中医护理常规技术操作规程中医内科护理常规.docx
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中医护理常规技术操作规程中医内科护理常规
中医护理常规技术操作规程中医内科护理常规
中医内科护理常规——一般护理常规
1.1病室环境
1.1.1病室环境清洁、舒适、安静,保持室内空气新鲜。
1.1.2根据病证性质,室内温湿度适宜。
1.2根据病种、病情安排病室,护送患者到指定床位休息。
1.3入院介绍
1.3.1介绍主管医师、护士,并通知医师。
1.3.2介绍病区环境及设施的使用方法。
1.3.3介绍作息时间及相关制度。
1.4生命体征监测,做好护理记录。
1.4.1测量入院时体温、脉搏、呼吸、血压、体重。
1.4.2新入院患者每日测体温、脉搏、呼吸2次,连续3日。
1.4.3若体温37.5?
以上者,每日测体温、脉搏、呼吸4次。
1.4.4若体温39?
以上者,每4小时测体温、脉搏、呼吸1次,或遵医嘱执行。
1.4.5体温正常3日后,每日测体温、脉搏、呼吸1次,或遵医嘱执行。
1.4.6危重患者生命体征监测遵医嘱执行。
1.5每日记录大便次数1次。
1.6每周测体重、血压各1次,或遵医嘱执行。
than6months,highearlystrengthcementupto1month,andbaggedthestackingheightofnomorethan15bagsofcement.
(2)water1)canbeusedwheresuitablefordrinkingwater,untreatedindustrialwastewatercannotbeused.2)waterusedinmixingthesubstancescontainedcannotaffecttheworkabilityandstrengthandgrowthandcausecorrosionofsteelandconcrete.3)waterPHvalue,insolubleandsolublesulfides,chlorides,phosphates,provisionsconsistentwiththefollowingtableofcontents.ContentlimitstableentryofprestressedconcreteconcreteconcreteinsolublematterinPHvalue>4>4>4mg/L<2000<2000<5000mg/L<2000<5000<10000chloridesolublematter(measuredinCL-)mg/L<500<1200<3500sulfate(SO2-4dollars)mg/L<600<2700<2700sulfide(S2-dollars)mg/L<100--------(3)Aggregate1)aggregatesofdifferentmaterialdiameterpiledup,respectively,donotmixwitheachotherandmixedwiththesoil;whenloadingandunloading,sizecoarseaggregatenetfallofgreaterthan40mmlessthan3M,andavoidseriousaggregatecrushing.2)fineaggregatefinenessmodulusshouldbecontrolledinthe...Maximumwater/cementratioconcreteparameterofconcretewater/cementratiothemaximumallowablevalue,abovethewaterleveldownstream(outsideofthedam)0.65,downstreamwaterlevelchange(outsideofthedam)0.55minimumlevelofupstreamanddownstream(outsideofthedam)0.500.600.700.60basissubjecttowatererosionparts(3)large-volumebuildingswithinconcreteofminimumamountofcementitiousmaterialtestresultssubmittedtotheengineer.Accordingtothecharacteristicsofthebuildings,steelcontent,methodoftransport,pouringconcrete,andclimaticconditions,asfaraspossiblesmallslump.(4)thisstandardconcretecollapsedegreesaccordingtoXiatableselectedcollapsedegreesparametertablebuildingsofnaturestandardroundcollapsedegrees(cm)hydraulicpigmentconcreteorlessreinforcedconcrete3~5distributionreinforcedratenotover1%ofreinforcedconcrete5~7distribution
1.7协助医师完成各项检查。
1.8遵医嘱执行分级护理。
1.9定时巡视病房,做好护理记录。
1.9.1严密观察患者生命体征、神志、瞳孔、舌脉、二便等变化,发现异常,及时报告医师,并配合治疗。
1.9.2注意观察分泌物、排泄物、治疗效果及药物的不良反应等,发现异常,及时报告医师。
1.9.3及时了解患者在生活起居、饮食、睡眠和情志等方面的问题,实施相应的护理措施。
1.10加强情志护理,疏导不良心理,使其安心治疗。
1.11根据病情,对患者或家属进行相关健康指导,使之对疾病、治疗、护理等知识有一定了解,积极配合治疗。
1.12遵医嘱准确给药。
服药的时间、温度和方法,依病情、药性而定,注意观察服药后的效果及反应,并向患者做好药物相关知识的宣教。
1.13遵医嘱给予饮食护理,指导饮食宜忌。
1.14预防院内交叉感染
1.14.1严格执行消毒隔离制度。
1.14.2做好病床单位的终末消毒处理。
1.15做好出院指导,并征求意见。
than6months,highearlystrengthcementupto1month,andbaggedthestackingheightofnomorethan15bagsofcement.
(2)water1)canbeusedwheresuitablefordrinkingwater,untreatedindustrialwastewatercannotbeused.2)waterusedinmixingthesubstancescontainedcannotaffecttheworkabilityandstrengthandgrowthandcausecorrosionofsteelandconcrete.3)waterPHvalue,insolubleandsolublesulfides,chlorides,phosphates,provisionsconsistentwiththefollowingtableofcontents.ContentlimitstableentryofprestressedconcreteconcreteconcreteinsolublematterinPHvalue>4>4>4mg/L<2000<2000<5000mg/L<2000<5000<10000chloridesolublematter(measuredinCL-)mg/L<500<1200<3500sulfate(SO2-4dollars)mg/L<600<2700<2700sulfide(S2-dollars)mg/L<100--------(3)Aggregate1)aggregatesofdifferentmaterialdiameterpiledup,respectively,donotmixwitheachotherandmixedwiththesoil;whenloadingandunloading,sizecoarseaggregatenetfallofgreaterthan40mmlessthan3M,andavoidseriousaggregatecrushing.2)fineaggregatefinenessmodulusshouldbecontrolledinthe...Maximumwater/cementratioconcreteparameterofconcretewater/cementratiothemaximumallowablevalue,abovethewaterleveldownstream(outsideofthedam)0.65,downstreamwaterlevelchange(outsideofthedam)0.55minimumlevelofupstreamanddownstream(outsideofthedam)0.500.600.700.60basissubjecttowatererosionparts(3)large-volumebuildingswithinconcreteofminimumamountofcementitiousmaterialtestresultssubmittedtotheengineer.Accordingtothecharacteristicsofthebuildings,steelcontent,methodoftransport,pouringconcrete,andclimaticconditions,asfaraspossiblesmallslump.(4)thisstandardconcretecollapsedegreesaccordingtoXiatableselectedcollapsedegreesparametertablebuildingsofnaturestandardroundcollapsedegrees(cm)hydraulicpigmentconcreteorlessreinforcedconcrete3~5distributionreinforcedratenotover1%ofreinforcedconcrete5~7distribution
中医内科护理常规——眩晕
因风阳上扰、痰瘀内阻,使脑窍失养,脑髓不充所致。
以头晕目
眩、视物旋转为主要临床表现。
病位在肝、肾、脾。
内耳性眩晕、颈
椎病、椎基底动脉供血不足等可参照本病护理。
than6months,highearlystrengthcementupto1month,andbaggedthestackingheightofnomorethan15bagsofcement.
(2)water1)canbeusedwheresuitablefordrinkingwater,untreatedindustrialwastewatercannotbeused.2)waterusedinmixingthesubstancescontainedcannotaffecttheworkabilityandstrengthandgrowthandcausecorrosionofsteelandconcrete.3)waterPHvalue,insolubleandsolublesulfides,chlorides,phosphates,provisionsconsistentwiththefollowingtableofcontents.ContentlimitstableentryofprestressedconcreteconcreteconcreteinsolublematterinPHvalue>4>4>4mg/L<2000<2000<5000mg/L<2000<5000<10000chloridesolublematter(measuredinCL-)mg/L<500<1200<3500sulfate(SO2-4dollars)mg/L<600<2700<2700sulfide(S2-dollars)mg/L<100--------(3)Aggregate1)aggregatesofdifferentmaterialdiameterpiledup,respectively,donotmixwitheachotherandmixedwiththesoil;whenloadingandunloading,sizecoarseaggregatenetfallofgreaterthan40mmlessthan3M,andavoidseriousaggregatecrushing.2)fineaggregatefinenessmodulusshouldbecontrolledinthe...Maximumwater/cementratioconcreteparameterofconcretewater/cementratiothemaximumallowablevalue,abovethewaterleveldownstream(outsideofthedam)0.65,downstreamwaterlevelchange(outsideofthedam)0.55minimumlevelofupstreamanddownstream(outsideofthedam)0.500.600.700.60basissubjecttowatererosionparts(3)large-volumebuildingswithinconcreteofminimumamountofcementitiousmaterialtestresultssubmittedtotheengineer.Accordingtothecharacteristicsofthebuildings,steelcontent,methodoftransport,pouringconcrete,andclimaticconditions,asfaraspossiblesmallslump.(4)thisstandardconcretecollapsedegreesaccordingtoXiatableselectedcollapsedegreesparametertablebuildingsofnaturestandardroundcollapsedegrees(cm)hydraulicpigmentconcreteorlessreinforcedconcrete3~5distributionreinforcedratenotover1%ofreinforcedconcrete5~7distribution
1护理评估
1.1眩晕发作的时间、程度、诱发因素、伴发症状。
1.2生活自理能力。
1.3心理社会状况。
1.4辨证:
风阳上扰证、痰浊上蒙证、气血亏虚证、肝肾阴虚证。
2护理要点
2.l一般护理
2.1.1按中医内科一般护理常规进行。
2.1.2重症宜卧床休息,轻症可闭目养神。
2.1.3改变体位时动作要缓慢,避免深低头、旋转等动作,眩晕严重者的坐椅、床铺避免晃动。
2.2病情观察,做好护理记录
2.2.1观察眩晕发作的时间、程度、诱发因素、伴发症状及血压等变化。
2.2.2出现头痛剧烈、呕吐、视物模糊、语音謇涩、肢体麻木或行动不便、血压持续上升时,应报告医师,并配合处理。
2.3给药护理
2.3.1中药汤剂宜温服,观察药后效果及反应。
2.3.2眩晕伴呕吐者中药宜冷服,或姜汁滴舌后服用,采用少量than6months,highearlystrengthcementupto1month,andbaggedthestackingheightofnomorethan15bagsofcement.
(2)water1)canbeusedwheresuitablefordrinkingwater,untreatedindustrialwastewatercannotbeused.2)waterusedinmixingthesubstancescontainedcannotaffecttheworkabilityandstrengthandgrowthandcausecorrosionofsteelandconcrete.3)waterPHvalue,insolubleandsolublesulfides,chlorides,phosphates,provisionsconsistentwiththefollowingtableofcontents.ContentlimitstableentryofprestressedconcreteconcreteconcreteinsolublematterinPHvalue>4>4>4mg/L<2000<2000<5000mg/L<2000<5000<10000chloridesolublematter(measuredinCL-)mg/L<500<1200<3500sulfate(SO2-4dollars)mg/L<600<2700<2700sulfide(S2-dollars)mg/L<100--------(3)Aggregate1)aggregatesofdifferentmaterialdiameterpiledup,respectively,donotmixwitheachotherandmixedwiththesoil;whenloadingandunloading,sizecoarseaggregatenetfallofgreaterthan40mmlessthan3M,andavoidseriousaggregatecrushing.2)fineaggregatefinenessmodulusshouldbecontrolledinthe...Maximumwater/cementratioconcreteparameterofconcretewater/cementratiothemaximumallowablevalue,abovethewaterleveldownstream(outsideofthedam)0.65,downstreamwaterlevelchange(outsideofthedam)0.55minimumlevelofupstreamanddownstream(outsideofthedam)0.500.600.700.60basissubjecttowatererosionparts(3)large-volumebuildingswithinconcreteofminimumamountofcementitiousmaterialtestresultssubmittedtotheengineer.Accordingtothecharacteristicsofthebuildings,steelcontent,methodoftransport,pouringconcrete,andclimaticconditions,asfaraspossiblesmallslump.(4)thisstandardconcretecollapsedegreesaccordingtoXiatableselectedcollapsedegreesparametertablebuildingsofnaturestandardroundcollapsedegrees(cm)hydraulicpigmentconcreteorlessreinforcedconcrete3~5distributionreinforcedratenotover1%ofreinforcedconcrete5~7distribution
频服。
2.4饮食护理
2.4.1饮食宜清淡,忌食辛辣、肥腻、生冷、烟酒之品。
2.4.2风阳上扰者,可食滋阴潜阳之品。
2.4.3气血亏虚者,多食血肉有情之品。
2.4.4肾阴不足者,多食滋阴益肾之品。
2.5情志护理
2.5.1关心体贴患者,使其心情舒畅。
2.5.2对肝阳上亢、情绪易激动者,减少情绪激动的刺激,掌握自我调控能力。