帶狀皰疹三區(qū)終極版

1、護(hù)理臨床查房護(hù)理臨床查房 Clinical nursing ward round 國(guó)際住院部二科三區(qū)國(guó)際住院部二科三區(qū) I.M.C Inpatient Dept.2 Ward.3人員介紹人員介紹 會(huì)診醫(yī)師 consulting staff掌握帶狀皰疹的護(hù)理。熟悉帶狀皰疹的病因、臨床表現(xiàn)及治療方法。Be familiar with the the risk factors,clinical manifestation and treatment of 提升護(hù)理人員的英文水平和學(xué)習(xí)興趣 Promote the English level and enhance the interest of nu

2、rses in English learning. 陽(yáng)吉菊女 69歲D: Hello ,Mrs Yang, my name is Dr Du,I am a doctor of Internal Medicine.I will be looking after you,how can I help you?P: Yes please!D: How old are you?P: 69 現(xiàn)病史現(xiàn)病史l患者主因陣發(fā)頭痛 1年，加重2天。l于4月10日為進(jìn)一步 檢查收入我科。 Present HistoryD: Please tell me whats wrong with you?P: I have

3、had bad headache for 2 days.D: Have you had this pain before?P: Come in waves for a year. 現(xiàn)病史現(xiàn)病史l無(wú)明顯誘因陣發(fā)右側(cè)頭痛，為針刺樣。l無(wú)頭暈、嘔吐、視物模糊等伴隨癥狀,睡眠不佳。Present HistoryD: Please point to where you feel pain?P: On my right side.D: Tell me what the pain is like?P: stabbing，it kept me awake.D: Do you have dizziness or

4、 vomit?P: No.D: Do you have blurring of vision?P: No.現(xiàn)病史現(xiàn)病史l頭顱CT無(wú)出血灶。Present HistoryD: Have you had any tests recently?P: I had a head CT and no hemorrhage.既往史既往史 l 有腔隙性腦梗死病史l 否認(rèn)冠心病、高血壓、 糖尿病史l 否認(rèn)藥物過敏史l 預(yù)防接種史不詳Previous History D: Do you have any existing medical health problem?P: Lacunar infarction.D

5、: Do you have any allergies?P: No,not that I know of. D: Are your vaccinations current?P: I am not sure.家族史家族史l家族中無(wú)類似病史， 否認(rèn)家族遺傳病史。Family History D: Do you have a family history of health problems?P: No個(gè)人史個(gè)人史l生于原籍l否認(rèn)疫區(qū)居住史l否認(rèn)毒物接觸史,l無(wú)煙酒等不良嗜好Personal HistoryD: Where are you lived in?P: Where I was born.

6、D: Is there anything you need to tell me that you think will be useful?P: No.D：你還有什么問題需要問我嗎？P：現(xiàn)在沒有。D：如果你有什么問題，你可以問護(hù)士，如果她不知道怎么辦，她會(huì)找知道的人來幫助你。D: Are there any questions you would like to ask me?P: No,not right now.D: If you have any problems,please ask the nurse,if she cant help you,she will find someo

7、ne who can.P：好的，非常感謝。D：不客氣，再見。P: Ok,thanks very much.D: Youre welcome,see you later. 經(jīng)查閱病歷、詳細(xì)詢問病史及查體后指示：患者目前頭痛部位以右側(cè)頭皮皮疹處為著，無(wú)顱內(nèi)高壓癥狀及體征，建議聯(lián)系皮膚科專家會(huì)診進(jìn)一步明確，密切觀察病情。 Reviewing the case, detailed inquiring medical history and examing , it is indicated that the patient headache location mainly at the right s

8、calp rash, havet symptoms and signs of intracranial hypertension. Recommended contact dermatologist to diagose and obseve patients condition. 會(huì)診會(huì)診 查體：右側(cè)頭皮、耳后、頸部散在小片片狀紅斑、丘疹，其上散在水皰，部分破潰滲出，觸痛。診斷為帶狀皰疹。外用 青鵬軟膏口服 鹽酸伐昔洛韋1g 3/日 維生素B1片20mg3/日 甲鈷胺片500mg3/日 普瑞巴林膠囊75mg2/日 Dermatology consultation: cluster red p

9、apules on examination found that left back, a diagnosis of herpes zoster. External use: Qing peng ointment. Take orally: Three times a day galloway hydrochloric acid; Three times a day vitamin B1; Three times a day a piece of cobalt amine; Two times a day lyrica capsule. 帶狀皰疹是由水痘-帶狀皰疹病毒(varicella-zo

10、ster virus,VZV)引起的一種沿某一脊神經(jīng)或顱神經(jīng)單側(cè)分布的簇集性水皰和神經(jīng)痛為特征的病毒性皮膚病。Herpes zoster is caused by the varicella-zoster virus a along a spinal nerve or the distribution of the cranial nerve unilateral cluster blister and neuralgia of the viral skin diseases.定義定義 Definition診斷診斷 Diagnosis病變皮膚出現(xiàn)簇集成群水皰，沿一側(cè)周圍神經(jīng)呈帶狀分布。有明顯的

11、神經(jīng)痛，伴局部淋巴結(jié)腫大。中間皮膚正常。the blister along one side of the peripheral never on the attached skin.Has obvious neuralgia, with local lymph node enlargement.Middle normal skin.診斷診斷 Diagnosis從水皰液中分離chu病毒或檢測(cè)VZV，HSV抗原或DNA是鑒別診斷唯一可靠的方法。Find the vzv、the HSV antigen or DNA is the only reliable reason for the diagn

12、oise.病因及發(fā)病機(jī)制病因及發(fā)病機(jī)制Etiology and pathogenesis VZV 呼吸道黏膜respiratory mucosa 血 液blood 顱神經(jīng)的感覺神經(jīng) 水痘 varicella 隱性感染inapparent infection 脊髓后根神經(jīng)節(jié) 機(jī)體抵抗力下降 VZV被激活 沿感覺神經(jīng)下行 支配區(qū)域的皮膚復(fù)制復(fù)制 水皰 blister 神經(jīng)炎neuritis典型表現(xiàn)典型表現(xiàn)General manifestation前驅(qū)癥狀：輕度乏力、低熱、納差等全身癥狀，患處皮膚自覺灼熱感或者神經(jīng)痛，觸之有明顯的痛覺敏感，持續(xù)13天，亦可無(wú)前驅(qū)癥狀即發(fā)疹。Weak,low-grad

13、e fever,poor appetite,loucal burning heat sensation or neuralgia,obvious sense of pain last 1-3 days, before blister,also blister with no formanifestation.典型表現(xiàn)典型表現(xiàn)General manifestation好發(fā)部位：肋間神經(jīng)、頸神經(jīng)、三叉神經(jīng)和腰骶神經(jīng)支配區(qū)域。Predilection:the skin govened by intercostal nerve,cervial nerve,trigeminal,lumbosacral

14、nerve.典型表現(xiàn)典型表現(xiàn)General manifestation出疹特點(diǎn)：首先出現(xiàn)潮紅斑，很快出現(xiàn)粟粒至黃豆大小的丘疹，簇狀分布而不融合，繼之迅速變?yōu)樗挘挶诰o張發(fā)亮，皰液澄清，外周繞以紅暈，各簇水皰群間皮膚正常。Red spot firstly, papule soon,and then the blister with circumambient flush.典型表現(xiàn)典型表現(xiàn)General manifestation皮損特點(diǎn)：沿某一周圍神經(jīng)呈帶狀排列，多發(fā)生在身體的一側(cè)，一般不超過正中線。Zonation Injury along some of peripheral nerve,

15、 always one of the side of the body ,not cross the midline.典型表現(xiàn)典型表現(xiàn)General manifestation神經(jīng)痛，可在發(fā)病前或伴隨皮損出現(xiàn)，老年患者常較為劇烈。病程一般23周，水皰干涸 、結(jié)痂脫落后留有暫時(shí)性淡 紅斑或色素沉著。 Neuralgia before the blister or following the skin injury,especially the older.Course of the diease always 2-3 weeks, temporary erythema.特殊表現(xiàn)特殊表現(xiàn) Spec

16、ial manifestation眼帶狀皰疹眼帶狀皰疹 三叉神經(jīng)眼支受累，眼瞼紅腫，結(jié)膜充血，可累及角膜形成潰瘍性角膜炎，疼痛劇烈。herpes zoster ophthalmicus Eyelids red swollen、 conjunctival congestion and maybe the ulcerative keratitis with severe pain by suffering from the eye branch of trigeminal.特殊表現(xiàn)特殊表現(xiàn) Special manifestation耳帶狀皰疹耳帶狀皰疹 病毒侵犯面神經(jīng)及聽神經(jīng)所致，表現(xiàn)為外耳道或鼓

17、膜皰疹?？沙霈F(xiàn)面癱、耳痛及外耳道皰疹三聯(lián)癥，稱為RamsayHunt綜合征。herpes zoster oticus 此患者即為此特殊類型！此患者即為此特殊類型！特殊表現(xiàn)特殊表現(xiàn) Special manifestation帶狀皰疹后遺神經(jīng)痛帶狀皰疹后遺神經(jīng)痛 帶狀皰疹常伴有神經(jīng)痛，在發(fā)疹前、發(fā)疹時(shí)以及皮損痊愈后均可發(fā)生，但多在皮損完全消退后或者1個(gè)月內(nèi)消失，少數(shù)患者神經(jīng)痛可持續(xù)超過1個(gè)月以上。minority Neuralgia lasts more than 1 month. 特殊表現(xiàn)特殊表現(xiàn) Special manifestation其他不典型帶狀皰疹其他不典型帶狀皰疹 頓挫型；不全型；

18、大皰型、出血性、壞疽型和泛發(fā)型 ；播散型帶狀皰疹。 Others Forme fruste(only neuralgia);incomplete(red spot,papule);big blister;bleeding,gangrenous,generalized and disseminated.全身治療全身治療 Systemic treatment抗病毒治療（盡早應(yīng)用伐昔洛韋）止痛藥干擾素皮質(zhì)醇類激素Antiviral therapy (use valaciclovir as early as possible)PainkillerInterferonCortisol hormone局部

19、治療局部治療 Local treatment復(fù)方鋅銅溶液或3%硼酸溶液作局部濕敷，外用3%5%阿昔洛韋霜，1%噴昔洛韋霜，干擾素-2b涂布劑，0.5%酞丁安搽劑等。眼部帶狀皰疹可用3%阿昔洛韋眼藥水，0.5%碘苷液，干擾素眼藥水點(diǎn)眼，34次/d。Wet packing with compound zinc copper solution, 3%5% Acyclovir、1% Penciclovir、 -2b interferon 、 0.5% Ftibamzone applecations3% Acyclovin eyedrop、0.5% lodine glycosides liquid、in

20、terferon 3-4 times every day for the herpes zoster ophthalmicus局部治療局部治療 Local treatment物理療法：可用紫外線局部照射，音頻電療法和氦氖激光照射消炎止痛，縮短病。針刺療法。Naturopathy:irrradiate with ultraviolet rays,helium and nitrogen laster；audioferquency current therapyAcupuncture therapy護(hù)理診斷護(hù)理診斷 Nursing diagnosis 1.1.疼痛疼痛 2. 2.舒適的改變舒適的改變

21、 3. 3.皮膚完整性受損皮膚完整性受損 4. 4.焦慮焦慮 Pain Comfort , alteredSkin integrity , impairedAnxiety護(hù)理措施護(hù)理措施 Nursing Intervention 診斷診斷1:1:疼痛疼痛 -與疾病引起的神經(jīng)痛 有關(guān)護(hù)理措施護(hù)理措施-遵醫(yī)囑給予鎮(zhèn)痛劑-做好心理護(hù)理，充分發(fā)揮心理鎮(zhèn)痛效應(yīng)。Pain related to the neuralgia Implementation -Give the analgesic as the doctors older -Psychological nursing 護(hù)理措施護(hù)理措施 Nursi

22、ng Intervention 診斷診斷2:2:舒適的改變舒適的改變 -與所患疾病引起疼痛及體位受限有關(guān) 護(hù)理措施護(hù)理措施1. 密切觀察病情變化，取舒適臥位。2. 盡量保持病房安靜，減少不良刺激。 Comfort , altered -related to the pain and limited position Implementation -Observe the changes of illness closely, get the comfortable lying position -Reduce the pessimal stimulation護(hù)理措施護(hù)理措施 Nursing I

23、ntervention 診斷診斷3:3:皮膚完整性受損皮膚完整性受損 -與疾病引起的水皰破裂 有關(guān)Skin integrity , impaired- related to the blisters rupture 護(hù)理措施護(hù)理措施 Nursing Intervention Implementation -Antiphlogosis、arefaction mainly -No scratching,improve patient training,to prevent the spread of lesions. 護(hù)理措施護(hù)理措施1.皰疹處以消炎、干燥為 主。2.不要搔抓患處，加強(qiáng)患者宣教，避

24、免病灶擴(kuò)散。改英文部分護(hù)理措施護(hù)理措施 Nursing Intervention護(hù)理措施護(hù)理措施3.泡液未破：阿昔洛韋乳 膏涂抹。4.皰疹破潰后：雙氧水、生理鹽水清洗，再用0.5%甲硝唑液局部濕敷。Implementation-Acyclovir applecations with the whole blister-Douche with hydrogen peroxide and normal saline、local wet packing with 0.5% metronidazole when rupture.護(hù)理措施護(hù)理措施 Nursing Intervention 診斷診斷4:4

25、:焦慮焦慮 - 與擔(dān)心疾病預(yù)后有 關(guān)。 Activity Intolerance - related to the illness prognosis護(hù)理措施護(hù)理措施 Nursing Intervention 護(hù)理措施護(hù)理措施1. 向病人及家屬講解疾病相關(guān)知識(shí)、成功治療經(jīng)驗(yàn)，增強(qiáng)戰(zhàn)勝疾病的信心。2.宣傳重視預(yù)防頸椎病，避免情緒波動(dòng)，及時(shí)開導(dǎo)患者，緩解頸椎病的癥狀和預(yù)防復(fù)發(fā)。Implementation- introduce the information about the VZV and the successful treatment experiences to the patiences and the relatives.-disseminate to prevent cervical spondylosis , avoid mood swing.護(hù)理措施護(hù)理措施 Nursing Intervention 護(hù)理措施護(hù)