【英語(yǔ)護(hù)理查房】PPT課件

1、IntussusceptionIntussusceptionNURSING ROUNDPediatric Surgical Department2015.9.251234ContentsContents Case ReportName Name ：Chen JingyaChen Jingya Sex Sex： female female Age Age： 7-month-old 7-month-old Date of Admission Date of Admission：2015-04-23 14:402015-04-23 14:40 Case Report paroxysmal cryin

2、gparoxysmal crying vomitingvomiting bloody stool bloody stool : :I Intussusception unable to resetntussusception unable to resetCase Report Case ReportAcute IntussusceptionAcute IntussusceptionT:36.9 P:110/minT:36.9 P:110/min R:20/min Wt:7.5kg R:20/min Wt:7.5kgroutine bloodroutine bloodroution urine

3、roution urinefull biochemicalfull biochemicalfull blood coagulation testfull blood coagulation testHIV,HBV,HCV,RPRHIV,HBV,HCV,RPR 2015-04-232015-04-232015-05-052015-05-05 Case Report KnowledgeKnowledge ofof I IntussusceptionntussusceptionEtiologySymptoms & SignsDefinitionIntussusception What is

4、intussusception?What is intussusception? Intussusceptionis a medical condition in Intussusceptionis a medical condition in which a part of the intestine has invaginated which a part of the intestine has invaginated into another section of intestineinto another section of intestine.Knowledge of Intus

5、susception-Definition Children intussusceptionChildren intussusception IntussusceptionIntussusception is is an common abdominal an common abdominal emergency in children. It is one of the most emergency in children. It is one of the most common causes of abdominal obstruction in common causes of abd

6、ominal obstruction in infants. infants. Knowledge of Intussusception-Definition ETIOLOGYETIOLOGY Knowledge of Intussusception. . Incidence:Incidence:Knowledge of Intussusception-Etiologyv Whats the reason of Whats the reason of the disease?the disease?v Why it happens to Why it happens to infants mo

7、stly? infants mostly?Knowledge of Intussusception-EtiologyKnowledge of Intussusception-EtiologyDietary alterationKnowledge of Intussusception-EtiologyTheThe complementary complementary foodfood of of childrenchildren can can not be not be changed changed tootoo soon. soon.It is supposed to be transf

8、ormed step by stepIt is supposed to be transformed step by step.Dietary alterationKnowledge of Intussusception-EtiologyKnowledge of Intussusception-Etiologyfeverfever(acute upper reappiratory (acute upper reappiratory tract infection)tract infection)lost its normal function /enterospasmlost its norm

9、al function /enterospasmDiseaseKnowledge of Intussusception-EtiologyKnowledge of Intussusception-EtiologyvR Researchers suspectesearchers suspect that that infectious agents: infectious agents: rotavirus&adenovirus.rotavirus&adenovirus.Virus infectionKnowledge of Intussusception-EtiologyvInt

10、ussusception causes have not clearly established Intussusception causes have not clearly established or understood.or understood.vThey can include infections, anatomical factors, They can include infections, anatomical factors, and altered motility. and altered motility. vS Studies and analysistudie

11、s and analysis have not conclusively have not conclusively established this. established this. Knowledge of Intussusception-EtiologyvA review of sparse data on the possible A review of sparse data on the possible association: the virus & intussusception has not association: the virus & intus

12、susception has not demonstrated until very recently. demonstrated until very recently. Knowledge of Intussusception-EtiologySymptoms and Signs1、General appearance2、Paroxysmal crying3、Bilious vomiting4、Red currant jelly stool5、Sausage-shaped massKnowledge of Intussusception Therapeutic ManagementTher

13、apeutic ManagementNonsurgical TherapyNonsurgical TherapySurgical TherapySurgical TherapyNonsurgical TherapyNonsurgical Therapy Air Enema Air Enema Barium EnemaBarium Enema Nonsurgical Therapy - Barium Enema Nonsurgical Therapy - Barium EnemaNonsurgical Therapy-Barium Enemacomplicationcomplicationc c

14、hemicalhemical peritonitisperitonitisNonsurgical Therapy- Barium EnemavIntussusception presenting 48 hours.Intussusception presenting 48 hours.vGood general appearance.Good general appearance.vWithout abdominal distention, high temperature Without abdominal distention, high temperature and toxicosis

15、 and toxicosis . ETIOLOGY1.Indications1.IndicationsNonsurgical Therapy- Air Enema 2.Procedure2.Procedure Restrained the patient, inserted the Foley catheter into rectum, inflated the balloon.Nonsurgical Therapy- Air Enema 2.head of 2.head of intussusceptumintussusceptum located in the hepatic locate

16、d in the hepatic flexure of the colonflexure of the colon1.before air clysis1.before air clysis3.reduction occur3.reduction occur4.reduction go on4.reduction go on5.the filling of numerous loops of intestine5.the filling of numerous loops of intestine3. Signs of Complete Reduction3. Signs of Complet

17、e ReductionFree flow of air into several loops of small Free flow of air into several loops of small bowel with simultaneous expulsion of feces.bowel with simultaneous expulsion of feces.Stop crying, be quiet.Stop crying, be quiet.Disappear of the abdominal mass.Disappear of the abdominal mass. Nons

18、urgical Therapy- Air Enema 4. Nursing Care of Post- air enema4. Nursing Care of Post- air enemaCarbon test: take 0.5-1g activated carbon orally, Carbon test: take 0.5-1g activated carbon orally, appearing in stool 6-8 hours later.appearing in stool 6-8 hours later.Basic therapy.Basic therapy.Dietary

19、 guidance.Dietary guidance.Clinical observation closely.Clinical observation closely. Nonsurgical Therapy- Air Enema Surgical TherapySurgical Therapy Pure manual reductionPure manual reduction Intestinal anastomosis Intestinal anastomosis Eterostomy EterostomySurgical Therapy 1.Surgical Indication1.

20、Surgical IndicationEnema failure. Enema failure. Intussusception occuring more than 48-72 Intussusception occuring more than 48-72 hours.hours.Intestinal necrosis. Intestinal necrosis. Intestinal perforationIntestinal perforation. .Surgical Therapy 2.Nursing Diagnosis2.Nursing DiagnosisPainPainAnxie

21、tyAnxietyHightHight risk for fluid volume deficitrisk for fluid volume deficitPotencial complicaion: shockPotencial complicaion: shockSurgical Therapy 3.Postoperative 3.Postoperative Nursing InterventionNursing InterventionM o n i t o r i n g t h e v i t a l s i g n s a n d M o n i t o r i n g t h e

22、 v i t a l s i g n s a n d consciousness state.consciousness state.Oral feeding on a gradual schedule -Oral feeding on a gradual schedule -obeying the doctors instruction. obeying the doctors instruction. Surgical Therapy Intensive care for nasogastric tubeIntensive care for nasogastric tube. .Preve

23、ntion of complications: prevention ofPrevention of complications: prevention of intestinalintestinal adhesion, fluid infusion to prevent adhesion, fluid infusion to prevent bleeding, infection, etc.bleeding, infection, etc.3.Postoperative 3.Postoperative Nursing Intervention Nursing InterventionSurg

24、ical Therapy Activity : Passive activityActivity : Passive activity3.Postoperative 3.Postoperative Nursing Intervention Nursing InterventionSurgical Therapy HealthHealth GuidanceGuidance for discharged patientsfor discharged patientsAn important way to preventAn important way to preventintussuscepti

25、on and finddiseases intussusception and finddiseases in timein time. .* Living guideLiving guide* Disease observationDisease observation* Diet guideDiet guide* Special care guide Special care guide Living Guide*Let the parents realize the importance of keep moving.*Enough physical activities.*Preven

26、tion of intestinal adhesion.Adenovirus infection Intestinal lymoph follicles hyperplasiaExcessive intestinal Stimulate the autonomic nervous systemperistalsisIntussusception*Prevent colds*Safety foodLiving GuideDisease Observation* Take a shower instead of bath.* Get rid of the risk factors of damaging the wound.* If the wound is red or cracks,please go to hospital.Disease ObservationAttentions!If