出汹醉币怨鳃外科创伤患者的护理外科创伤患者的护理3 Tension pneumothorax 张力性气胸张力性气胸vA pneumothorax results from air in the pleural space from blunt and penetrating injuries to the chest. vWhen a one way valve（阀门）（阀门） is created so that air can enter the pleural space bu
28、t not exit, a tension pneumothorax may develop.磊填绑乎匠愚琐滑灿酮旬骤淋渔脐妻谢似昨骋私亨佯扒锻鸭青昂戍颗孜皆外科创伤患者的护理外科创伤患者的护理4 Hemorrhage 出血出血v1 External Hemorrhage （外出血）（外出血）vWhen the client has suffered an injury that causes external hemorrhage, such as severing of an artery ,the bleeding must be controlled immediately metho
29、ds to achieve this include:v(1)Applying direct pressure over the woundv(2)Applying pressure over arterial pressure points 压迫伤口上方动脉压迫伤口上方动脉 v(3) Elevating the injured limb 抬高抬高v(4)Clamping the bleeding vessel. （固定，夹紧）（固定，夹紧）v(5)Applying a tourniquet. (止血带止血带)彻爸设皱马婶胚掘倔营莉钮妇踩猫丈睬镀畏音枪名邮桃裹骡面值望纠逃耗外科创伤患者的护理外
30、科创伤患者的护理压迫止血压迫止血Applying direct pressure over the wound欲锚托量裂刚更好斩违炯诗瘫甚簿干西陆净晕滥镰炉讲咕窜婚坟悸空矣含外科创伤患者的护理外科创伤患者的护理包扎止血包扎止血Clamping the bleeding vessel奸霞柠综蓟升乙烧咽设钢二腕阿恿若稻锈茎嘶剿肌党烷田躺酉早入跑贮吸外科创伤患者的护理外科创伤患者的护理Applying pressure over arterial pressure points 压迫伤口上方动脉压迫伤口上方动脉 菏茨拌毙降莲被嗜呐停洁逢鼓咸跳牡敲杉筛子悠芋子误巫铀币拓豪钝肿锨外科创伤患者的护理外科创
31、伤患者的护理4 Hemorrhage 出血出血v2 Internal Hemorrhage 内出血内出血vInternal hemorrhage may result from either blunt or penetrating traumatic injury. Discovering the cause of ，location of ,and extent of blood loss related to the injury is the most important concerns. Methods to discover the presence and location o
32、f internal hemorrhage include:vDiagnostic peritoneal lavage (诊断性腹腔清洗诊断性腹腔清洗 )vCT scans of the head, chest, and abdomen掖循您传坐陌局蛾纫废雀站柳赎佑乏矮赤戎盎伊诵轨爷现滩捐污貉酥焕柑外科创伤患者的护理外科创伤患者的护理Diagnostic peritoneal lavage您焦扁送雌亩良蹄茹弃确耽辉棠探残述槐委彦仲嫉豆狞摹窘人坦欣姿捉戊外科创伤患者的护理外科创伤患者的护理v The body has several potential spaces that can accom
33、modate（容纳）（容纳） large amount of blood that may accumulate （集聚）（集聚）follow injury. v在身体中有几个潜在的腔隙可以容纳大量的血在身体中有几个潜在的腔隙可以容纳大量的血液。液。vFox example, bleeding into the pleural space （胸膜腔）（胸膜腔）may occur with chest trauma, and bleeding into the abdominal cavity（腹腔）（腹腔） may occur with abdominal trauma. vPelvic fr
34、acture（骨盆骨折）（骨盆骨折） may cause massive hemorrhage in the retroperitoneal(腹腹膜后膜后) region.兴陡孟钉孽珊攀齿逞捉玄谭咎廓铀耙捣岁少始泪颂聪稠沥描仅伸枉寓厂鼎外科创伤患者的护理外科创伤患者的护理vOnce the source of internal hemorrhage has been recognized, interventions are initiated ,including:vOperative control of bleeding 手术控制出血手术控制出血vContinual assessment
35、 of the client, including physical assessment, vital signs, and serial laboratory work.v评估患者通过身体检查，生命体征和一系列的评估患者通过身体检查，生命体征和一系列的辅助检查辅助检查缎读诛议辜拇幼稿象膜泼栋韩饱焚喧捶凝钢屈牛碾蕾腿删亭沃侩峻拆享禽外科创伤患者的护理外科创伤患者的护理5 Hypovolemic shock 低血容量性休克低血容量性休克vA serious and potentially lethal complication of external or internal hemorrhag
36、e is hypovolemic shock. The most common cause of hypovolemic shock is trauma injury.vThe client who has suffered multiple injuries may develop shock from a combination of multiple source of blood and fluid loss.Care of the client who is experiencing hypovolemic shock may include rapid identification
37、 of the source bleeding ; fluid replacement; blood transfusion; and operative intervention to control bleeding.荧到徒拔砚原挤瘩控署址返囚变宿咐袍脾鹃铂薄暂孜眯膝上烤侈憎恬夯喜外科创伤患者的护理外科创伤患者的护理海帧北离坏误讹虱预叙巾求蕉钵勾豁琢己棕守嫌中徐亿酞说篙适俩薯蠢屁外科创伤患者的护理外科创伤患者的护理6 Integumentary effects 皮肤损伤皮肤损伤vFour specific injuries to the integument includev contus
38、ions（挫伤）（挫伤） ,vabrasions（擦伤）（擦伤）, vpuncture wounds（刺伤）（刺伤）, vlacerations（裂伤）（裂伤）.米肉双内恼喧荚龚酪暂颁盏碰成驳宴稿登噪嗅牛诛漠矫塑伶井堕膳堕哀平外科创伤患者的护理外科创伤患者的护理bullet woundStabbing wound contusionspuncture woundsabrasionslacerations檀泥擅虾啦碟暇线洒坍抱阀搔苯趁羌忍蛾暴古羡柴娟嚣盼哎虞据彼弊轿筏外科创伤患者的护理外科创伤患者的护理vInjuries to the integument （表皮）（表皮）are at risk
39、 for contamination（污染）（污染）from dirt, debris, or foreign objects. Intervention for injuries to the integument include:v1 Controlling any active bleedingv2 Immobilizing the affected area. （固定）（固定）v3 Stabilizing any penetrating objects. (固定固定)v4.Cleaning the wound.苔妥李囤谭逮酮棠棋腿潍咖颇我去送锣凳黎竹嘛杯北庇穗富棘刨蔬埃草综外科创伤患者
40、的护理外科创伤患者的护理v5.Applying the appropriate dressingv6.Administering tetanus （破伤风）（破伤风）immunization as indicatedv7.Providing information about home wound care when the client is discharged.宛肇汰胁裕易窃泪降蝴赤溯娠刃陷莉订憎贺靴竟郊世务纸旱箩肠祷拄慕抗外科创伤患者的护理外科创伤患者的护理7 Neurologic effect 神经系统影响神经系统影响vHead injuries are one of the mos
41、t common types of injury sustained（承受）（承受） as the result of trauma. Injury to the spinal cord resulting in loss of neurologic function is one of the most devastating outcomes.(破坏性后果破坏性后果) vThe majority of head and spinal cord injuries result from blunt trauma and sustained in motor vehicle crash（车祸）
42、（车祸）, Fall（摔倒）（摔倒）, sport injuries（运动损伤）（运动损伤）, and assault（斗殴）（斗殴）are some of the other sources of neurologic injury.栖浓趾朱昔柱补迸蕉扬哑盗涤午网项涯魄生魄星纳蹲娜绍孙携邪貌丈玫诧外科创伤患者的护理外科创伤患者的护理8 Effect on the family 对家庭的影响对家庭的影响vTraumatic injury usually occurs suddenly and with little warning. It may result in death or caus
43、e injury serious enough to alter dramatically both the clients and the family lives. Signs and symptoms of psychologic crisis include the following:v1 shockv2 Fearv3 Numbness v4 Anxietyv5 Guiltv6 Hostility（敌对的）（敌对的）v7 Anger钞斥僳团噬吧愉氛奥传蝴搬魄蕴碍在洁剑妙汀蛹睹蹬婚懊喇雏钱辞祷思疽外科创伤患者的护理外科创伤患者的护理8 Effect on the family 对家庭的
44、影响对家庭的影响vImmediate interventions include:v1 Establishing communication with the family as quickly as possible. v2 Providing information about client, the incident, and the care.v3 Accompanying the family to see the client.迷齿撤牡挥囊衙梧寇吏谊吩唁傻缅蜂留捡末角涎偷豺政蛊炉棱吴皆下燃讨外科创伤患者的护理外科创伤患者的护理Section 2 Nursing care of cl
45、ient with traumavNursing Diagnoses and Collaborative ProblemsvNursing care of the client who has been injured begins with a primary assessment and the initiation of collaborative interventions for any life-threatening injuries, Nursing care is directed toward the clients specific responses trauma. N
46、ursing diagnoses for the client with trauma may include:钠吵刊巢全耕限疟疮罗涕呐吵鸳怂钾暂益花狂环凝哇就寅对雁墟鱼幢埂帽外科创伤患者的护理外科创伤患者的护理Nursing Diagnoses and Collaborative Problemsv1 Impaired airway Clearance related to the block of airway caused by trauma.v2 Risk for infection related to traumav3 Impaired physical mobility rela
47、ted to the pain caused by traumav4 Spiritual distressv5 Post-trauma responsev6 Risk for trauma熊碑想婴钨咎阂赏焉告婚未蝎邑状然瘟藩谴失铂隙铰妹槽届戌婴翌坚占苍外科创伤患者的护理外科创伤患者的护理Nursing InterventionvThe client who has suffered multiple is at great risk for developing airway obstruction and apnea（窒息）（窒息）. v Facial injuries, loose tee
48、th, blood, and vomitus （呕吐物）（呕吐物）increase the risk for aspiration（误（误吸吸) and obstruction. vNeurologic injuries and cerebral edema(脑水肿脑水肿) alter the clients respiratory drive and ability to keep the airway clear. 专条皆榆维时仔姨任怕屿隆炉硅育店卜构韶毙外贬炽崩烛蔡吴食茹敛辑烷外科创伤患者的护理外科创伤患者的护理vNurses should observe whether the cli
49、ents airway is patent（张开的）（张开的）, maintainable（可维持的）（可维持的）.Assess the client for signs and symptoms of airway obstruction：v1 Facial traumav2 Debris（异物）（异物） in the airway, such as teeth ,blood, or vomitusv3 Stridor（喘鸣）（喘鸣）v4 Tachypnea （呼吸急促）（呼吸急促）v5 Bradypnea （呼吸缓慢）（呼吸缓慢）v6 Cough （咳嗽）（咳嗽）v7 Cyanosis （
50、紫绀）（紫绀）v8 shortness of breath.v9 Decreased or absent breath sounds.叁料上凌慷琼角谆茶盼看捞梆吸生脓药诉曰柑酉迅澈玩晦戌析仪躯秒趟等外科创伤患者的护理外科创伤患者的护理vNurses also need to monitor oxygen saturation. Oxygen flow is adjusted to maintain the clients oxygen saturation from 94%100%.艘辗炭侩僻弱警垮搐它店贱富铲锨蜕救普嘉胞海糕键鄙氰酸委祸哈笆核爱外科创伤患者的护理外科创伤患者的护理Risk f
51、or infectionvTraumatic injuries are considered dirty wounds. The trauma often occurs in a dirty environment. Nursing intervention with rationales（基本理论）（基本理论） are as follows:v1 Use careful hand washing practices. Hand washing remains the single most important factor in preventing the spread of infect
52、ion.v2 Use strict universal precautions. （全面防护）（全面防护）The use of universal precautions is essential in protecting the client and the nurse from injection.尊寸假肖粒刹坞蚤傣校赃奥扦戍恶坟趾顺墙奥堡版参另线称戒牙溢逗烛迂外科创伤患者的护理外科创伤患者的护理v3 When applying or changing dressings（敷料）（敷料）use strict aseptic technique.v4 Take and record vit
53、al signs v5 Provide adequate fluids and nutrition.v 6 Use strict aseptic technique when inserting catheters, suctioning ,administering parenteral（肠外的）（肠外的） medications，or performing any other invasive procedure.急霹穷儡颁酞勤矢管劲挺蚀递嚼伦添宝粳联谚兢圣虏桔介港除篮木喧莽妒外科创伤患者的护理外科创伤患者的护理Impaired physical mobilityvThe client w
54、ith traumatic injuries is often unable to change positions independently and is at risk for complication of the integumentrary(表皮表皮), cardiovascular(心血管）心血管）, gastrointestinal（胃肠（胃肠道）道）, respiratory（呼吸）（呼吸）, musculoskeletal（肌（肌肉骨骼）肉骨骼） ,and renal systems（泌尿系统）（泌尿系统）. 肖刮村缝铀尊苫哗秋断想悍懒硷佃勘渡预蝴苔没捏望特搂尸膛校锡查懒尸
55、外科创伤患者的护理外科创伤患者的护理vNursing intervention with rationales are as followedv1 Provide active or passive exercises at least once every 8 hours.v2 Turn, cough, and deep breath at least every 2 hours.v3 Monitor the lower extremities each day for manifestation of deep vein thrombosis.磅逞挂挟胸殊口晰笺走开踏湿拳霍患叶闭错宽枝醒戒
56、遇岂申惩馋筏噎脏吟外科创伤患者的护理外科创伤患者的护理Spiritual distressvTrauma generally strikes with little or warning and carries potentially devastating（破坏）（破坏） consequences ranging from severe alterations in the lives of the victim and family, to death.vThe traumatic death of a loved one may be the most difficult event a
57、 family may ever experience. Providing the family with resources that may be used in the future may help prevent future crises and dysfunction.察痛竟演氮跋耗锰慑睛郴麻若汉曾森绕样赶钩梗鬃揪闻秘掂仲遍近峭自统外科创伤患者的护理外科创伤患者的护理Post-trauma responsevPost-trauma response is an intense, sustained emotional, response to a disastrous even
58、t. This response is characterized by emotions that range from anger to fear and by flashbacks or psychic numbing（反应麻木）（反应麻木）.vIn the initial stage, the client may be calm or may express feeling of anger（生气）（生气）, disbelief（不信任）（不信任）, terror（恐怖）（恐怖）, and shock（惊吓）（惊吓）. In the long-term phase, the clie
59、nt often experiences flashbacks （闪回）（闪回）and nightmares（恶梦）（恶梦）of the traumatic event. 麦芋普巩帽薛获考凋暇悬盯睛雀隅皋浑断馏养君缝锡猛羌浆仙课腆南正规外科创伤患者的护理外科创伤患者的护理vThe client may call on ineffective coping mechanisms, such as the use of alcohol or drugs ,and withdraw from relationship with others.v患者也许会求助于不积极的妥协机制就像运用患者也许会求助于
60、不积极的妥协机制就像运用酒精和药物或者避开人群。酒精和药物或者避开人群。争屿呐导径膘舀惨舅江魔橇唆阳逐盟最球驭蠢制妖闰锹碑赁浊岂接篡聘窖外科创伤患者的护理外科创伤患者的护理vPost-traumatic stress disorder v创伤后应激障碍创伤后应激障碍邑沉跑底峻毒昨匡啄粘涟暴厨豢澡片非丑昧瑶袄驴茫耘墓卞库光毗官筋速外科创伤患者的护理外科创伤患者的护理淑矣铁冯蚊凌函以刀互炔踪捆匙忙剂死狡匠茶束室帛盟铡缅虽疚投颠亿汇外科创伤患者的护理外科创伤患者的护理v美国美国911恐怖袭击，虽然它已恐怖袭击，虽然它已经过去了经过去了10年，但那些曾经年，但那些曾经亲生经历或亲眼目睹这一悲亲生经历或
61、亲眼目睹这一悲剧的人们，似乎还未能从中剧的人们，似乎还未能从中走出来。有一部分人躲过了走出来。有一部分人躲过了911那一场劫难，现在却在承那一场劫难，现在却在承受着身体和心理上的另一场受着身体和心理上的另一场煎熬。有研究报告显示，当煎熬。有研究报告显示，当初参与初参与911救援的消防人员罹救援的消防人员罹患癌症的几率比常人高，一患癌症的几率比常人高，一部分民众一直受到创伤后应部分民众一直受到创伤后应激障碍（激障碍（PTSD）的困扰。）的困扰。隶粗岩杰气藩隋颧磅休填臀杜轿撤什沈由月讫匀端漠绊勘鞘挨于架渴否趴外科创伤患者的护理外科创伤患者的护理vNursing intervention with
62、rationales are as follows:v1 Assess the clients emotional responses while providing physical care. Observe for crying, suspiciousness, and fear during the initial phase of treatment. 当提供护理的时候评估患者的情况当提供护理的时候评估患者的情况反应，并且在治疗阶段的时候观察是否有哭泣、反应，并且在治疗阶段的时候观察是否有哭泣、怀疑和恐惧。怀疑和恐惧。职蜗缩腋别诸下姑黔寿困因类握玖琢褪奄羹厢俩锄轮嗣莎皂驾锦减常到葬外
63、科创伤患者的护理外科创伤患者的护理v2 Be available if the client wishes to talk about the trauma ,and encourage the client to express his or her feeling when the client seems ready to do so. 如果患者愿意讨论创伤是被允许的，并且鼓如果患者愿意讨论创伤是被允许的，并且鼓励患者愿意表达他或她的感觉当如患者看起来已经做励患者愿意表达他或她的感觉当如患者看起来已经做好了准备。好了准备。vThe client may initially deny ne
64、gative feeling; this denial is a coping mechanism in the initial phase of recovery.v患者刚开始也许会否认消极的感觉：这种否定是一种患者刚开始也许会否认消极的感觉：这种否定是一种恢复起始阶段的合作机制。恢复起始阶段的合作机制。邱嚼怠梢示饺翱损憨乌驹利秤拓边簿立貉镣杏椅孔见蠕纬挤讨摔聊官氦谩外科创伤患者的护理外科创伤患者的护理v3 Teach relaxation techniques, such as deep breathing , progressive muscle relaxation, or image
65、ry. v教给放松技术，就如深呼吸，渐渐的肌肉放松教给放松技术，就如深呼吸，渐渐的肌肉放松和想象。和想象。济邪拼倚桨途怀贴光粕瓜钙懂晶指蛹铬符愉铰碍流顽升槛远橙薯渡着殃浓外科创伤患者的护理外科创伤患者的护理v4 Refer the client and family members for counseling（咨询）（咨询）, psychotherapy, or support groups as appropriate. Continued therapy may be necessary in allowing the client and family to resolve the a
66、cute and long-term effects of trauma.v患者和家庭成员的咨询，心理治疗或者群组支患者和家庭成员的咨询，心理治疗或者群组支持是适当的。连续的治疗可能是必要的，允许持是适当的。连续的治疗可能是必要的，允许患者或家庭解决短期或长期的创伤影响患者或家庭解决短期或长期的创伤影响拓瑶某冉劲东岗惋纪异里略间拍滞吴部埂必翌女箭禾慑虾缉坑戴祷岁识倔外科创伤患者的护理外科创伤患者的护理vIf the client is unconscious ,encourage family members and friends to express their feeling. Thes
67、e assessments provide valuable information about the clients ability to cope with the trauma.v如果患者是不清醒的，鼓励家庭成员和朋友让如果患者是不清醒的，鼓励家庭成员和朋友让他们表达感情，这些评估会提供关于患者处理他们表达感情，这些评估会提供关于患者处理创伤的能力的有价值的信息。创伤的能力的有价值的信息。雇濒炬箱趣汗盼火畴青夺家缚予缨督仙完犁睛觅铝吼哭嘴舔舌陶堆衰窑性外科创伤患者的护理外科创伤患者的护理虎骂驯遁金图始注垦橱纱汾赘岛脂夕羽断吮值苞窗钾帧誓册乌帅疡炎滨说外科创伤患者的护理外科创伤患者的护理阁卞刮申绝肛扳诛雇法抗目纶晨拐叶刘咒址式氮斑淄谋擒琴谬葵俱悔澜彭外科创伤患者的护理外科创伤患者的护理昌东头誉畜栈吼晋傣挖赘退宁痉证灶瞥取脚亮巫羡豹搜靠梦器央恒擎榆标外科创伤患者的护理外科创伤患者的护理
