電大開放教育護(hù)理本科外科護(hù)理學(xué)形成性考核冊(cè)期末復(fù)習(xí)資料

1、電大護(hù)理本科外科護(hù)理學(xué)形成性考核冊(cè)期末復(fù)習(xí)資料小抄名詞解釋1. 等滲性缺水：水和鈉成比例喪失，血清鈉和細(xì)胞外液滲透壓維持在正常范圍；因細(xì)胞外液量迅速減少，故又稱急性缺水或混合性缺水。2.完全胃腸外營養(yǎng)：若病人所需的營養(yǎng)物質(zhì)全部經(jīng)靜脈途徑供給病人，則稱完全胃腸外營養(yǎng)。3. 急性呼吸窘迫綜合征（ARDS）：是指嚴(yán)重創(chuàng)傷、感染等危重病癥時(shí)，因肺實(shí)質(zhì)發(fā)生急性彌漫性損傷而導(dǎo)致的急性缺氧性呼吸衰竭，臨床上以進(jìn)行性呼吸困難和頑固性低氧血癥為特征。4. 呼吸末正壓（PEEP）：是指呼氣末借助呼氣端的阻力閥等裝置使氣道的壓力高于大氣壓?？梢栽黾庸δ軞垰饬亢头雾槕?yīng)性，降低氣道阻力，使萎陷的肺泡擴(kuò)張，改善通氣和氧合

2、，并減輕對(duì)循環(huán)功能的影響。目的是降低肺內(nèi)分流量，糾正低氧血癥。5. 急性排斥反應(yīng) ：是同種異體器官移植時(shí)最常見的一種排斥反應(yīng)，常發(fā)生于移植術(shù)后幾天至數(shù)月內(nèi)。急性排斥反應(yīng)發(fā)生時(shí)可出現(xiàn)特異性地針對(duì)移植物抗原的一切免疫反應(yīng)現(xiàn)象，是一種細(xì)胞介導(dǎo)的遲發(fā)型超敏反應(yīng)。1顱內(nèi)動(dòng)脈瘤：是因顱內(nèi)局部血管壁異常所致的局部腦血管擴(kuò)大形成的腦血管瘤樣突起。顱內(nèi)動(dòng)脈瘤不僅可以引起局部壓迫癥狀，若破裂常引起蛛網(wǎng)膜下腔出血。2酒窩征：乳房腫瘤增大可致局部隆起。若腫瘤累及Cooper韌帶，可使其縮短而致乳房表面皮膚凹陷，形成“酒窩征”。3橘皮征：鄰近乳頭或乳暈的癌腫可侵及乳管使之短，將乳頭牽向癌腫一側(cè)，可使乳頭扁平、回縮、內(nèi)陷

3、。若皮下淋巴管被癌細(xì)胞堵塞，引起淋巴回流障礙，出現(xiàn)真皮水腫，乳房皮膚呈“橘皮樣”改變。4Horner征：亦稱為頸交感神經(jīng)綜合征，指頸部腫瘤等壓迫頸交感神經(jīng)，導(dǎo)致同側(cè)上眼瞼下垂、瞳孔縮小、眼球內(nèi)陷、面部無汗等。5Pancoast腫瘤：亦稱為上葉頂部肺癌，可侵入縱隔和壓迫位于胸廓上口的器官或組織，如第1肋間、鎖骨下動(dòng)靜脈、臂叢神經(jīng)、頸交感神經(jīng)等，而產(chǎn)生劇烈胸肩痛、上肢水腫、臂痛、上肢靜脈怒張和運(yùn)動(dòng)障礙1急腹癥：由于腹腔內(nèi)、盆腔內(nèi)和腹膜后組織或臟器發(fā)生急性生理病理變化，而產(chǎn)生以腹部癥狀和體征為主、同時(shí)伴全身反應(yīng)的臨床表現(xiàn)，稱為急腹癥。2傾倒綜合征：系由于胃大部切除術(shù)后，失去原有的控制胃排空的幽門竇、

4、幽門括約肌及十二指腸球部解剖結(jié)構(gòu)，又因部分患者胃腸吻合口過大，導(dǎo)致胃排空過速所產(chǎn)生的一系列綜合癥3低血糖綜合征：晚期傾倒綜合征：又稱低血糖綜合征，由于胃排空快，高滲食物迅速進(jìn)入小腸、快速吸收，引起高血糖，致胰島素大量分泌，繼而發(fā)生反應(yīng)性低血糖綜合征。表現(xiàn)為在進(jìn)餐后24小時(shí)，病人出現(xiàn)心慌、無力、面色蒼白、眩暈、出冷汗、嗜睡，也可導(dǎo)致虛脫。采用飲食調(diào)整，病人逐漸適應(yīng)而改善癥狀，包括出現(xiàn)癥狀時(shí)稍進(jìn)飲食，尤其是糖類即可緩解，飲食中減少糖類含量，增加蛋白質(zhì)比例，少量多餐可防止其發(fā)生。4Charcot三聯(lián)癥：當(dāng)結(jié)石阻塞膽管并繼發(fā)感染時(shí)可致典型的膽管炎癥狀，腹痛、寒戰(zhàn)高熱和黃疸，稱為Charcot三聯(lián)癥。5

5、、靜息痛: 是病變的中期表現(xiàn)，當(dāng)病變發(fā)展，下肢缺血加重，不行走也發(fā)生疼痛，稱為靜息痛。這種疼痛大多局限在趾或足遠(yuǎn)端，夜間尤甚，臥位時(shí)疼痛加劇，下肢垂下可有緩解，夜間靜息痛或休息痛。因睡眠時(shí)心輸出量最少，下肢灌注注血量也減少，故疼痛常在夜間加重。1尿外滲: 尿液可滲至膀胱周圍、會(huì)陰、陰囊、陰莖或腹壁。組織受尿液浸潤可繼發(fā)感染，嚴(yán)重時(shí)造成蜂窩組織炎甚至膿毒血癥。2尿瘺: 膀胱與附近器官相通形成時(shí)，尿液可從直腸、陰道或腹部傷口流出，可形成膀胱直腸瘺、膀胱陰道瘺等。3腎絞痛: 腎與輸尿管結(jié)石時(shí)，結(jié)石活動(dòng)或引起輸尿管完全梗阻時(shí)，出現(xiàn)腎絞痛。典型的絞痛位于腰部或上腹部，沿輸尿管走向向小腹和會(huì)陰部放射，可至

6、大腿內(nèi)側(cè)；性質(zhì)為陣發(fā)性絞痛，如刀割；程度劇烈，病人輾轉(zhuǎn)不安，面色蒼白、冷汗，甚至休克；伴隨癥狀為惡心、嘔吐。疼痛時(shí)間持續(xù)幾分鐘至數(shù)小時(shí)不等?？砂槊黠@腎區(qū)叩擊痛。結(jié)石位于輸尿管膀胱壁段和輸尿管口處或結(jié)石伴感染時(shí)可有尿頻、尿急、尿痛癥狀，有尿道和陰莖頭部放射痛4、腎癌三聯(lián)癥: 血尿、腰痛和腫塊在臨床上常稱為“腎癌三聯(lián)癥”。三大癥狀同時(shí)出現(xiàn)的機(jī)會(huì)約有1015，往往是晚期的標(biāo)志。5直腿抬高試驗(yàn): 正常人直腿抬高6070才開始感到不適，而腰椎間盤突出癥病人由于神經(jīng)根受壓或粘連影響了活動(dòng)度，仰臥被動(dòng)直腿抬高患肢60以內(nèi)即出現(xiàn)坐骨神經(jīng)痛，稱直腿抬高試驗(yàn)陽性。選擇題：1.輕度高滲性脫水最主要的表現(xiàn)是（B）口渴

7、2.急性消化道失液的病人，醫(yī)囑靜脈給以下列液體輸注，作為其責(zé)任護(hù)士，你考慮首先給其輸入（E）5%葡萄糖鹽水3.高鉀血癥病人出現(xiàn)心律失常時(shí)，首先應(yīng)給予（C）10%葡萄糖酸鈣4.成人靜脈補(bǔ)充鉀離子時(shí)，要求尿量每小時(shí)不得少于（D）40ml5.女性，30歲，哮喘持續(xù)狀態(tài)2天，動(dòng)脈血?dú)夥治鯬H7.35，Paco2 9.3kpa，Pao2 6.6kpa，BE+2mmol/L，HCO3-25mmol/L，其酸堿失衡的類型是（D）呼吸性酸中毒代償期6.經(jīng)鼻胃管灌注飲食時(shí)病人最好?。ˋ）半臥位7.長期胃腸外營養(yǎng)的病人置管的部位是（D）上腔靜脈8.全胃腸外營養(yǎng)支持病人可能發(fā)生的最嚴(yán)重的代謝并發(fā)癥是（D）高滲性非酮

8、性昏迷9.下列關(guān)于腸外營養(yǎng)的護(hù)理正確的是（C）不要經(jīng)中心靜脈導(dǎo)管取血10.急性腎功能衰竭少尿期病人早期死亡的最常見原因是（D）高鉀血癥11.屬于腎性功能衰竭的病因是（A）腎中毒12.ARDS病人主要特征性的臨床表現(xiàn)為（E）進(jìn)行性呼吸困難13.對(duì)ARDS的診斷和病情判斷有重要意義的檢查是（A）血?dú)夥治?4.導(dǎo)致氣道峰值壓增高的原因不包括（D）氣管導(dǎo)管氣囊漏氣15.反映心臟后負(fù)荷的指標(biāo)時(shí)（A）血壓16.由病人控制主要呼吸參數(shù)，可降低自主呼吸的呼吸做功的通氣方式是（E）壓力支持通氣17.反映病人身體脂肪量的指標(biāo)是（C）三頭肌皮褶厚度18.慢性排斥反應(yīng)的特點(diǎn)是（D）移植器官功能諑漸減退19.下列關(guān)于腫

9、瘤化療的護(hù)理敘述不正確的是（C）若出現(xiàn)藥液外滲,應(yīng)立即熱敷20.在腫瘤病人化療或放療期間，最主要的觀察項(xiàng)目是（A）血項(xiàng)1.開顱手術(shù)最危險(xiǎn)地并發(fā)癥是（B）顱內(nèi)出血2.顱內(nèi)動(dòng)靜脈畸形最常見的首發(fā)癥狀是（A）出血3.高血壓腦出血最好發(fā)的部位是（E）基地節(jié)殼部4.腦出血最常見的原因（C）高血壓腦動(dòng)脈硬化5.顱腦手術(shù)后留置腦室引流，通常情況下每日引流量不宜超過（D）500ml6.女性，45歲，因腦腫瘤、顱內(nèi)壓增高，行腦室引流術(shù)后3小時(shí)，引流管無腦脊液流出，不正確的處理方法是（D）生理鹽水沖洗7.診斷椎管內(nèi)腫瘤最有價(jià)值的輔助檢查方法是（B）脊髓MRI8.全廢切除術(shù)后放置胸腔閉式引流的目的是（D）調(diào)節(jié)兩側(cè)胸

10、腔壓力9.對(duì)放療及化療均敏感的肺癌類型是（B）小細(xì)胞癌10.肺癌病人出現(xiàn)一側(cè)眼瞼下垂，瞳孔縮小，眼球內(nèi)陷，額部與胸部少汗的原因是（B）交感神經(jīng)受壓11.甲狀腺腺瘤病人的腫塊特點(diǎn)是（C）邊界清晰12.給甲狀腺全切術(shù)后病人的出院導(dǎo)致內(nèi)容正確的是（D）藥物劑量 一旦確定不再改變13.乳癌病人局部皮膚出現(xiàn)酒窩征的原因（D）癌腫侵及Cooper 韌帶14.乳癌根治術(shù)后第2天護(hù)理措施不正確的是（D）指導(dǎo)肩關(guān)節(jié)的活動(dòng)15.乳癌根治術(shù)術(shù)后病人的護(hù)理措施中不正確的是（D）早期活動(dòng)患肢16.乳癌淋巴轉(zhuǎn)移的最早和最常見的部位是（C）腋窩淋巴結(jié)17.乳癌最常見的臨床表現(xiàn)（C）無痛性腫塊狀18.風(fēng)濕性心臟病病人尤其應(yīng)注

11、意的電解質(zhì)紊亂類型（C）低鉀血癥19.女性，29歲，因風(fēng)濕性心臟病行二間瓣瓣膜置換。術(shù)后服用發(fā)華林，對(duì)其健康教育中最重要的是（A）定期檢查凝血功能20.不符合體外循環(huán)后低心排綜合征的表現(xiàn)是（E）中樞性高熱1.急腹癥病人未明確診斷前應(yīng)禁用（D）哌替啶2.女性吧你個(gè)人，畢式胃大部切除術(shù)后第5天，突發(fā)右上腹劇痛，伴有腹膜刺激征，應(yīng)考慮（E）十二指腸殘端破裂3.女性病人，50歲。胃大部切除術(shù)后2周，病人進(jìn)食后約15分鐘出現(xiàn)上腹飽脹，惡心、嘔吐、頭暈、心悸、出汗、腹瀉等。應(yīng)考慮并發(fā)了（C）傾倒綜合征4.胃大部切除術(shù)后需要及早手術(shù)的梗阻類型是（B）吻合口完全梗阻5.單純性腸梗阻的主要治療措施是（D）胃腸減

12、壓，矯正水電解質(zhì)失衡6.單純性腸梗阻與絞窄性腸梗阻的主要區(qū)別是（D）腸管壁有無血運(yùn)障礙7.用于保護(hù)瘺口周圍皮膚的常用藥膏是（D） 氧化鋅軟膏8.腸瘺最常見的電解質(zhì)紊亂是（B） 低鉀、高鈉9.腸梗阻辨認(rèn)非手術(shù)治療后，腸梗阻解除的標(biāo)志是（D）肛門有排氣、排便10.左半結(jié)腸癌的主要癥狀是（E）排便習(xí)慣及糞便性狀改變11.直腸癌根治術(shù)能否保留肛門取決于（A）腫瘤距肛門的距離12.直腸癌的早期癥狀是（B）排便習(xí)慣改變13.原發(fā)性肝癌最常見的首發(fā)癥狀是（E）黃疸14.男性，65歲，肝癌肝葉切除術(shù)后第一天，病人感腹痛、心慌、氣促、出冷汗、血壓12/8Kpa，首先應(yīng)考慮為（A）膽汁性腹膜炎15.肝葉切除術(shù)后避

13、免過早活動(dòng)的目的是（E）避免肝斷面出血16.關(guān)于T管護(hù)理敘述正確的是（C）膽總管下段阻塞時(shí)引流量增多17.膽道T管引流的病人膽道遠(yuǎn)端通暢的表現(xiàn)是（D）食欲好轉(zhuǎn)，黃疸消退，引流量減少18.胰腺癌最常見的首發(fā)癥狀是（E）上腹痛及上腹飽脹不適19.下肢靜脈血栓形成最嚴(yán)重的并發(fā)癥是（B）肺動(dòng)脈栓塞20.下肢深靜脈血栓病人最主要的治療方法是（E）手術(shù)取栓1.關(guān)于腎盂造瘺管的護(hù)理不正確的是（C）每次沖洗引流管的液量不超過20ml2.腎損傷出現(xiàn)出現(xiàn)明顯血尿時(shí)見于（D）腎實(shí)質(zhì)深度裂傷、破入腎盞腎孟3.鑒別腹膜內(nèi)型和腹膜外型的膀胱破例，最好的方法是（C）膀胱造影4.輸尿管結(jié)石病人絞痛發(fā)作時(shí)，最重要處理方法是（C

14、）解痙止痛5.為預(yù)防結(jié)石復(fù)發(fā)需要酸化尿液的結(jié)石是（E）尿酸氨結(jié)石和磷酸鹽結(jié)石6.確診膀胱腫瘤最可靠地檢查方法是（B）膀胱鏡檢查活檢7.腎癌的典型三大癥狀是（A）血尿、腫塊和疼痛8.牽引病人護(hù)理措施正確的是（D）肢體縱軸應(yīng)與牽引力線平行9.骨牽引病人出現(xiàn)患肢麻木，皮溫低，足背動(dòng)脈搏動(dòng)減弱和被動(dòng)伸指劇痛等表現(xiàn)，可能的原因是（E）牽引重量過大10.女性，39歲，左前臂行石膏繃帶包扎后1小時(shí)，出現(xiàn)手指劇痛，蒼白發(fā)涼，橈動(dòng)脈搏動(dòng)減弱，應(yīng)首先采取的措施是（D）適當(dāng)松解石膏繃帶11.股骨頸骨折病人行皮牽引時(shí)應(yīng)采取的體位是（A）30o外展中立位12.腰椎間盤突出癥的基本病因是（D）椎間盤退行性變13.腰椎間盤

15、突出癥患者術(shù)后行直腿抬高練習(xí)的最主要的目的是為了預(yù)防（A）神經(jīng)根粘連14.頸椎前路手術(shù)后最危急的并發(fā)癥是（A）呼吸困難15.男性，39歲，因脊髓型頸椎病接受手術(shù)治療，對(duì)其的出院指導(dǎo)中正確的是（A） 避免猛力轉(zhuǎn)頭動(dòng)作16.骨巨細(xì)胞瘤病人的X線檢查可見（D）肥皂泡樣骨質(zhì)破壞陰影17.女性，18歲，因骨肉瘤行右大腿截肢術(shù)，術(shù)后出現(xiàn)幻肢痛最主要的依據(jù)是（B）殘肢制動(dòng)以避免疼痛18.診斷惡性骨腫瘤最主要的依據(jù)是（D）病理組織學(xué)檢查19.關(guān)于坐骨神經(jīng)痛的敘述正確的是（A）下肢放射痛伴麻木感20.腰椎間盤突出最常壓迫的神經(jīng)根是（D）L5和S1神經(jīng)根簡(jiǎn)答題一、.簡(jiǎn)述靜脈補(bǔ)鉀的注意事項(xiàng)？答：應(yīng)注意濃度、速度、用

16、量等要求掌握總量，一般每日補(bǔ)鉀40-80mmol，相當(dāng)于氯化鉀3-6g控制濃度，每升液體含鉀量不超過40mmol限定速度，輸注含鉀溶液每小時(shí)不超過20mmol尿暢補(bǔ)鉀，成人尿量超過每小時(shí)40ml后才可輸注含鉀溶液二、.簡(jiǎn)述腸內(nèi)營養(yǎng)支持病人誤吸的預(yù)防措施和發(fā)生誤吸后的緊急處理措施？答：停止輸注食物，通知醫(yī)生。抬高床頭30，將胃內(nèi)容物吸凈，即使小量誤吸，也應(yīng)鼓勵(lì)患者咳嗽，咳出氣管內(nèi)液體。如有食物顆粒進(jìn)入氣管，應(yīng)立即行氣管鏡檢查，應(yīng)用抗生素治療肺內(nèi)感染，行靜脈輸液及皮質(zhì)激素消除水腫三、列舉ICU獲得性感染的相關(guān)危險(xiǎn)因素？答：一是機(jī)體因素，包括原有疾病（如免疫缺損或缺陷、糖尿病、腎衰竭）各種體質(zhì)內(nèi)置管

17、等二是環(huán)境因素，包括空氣及各種裝置的污染，無菌操作不嚴(yán)、患者之間的交叉感染等四、簡(jiǎn)述犬咬傷后創(chuàng)面的處理方法及免疫治療方法？答：傷口處理：1.徹底沖洗：用肥皂水或清水徹底沖洗傷口至少15分鐘2.消毒處理：徹底沖洗后用2%-3%碘酒或75%乙醇涂擦傷口3.沖洗和消毒后傷口處理：傷口應(yīng)敞開，不宜一期縫合，也不應(yīng)包扎免疫治療：1.狂犬病疫苗接種：首次被傷后：原則上是越早越好 再次被傷后：全程接種符合效價(jià)標(biāo)準(zhǔn)的疫苗后1年再次被傷者，應(yīng)于0和3天各接種一劑疫苗。在1-3年內(nèi)再次被動(dòng)物致傷且已進(jìn)行過上述處置者，應(yīng)于0、3、7天內(nèi)閣接種一劑疫苗。超過3年者應(yīng)接種全程疫苗。2、被動(dòng)免疫制劑的使用：傷后應(yīng)以狂犬疫

18、苗免疫球蛋白 行傷口周圍清潤注射五、簡(jiǎn)述顱內(nèi)動(dòng)脈瘤破裂的相關(guān)危險(xiǎn)因素？答：血壓應(yīng)控制在穩(wěn)定狀態(tài)，避免血壓劇烈波動(dòng)造成動(dòng)脈瘤破裂；保持大便通暢，必要時(shí)使用緩瀉劑；避免情緒激動(dòng)和劇烈運(yùn)動(dòng)。六、簡(jiǎn)述開顱術(shù)后病人頭痛的原因及特點(diǎn)？答：切口疼痛多發(fā)生于術(shù)后24小時(shí)內(nèi)，給予一般止痛劑可奏效。顱內(nèi)壓增高所引起的頭痛，多發(fā)生在術(shù)后24日腦水腫高峰期，常為搏動(dòng)性頭痛，嚴(yán)重時(shí)伴有嘔吐，需依賴脫水、激素治療降低顱內(nèi)壓；脫水劑和激素的使用應(yīng)注意在24小時(shí)內(nèi)合理分配。若系術(shù)后血性腦脊液刺激腦膜引起的頭痛，需于術(shù)后早期行腰椎穿刺引流血性腦脊液。應(yīng)注意腦手術(shù)后不論何種原因引起的頭痛均不可輕易使用嗎啡和哌替啶。七、簡(jiǎn)述避免或

19、減輕乳腺癌病人患側(cè)上肢水腫的方法？答：術(shù)后預(yù)防性抬高患側(cè)上肢，防止發(fā)生患肢水腫。按摩患側(cè)上肢或進(jìn)行握拳、屈、伸肘運(yùn)動(dòng)，以促進(jìn)淋巴回流。注意保護(hù)患側(cè)上肢，不在患肢進(jìn)行測(cè)血壓、靜脈穿刺等護(hù)理操作。術(shù)后3天患側(cè)上肢制動(dòng)，避免上臂外展，下床活動(dòng)時(shí)應(yīng)用吊帶托扶。八、簡(jiǎn)述乳腺癌病人患側(cè)上肢功能鍛煉的方法？答：為避免患側(cè)上肢功能障礙，應(yīng)鼓勵(lì)和協(xié)助病人早期開始患側(cè)上肢的功能鍛煉。術(shù)后24小時(shí)內(nèi)，活動(dòng)手指及腕部，可作伸指、握拳、屈腕等鍛煉；術(shù)后35日，開始肘部活動(dòng)；術(shù)后7日上舉；10天外展。腋下引流管拔除之后，術(shù)后1012天左右可教病人逐漸作上臂的全范圍關(guān)節(jié)活動(dòng)，直至患側(cè)手指能高舉過頭，能自行梳理頭發(fā)。九、簡(jiǎn)述

20、急腹癥病人的病情觀察要點(diǎn)？答：（1）定時(shí)觀察生命體征變化。（2）定時(shí)觀察腹部癥狀和體征的變化。（3）動(dòng)態(tài)觀察實(shí)驗(yàn)室檢查結(jié)果變化。十、簡(jiǎn)述為腸瘺病人采用外堵法和內(nèi)堵法護(hù)理時(shí)的注意事項(xiàng)？在感染控制后，通過堵塞瘺管，使腸液不再外流，直至瘺口自行愈合。（1）外堵法：適用于已形成完整、管徑直的瘺管。（2）內(nèi)堵法：適用于瘺管短且口徑大的瘺管。十一、腸梗阻病人非手術(shù)治療的主要措施？（1）禁食禁飲、胃腸減壓 是治療腸梗阻的主要措施之一。（2）糾正水、電解質(zhì)紊亂與酸堿失衡 （3）防治感染 （4）其他 對(duì)癥治療，如解痙止痛劑、鎮(zhèn)靜劑等，但診斷不明者應(yīng)禁用止痛劑。十二、簡(jiǎn)述Miles術(shù)后結(jié)腸造口病人并發(fā)癥的觀察和護(hù)

21、理？造口缺血壞死：觀察造口部位粘膜的顏色，一旦出現(xiàn)粘膜呈暗紫色或黑色，則說明造口腸管血運(yùn)有障礙，應(yīng)首先為病人去除及避免一切可能加重造口缺血壞死的因素，評(píng)估造口的活力并通知醫(yī)生；造口出血：如有造口處靜脈或毛細(xì)血管出血情況發(fā)生，可用紗布或棉球、腎上腺素藥棉敷在出血處即可止血，若為動(dòng)脈出血應(yīng)找出出血?jiǎng)用}分支，結(jié)扎或電凝止血治療；腸管回縮：非嚴(yán)重病例可選用凸面造口用品，也可建議病人使用結(jié)腸造口灌洗，肥胖病人可讓其減體重；一旦腸管已回縮到腹腔，產(chǎn)生腹膜炎征象，應(yīng)立即行手術(shù)治療；造口狹窄：情況不嚴(yán)重者，應(yīng)定期擴(kuò)肛，先洗凈雙手，操作手戴一次性手套，手指蘸潤滑劑，伸入造口，向周圍擴(kuò)張，用力不宜過大，以免損傷造

22、口，停留25分鐘，每天一次或每周23次；情況嚴(yán)重者須外科手術(shù)治療。十三、簡(jiǎn)述膀胱造瘺管的護(hù)理要點(diǎn)？答：（1）妥善固定引流管，避免脫出。（2）保持引流管通暢，必要時(shí)可用無菌生理鹽水沖洗。（3）及時(shí)換藥，避免尿液逆流，鼓勵(lì)病人多飲水，定期更換引流袋，避免感染。（4）通常放置12天后方可拔管，以免尿液外瘺引起感染。拔管前先行夾管試驗(yàn)，證明尿道排尿通暢，方可拔管。應(yīng)先間斷夾管，訓(xùn)練膀胱肌排尿、儲(chǔ)尿功能。拔管后注意排尿情況。若造瘺口不愈合，可行手術(shù)清創(chuàng)、修整、縫合。十四、簡(jiǎn)述尿路結(jié)石的主要預(yù)防措施。1.飲食（1）大量飲水，以增加尿量，稀釋尿液，可減少尿中晶體沉積。成人保持每日尿量在2 000 ml以上，

23、尤其是睡前及半夜飲水，效果更好。（2）根據(jù)結(jié)石成分調(diào)節(jié)飲食。2.藥物預(yù)防根據(jù)結(jié)石成分，血、尿鈣磷、尿酸、胱氨酸和尿PH，采用藥物降低有害成分、堿化或酸化尿液，預(yù)防結(jié)石復(fù)發(fā)。3.相關(guān)疾病治療伴甲狀旁腺功能亢進(jìn)者，必須手術(shù)摘除腺瘤或增生組織；鼓勵(lì)長期臥床者功能鍛煉，防止骨脫鈣，減少尿鈣排出；盡早解除尿路梗阻、感染、異物等因素。十五、可控膀胱術(shù)后如何進(jìn)行代膀胱功能訓(xùn)練？答：可在術(shù)后23周左右開始進(jìn)行代膀胱的訓(xùn)練，間斷夾閉輸出引流管，1小時(shí)至34小時(shí)不等，約一周左右完成，3040天拔除尿管，自行導(dǎo)尿。若出現(xiàn)腰部脹痛、發(fā)熱等應(yīng)延長功能鍛煉的時(shí)間。十六、腰椎間盤突出癥病人術(shù)后應(yīng)做哪些練習(xí)？目的是什么？答：

24、手術(shù)后24小時(shí)開始指導(dǎo)病人做直腿抬高和股四頭肌舒縮練習(xí)，以防神經(jīng)根粘連和肌肉萎縮。手術(shù)57天后開始腰背肌練習(xí)，如飛燕點(diǎn)水、五點(diǎn)式和三點(diǎn)式等，堅(jiān)持鍛煉半年以上。頸椎有病變者不宜用三點(diǎn)式。病例分析題一、某5歲患兒，腹瀉3天，10余次/天，可能會(huì)發(fā)生何種水、電解質(zhì)代謝紊亂？為什么？答：可發(fā)生脫水、低鉀血癥。因?yàn)榇罅縼G失消化液使體液容量不足產(chǎn)生脫水，消化液基本為等滲液，在病理中的調(diào)節(jié)可維持滲透壓正常發(fā)生等滲性脫水。若病程中因口渴過量飲用純水而未補(bǔ)充鈉鹽，則可出現(xiàn)低滲性脫水。皮膚蒸發(fā)繼續(xù)丟失相當(dāng)數(shù)量的水而無相應(yīng)的電解質(zhì)丟失，則可產(chǎn)生高滲性脫水。因消化液中含有豐富的鉀，丟失消化液過多可產(chǎn)生低鉀血癥二、男性

25、，30歲，下肢被汽車 壓傷后4天，尿量小于200ml/24h，伴有惡心、嘔吐、嗜睡、昏迷、抽搐等癥狀?；?yàn)：血肌酐460umol/L，尿素氮26mmol/L。問：可能的診斷是什么？目前的治療措施是什么？該病人的護(hù)理要點(diǎn)有哪些？答：診斷：急性腎功能衰竭治療措施：透析療法護(hù)理要點(diǎn)：1.病情觀察與檢測(cè)：嚴(yán)格記錄病人24小時(shí)的液體出入量觀察水腫情況定期監(jiān)測(cè)生命體征，嚴(yán)格監(jiān)測(cè)血電解質(zhì)的變化2.限制蛋白的攝入，同時(shí)保證熱量的供給3.防止感染4.透析過程中注意觀察病人的生命體征和透析設(shè)備的運(yùn)行情況，對(duì)血液透析病人應(yīng)注意有無熱源反應(yīng)、失衡綜合征和癥狀性低血壓三、60歲，男性，劇烈咳嗽之后出現(xiàn)劇烈頭痛、嘔吐。查

26、體：神清，右側(cè)眼瞼下垂，右側(cè)瞳孔8mm，直接對(duì)光反應(yīng)消失，左側(cè)瞳孔4mm，對(duì)光反射存在。體溫：36.8，脈搏80次/分，呼吸20次/分，血壓160/90mmhg。頸項(xiàng)強(qiáng)直，克氏征（+）。腰穿：顱內(nèi)高壓，引流出血性腦脊液。初步診斷為顱內(nèi)動(dòng)脈瘤、蛛網(wǎng)膜下腔出血。問：為進(jìn)一步明確診斷需要做何檢查？此疾病發(fā)生的額誘有哪些？如何預(yù)防出血？目前主要護(hù)理措施有哪些？答：腦血管造影。主要有運(yùn)動(dòng)、情緒激動(dòng)、用力排便、咳嗽等誘因，但部分病人可無明顯誘因或在睡眠中發(fā)生。預(yù)防出血的方法主要有適當(dāng)控制血壓，避免血壓劇烈波動(dòng)；保持大便通暢，必要時(shí)使用緩瀉劑；避免情緒激動(dòng)和劇烈運(yùn)動(dòng)等。目前病人應(yīng)臥床休息，保持安靜，避免情緒

27、激動(dòng)，保持大便通暢，遵醫(yī)囑給予脫水劑，降低顱內(nèi)壓。維持正常血壓，使用藥物降低血壓時(shí)，注意觀察有無頭暈、意識(shí)改變等腦缺血癥狀，及時(shí)通知醫(yī)師處理。遵醫(yī)囑使用止血?jiǎng)?，使用氨基己酸時(shí)，應(yīng)注意觀察血栓形成跡象。四、女性，37歲，因右乳乳腺癌在全麻下行乳腺癌改良根治術(shù)，現(xiàn)為術(shù)后第1天，病人T37.4、P88次/分、R24次/分、BP125/80mmHg，胸部用繃帶加壓包扎，皮瓣下置引流管持續(xù)引流，病人訴傷口疼痛，且現(xiàn)在不能自己洗漱、進(jìn)餐、如廁等，病人向家人和護(hù)士訴說不能接受一側(cè)乳房切除的事實(shí)。問：列出病人目前2個(gè)主要的護(hù)理診斷/問題。敘述病人患側(cè)上肢的護(hù)理要點(diǎn)及功能鍛煉方法答：1.護(hù)理診斷：疼痛：與手術(shù)切

28、口有關(guān)。（進(jìn)食、衛(wèi)生、如廁）自理缺陷：與術(shù)后患側(cè)上肢活動(dòng)受限有關(guān)。自我形象紊亂：與乳癌根治術(shù)切除一側(cè)乳房有潛在并發(fā)癥：出血、患側(cè)上肢水腫、皮下積液、皮瓣壞死等。2.患側(cè)上肢的護(hù)理要點(diǎn)：術(shù)后3日內(nèi)患側(cè)上肢制動(dòng)，避免外展，保持內(nèi)收姿勢(shì)；注意觀察患側(cè)上肢末端皮膚顏色、溫度、有無腫脹；抬高患肢，避免在患側(cè)上肢進(jìn)行穿刺、量血壓等操作。3.功能鍛煉的方法：術(shù)后24小時(shí)內(nèi)活動(dòng)手指及腕部；術(shù)后35日，開始肘部活動(dòng)；術(shù)后7日，上舉；10天外展。腋下引流管拔除之后，術(shù)后1012天左右可教病人逐漸作上臂的全范圍關(guān)節(jié)活動(dòng)，直至患側(cè)手指能高舉過頭，能自行梳理頭發(fā)。五、男性，64歲，右股骨干骨折手術(shù)后一直臥床，術(shù)后第8天

29、突然出現(xiàn)右小腿疼痛，腫脹且有深壓痛，右足過度背屈時(shí)小腿肌肉疼痛劇烈，全身其他部位無明顯不適。問：1、該病人最可能發(fā)生了什么疾?。?、此時(shí)應(yīng)預(yù)防哪種嚴(yán)重并發(fā)癥？3、在非手術(shù)治療期間應(yīng)采取哪些具體預(yù)防措施？答：1、小腿神靜脈血栓形成 2、肺動(dòng)脈栓塞3、深靜脈栓塞形成的急性期時(shí)應(yīng)絕對(duì)臥床休息2周，抬高患肢20-30cm，嚴(yán)禁按摩患肢。全身癥狀和局部壓痛緩解后，可起床進(jìn)行輕度活動(dòng)。活動(dòng)時(shí)要使用彈力襪或彈力繃帶，同時(shí)觀察患者是否發(fā)生胸痛、呼吸困難、血壓下降等情況，一旦發(fā)生及時(shí)處理六、男性，40歲，每日大便次數(shù)十余次，不成形，間有膿血便，伴有腹瀉和便秘交替出現(xiàn)三月余，腹痛較輕，內(nèi)科藥物治療一個(gè)月無好轉(zhuǎn)，全

30、身狀況尚好，腹部可捫及一較硬腫塊。問：1、可能的診斷是什么？2、目前的治療措施是什么？3、才用該治療方法應(yīng)注意的并發(fā)癥的觀察和處理措施有哪些？答：1、結(jié)腸癌2、行結(jié)腸根治術(shù)3、術(shù)后尤應(yīng)注意有無切口感染和吻合口瘺，觀察和處理措施有：密切觀察生命體征和傷口敷料情況，保持切口周圍清潔干燥，及時(shí)遵醫(yī)囑應(yīng)用抗生素，若發(fā)生切口感染，則開放傷口，徹底清創(chuàng)注意觀察引流管情況、排便的性狀、次數(shù)及量和腹部有無不適癥狀，術(shù)后7-10天不可灌腸，以免影響吻合口愈合，若發(fā)生吻合口瘺，應(yīng)予以充分引流，以控制感染，瘺口大、伴有腹膜炎或盆腔膿腫，則需行吻合口近側(cè)結(jié)腸造口七、青年男性，不慎從高空墜落，急診送往醫(yī)院。體檢：臀部及

31、右腰部疼痛明顯，右腰部有壓痛，無包塊，腹肌柔軟，無壓痛，無反跳痛。有明顯血尿，血壓10060mmHg，心率100次/分。B超檢查提示腎包膜完整、部分腎實(shí)質(zhì)損傷。醫(yī)生決定為其行非手術(shù)治療。問：請(qǐng)列出該病人存在的2個(gè)護(hù)理診斷。該病人目前主要的處理措施有哪些？該病人治療期間的病情觀察要點(diǎn)有哪些？答：疼痛：與腎損傷有關(guān)；PC：休克、感染。絕對(duì)臥床休息至少24周；補(bǔ)液，必要時(shí)輸血；應(yīng)用廣譜抗生素預(yù)防感染；使用止痛、鎮(zhèn)靜和止血藥物等。病情觀察是非手術(shù)治療過程中非常重要的措施，必須密切觀察血壓、脈搏、血尿、血紅蛋白等指標(biāo)有無變化。記錄尿量、顏色；注意腰部腫塊變化，及時(shí)準(zhǔn)確記錄；隨時(shí)復(fù)查血常規(guī)。若血尿加重、腰

32、部腫塊增大，說明病情加重。八、男性，37歲，從事搬運(yùn)工作13年，工作中不慎扭傷腰部，當(dāng)即出現(xiàn)明顯腰痛，疼痛向下腰部和臀部放射，腰部活動(dòng)受限，行走困難，遂來醫(yī)院就診，被診為腰椎間盤突出癥，準(zhǔn)備采取非手術(shù)治療。該病人既往體健，無類似病史，此次忽然患病，擔(dān)心今后無法康復(fù)行走，神情沮喪，不愿意與人溝通，但是經(jīng)常對(duì)家屬發(fā)脾氣。問：請(qǐng)列舉病人目前兩個(gè)主要護(hù)理問題/診斷。非手術(shù)治療期間，護(hù)士對(duì)該病人的主要護(hù)理措施和指導(dǎo)內(nèi)容有哪些？答：護(hù)理診斷/問題：疼痛：與突出的腰椎間盤壓迫和刺激神經(jīng)根有關(guān)。焦慮：與擔(dān)心受傷后無法康復(fù)行走有關(guān)。非手術(shù)治療的護(hù)理：臥硬板床時(shí)，取側(cè)臥屈膝屈髖體位，兩腿間可墊枕，避免“蜷縮”姿勢(shì)

33、。仰臥位時(shí)可膝、腿下墊枕，墊起肩，避免頭前傾、胸部凹陷的不良姿勢(shì)。俯臥位時(shí)可在腹部及踝部墊薄枕，以使脊柱肌肉放松。在牽引帶壓迫的髂緣部位加墊以預(yù)防壓瘡。觀察病人體位、牽引力線及重量是否正確，皮膚有無疼痛、發(fā)紅或壓瘡等。疼痛嚴(yán)重時(shí)可遵醫(yī)囑給予非甾體類消炎鎮(zhèn)痛藥，如扶他林25 mg，每日3次。配合熱敷等理療措施也可緩解疼痛。指導(dǎo)病人側(cè)身起臥，急性期過后，可依病人年齡、體力不同指導(dǎo)其循序漸進(jìn)地進(jìn)行腹肌、背肌和臀肌鍛煉，以增強(qiáng)脊柱的穩(wěn)定性。常用方法包括飛燕點(diǎn)水、五點(diǎn)式和三點(diǎn)式等。若病人不能進(jìn)行主動(dòng)鍛煉，則應(yīng)在醫(yī)務(wù)人員幫助下做肢體的被動(dòng)活動(dòng)，以防肌肉萎縮和關(guān)節(jié)僵直。請(qǐng)您刪除一下內(nèi)容，O(_)O謝謝！20

34、16年中央電大期末復(fù)習(xí)考試小抄大全，電大期末考試必備小抄，電大考試必過小抄Basketball can make a true claim to being the only major sport that is an American invention. From high school to the professional level, basketball attracts a large following for live games as well as television coverage of events like the National Collegiate At

35、hletic Association (NCAA) annual tournament and the National Basketball Association (NBA) and Womens National Basketball Association (WNBA) playoffs. And it has also made American heroes out of its player and coach legends like Michael Jordan, Larry Bird, Earvin Magic Johnson, Sheryl Swoopes, and ot

36、her great players. At the heart of the game is the playing space and the equipment. The space is a rectangular, indoor court. The principal pieces of equipment are the two elevated baskets, one at each end (in the long direction) of the court, and the basketball itself. The ball is spherical in shap

37、e and is inflated. Basket-balls range in size from 28.5-30 in (72-76 cm) in circumference, and in weight from 18-22 oz (510-624 g). For players below the high school level, a smaller ball is used, but the ball in mens games measures 29.5-30 in (75-76 cm) in circumference, and a womens ball is 28.5-2

38、9 in (72-74 cm) in circumference. The covering of the ball is leather, rubber, composition, or synthetic, although leather covers only are dictated by rules for college play, unless the teams agree otherwise. Orange is the regulation color. At all levels of play, the home team provides the ball. Inf

39、lation of the ball is based on the height of the balls bounce. Inside the covering or casing, a rubber bladder holds air. The ball must be inflated to a pressure sufficient to make it rebound to a height (measured to the top of the ball) of 49-54 in (1.2-1.4 m) when it is dropped on a solid wooden f

40、loor from a starting height of 6 ft (1.80 m) measured from the bottom of the ball. The factory must test the balls, and the air pressure that makes the ball legal in keeping with the bounce test is stamped on the ball. During the intensity of high school and college tourneys and the professional pla

41、yoffs, this inflated sphere commands considerable attention. Basketball is one of few sports with a known date of birth. On December 1, 1891, in Springfield, Massachusetts, James Naismith hung two half-bushel peach baskets at the opposite ends of a gymnasium and out-lined 13 rules based on five prin

42、ciples to his students at the International Training School of the Young Mens Christian Association (YMCA), which later became Springfield College. Naismith (1861-1939) was a physical education teacher who was seeking a team sport with limited physical contact but a lot of running, jumping, shooting

43、, and the hand-eye coordination required in handling a ball. The peach baskets he hung as goals gave the sport the name of basketball. His students were excited about the game, and Christmas vacation gave them the chance to tell their friends and people at their local YMCAs about the game. The assoc

44、iation leaders wrote to Naismith asking for copies of the rules, and they were published in the Triangle, the school newspaper, on January 15,1892. Naismiths five basic principles center on the ball, which was described as large, light, and handled with the hands. Players could not move the ball by

45、running alone, and none of the players was restricted against handling the ball. The playing area was also open to all players, but there was to be no physical contact between players; the ball was the objective. To score, the ball had to be shot through a horizontal, elevated goal. The team with th

46、e most points at the end of an allotted time period wins. Early in the history of basketball, the local YMCAs provided the gymnasiums, and membership in the organization grew rapidly. The size of the local gym dictated the number of players; smaller gyms used five players on a side, and the larger g

47、yms allowed seven to nine. The team size became generally established as five in 1895, and, in 1897, this was made formal in the rules. The YMCA lost interest in supporting the game because 10-20 basketball players monopolized a gymnasium previously used by many more in a variety of activities. YMCA

48、 membership dropped, and basketball enthusiasts played in local halls. This led to the building of basketball gymnasiums at schools and colleges and also to the formation of professional leagues. Although basketball was born in the United States, five of Naismiths original players were Canadians, an

49、d the game spread to Canada immediately. It was played in France by 1893; England in 1894; Australia, China, and India between 1895 and 1900; and Japan in 1900. From 1891 through 1893, a soccer ball was used to play basketball. The first basketball was manufactured in 1894. It was 32 in (81 cm) in c

50、ircumference, or about 4 in (10 cm) larger than a soccer ball. The dedicated basketball was made of laced leather and weighed less than 20 oz (567 g). The first molded ball that eliminated the need for laces was introduced in 1948; its construction and size of 30 in (76 cm) were ruled official in 19

51、49. The rule-setters came from several groups early in the 1900s. Colleges and universities established their rules committees in 1905, the YMCA and the Amateur Athletic Union (AAU) created a set of rules jointly, state militia groups abided by a shared set of rules, and there were two professional

52、sets of rules. A Joint Rules Committee for colleges, the AAU, and the YMCA was created in 1915, and, under the name the National Basketball Committee (NBC) made rules for amateur play until 1979. In that year, the National Federation of State High School Associations began governing the sport at the

53、 high school level, and the NCAA Rules Committee assumed rule-making responsibilities for junior colleges, colleges, and the Armed Forces, with a similar committee holding jurisdiction over womens basketball. Until World War II, basketball became increasingly popular in the United States especially

54、at the high school and college levels. After World War II, its popularity grew around the world. In the 1980s, interest in the game truly exploded because of television exposure. Broadcast of the NCAA Championship Games began in 1963, and, by the 1980s, cable television was carrying regular season c

55、ollege games and even high school championships in some states. Players like Bill Russell, Wilt Chamberlain, and Lew Alcindor (Kareem Abdul-Jabbar) became nationally famous at the college level and carried their fans along in their professional basketball careers. The womens game changed radically i

56、n 1971 when separate rules for women were modified to more closely resemble the mens game. Television interest followed the women as well with broadcast of NCAA championship tourneys beginning in the early 1980s and the formation of the WNBA in 1997. Internationally, Italy has probably become the le

57、ading basketball nation outside of the United States, with national, corporate, and professional teams. The Olympics boosts basketball internationally and has also spurred the womens game by recognizing it as an Olympic event in 1976. Again, television coverage of the Olympics has been exceptionally

58、 important in drawing attention to international teams. The first professional mens basketball league in the United States was the National Basketball League (NBL), which debuted in 1898. Players were paid on a per-game basis, and this league and others were hurt by the poor quality of games and the

59、 ever-changing players on a team. After the Great Depression, a new NBL was organized in 1937, and the Basketball Association of America was organized in 1946. The two leagues came to agree that players had to be assigned to teams on a contract basis and that high standards had to govern the game; u

60、nder these premises, the two joined to form the National Basketball Association (NBA) in 1949. A rival American Basketball Association (ABA) was inaugurated in 1967 and challenged the NBA for college talent and market share for almost ten years. In 1976, this league disbanded, but four of its teams