It is the primary task to treat critically ill patients in ICU, so it is the most important work to closely observe the changes of vital signs and pay attention to the dysfunction of vital organs. The following is a nursing paper on critically ill patients that I have compiled for your reference. Model essay on nursing care of critically ill patients: safe nursing care of hospital transport of critically ill patients
Abstract Objective: To explore the effect of nursing safety management methods and approaches in hospital transport of critically ill patients. Methods: Evaluate the condition and risk of critically ill patients before transport, implement nursing safety management mode in hospital transport of critically ill patients, pay attention to the observation of their condition and pipeline care during transport, and make oral and written handover of critically ill patients. Results: The safety of hospital transport nursing for critically ill patients was improved. Conclusion: Implementing hospital transport management for critically ill patients can shorten transport time, improve transport efficiency and reduce the incidence of adverse events and accidents during transport.
key words: critically ill patients; In-hospital transport; Safety nursing
Chinese library classification number R473 document identification code B article number 14-4949(214)2-228-1
It is important and necessary to do a good job in safety nursing for all kinds of critically ill patients in transit, which has certain significance and necessity for patients' treatment, prognosis and rehabilitation [1]. Since January 211, our hospital has strengthened the management of safe transport of critically ill patients in the hospital, reducing the incidence of adverse events and accidents. Now it is reported as follows.
1 Materials and Methods
1.1 Clinical data: There are 6 critically ill patients safely transported in the hospital every year in the Department of Critical Care Medicine, including 346 males and 254 females; The age ranged from 16 to 9 years, with an average of 45 years; There were 8 patients in internal medicine and 52 patients with major surgical operations, 594 patients were transferred back to the ward after their condition was stable, and 6 patients died.
2 Nursing methods
2.1. Care before transport
2.1.1 Introduce yourself to the patients and their families before transport, explain the purpose and necessity of transport, and obtain their maximum cooperation. It obtains cooperation.
2.1.2. Evaluation of the condition before transport. The condition of severe patients is complex, dangerous and changes rapidly, and there may be different degrees of complications and some unexpected situations during transport. Therefore, it is the key for nurses to accurately and comprehensively evaluate the patient's condition before transporting the patient [2]. Nurses on duty must fully understand and evaluate the condition of all patients before transfer. According to the assessment, make corresponding preparations.
2.1.3 For potentially dangerous patients, such as patients with severe craniocerebral trauma and massive cerebral hemorrhage, the factors that increase intracranial pressure should be removed as far as possible, including sucking sputum before transport, controlling restlessness, raising head during transport, properly restraining, etc., and taking portable sputum aspirator; For comatose patients, oropharyngeal snorkel, artificial respiration skin and tracheal intubation should be prepared. For those with tracheotomy, the fixation of artificial airway should be checked and reinforced if necessary to prevent the intubation from falling off or shifting.
2.1.4. Check whether the venous access is unobstructed and whether the connections are tight. It is best to use intravenous indwelling needle for infusion to ensure effective venous access during transfer.
2.1.5 preparation of articles, medicines and instruments needed during transportation; different rescue medicines, such as epinephrine, atropine, lidocaine hydrochloride, nikethamide, lobeline, diazepam and sodium lactate ringer's solution, are prepared according to the patient's condition. At the same time, prepare a kind-hearted electric monitor, oxygen bag, simple breathing airbag, sputum aspirator, etc., and prepare a portable ventilator when necessary.
2. 1.6 Strengthen effective communication and coordination with ICU. Before transshipment, inform ICU to make corresponding preparations, and inform the patient's basic situation, including the patient's initial diagnosis, current vital signs, drugs and instruments to be prepared, so as to reduce the waiting time and gain time for the patient's diagnosis and treatment.
2. 1.7 Nursing in the process of transportation The nurse in charge of transportation should have a strong sense of responsibility, accurate judgment, and the ability to work independently and deal with problems in an emergency. If the patient's vital signs are unstable, at least two accompanying personnel are needed during transportation, and the competent doctor is required to go with him.
2.1.8 preparation of receiving department. The preparation of the receiving department is also very important. Before transshipment, you should call the relevant departments to make corresponding preparations. If the patient has an artificial airway and uses a ventilator, it should be notified in advance to inform the patient's basic situation. Before departure, reconfirm that the receiver has made relevant preparations, inform the patient of the arrival time or contact the inspection department for the exact time to ensure that it can be done on demand.
2.2 care in transit:
2.2 care in transit.
2.2.1 monitoring vital signs.
closely observe the conditions of various pipelines. Check whether the pipes are in place and properly fixed. Check whether the pipes are fixed securely one by one from head to toe, and require the joints of the joints and tees to be tightened. Keep all kinds of pipes unblocked and effective, and prevent them from twisting, pressing and slipping. Pay attention to the color, nature and quantity of drainage fluid. Make sure that the intravenous infusion is smooth during transit, so as to take medicine during rescue. The drainage pipes that can be temporarily closed, such as urinary catheter and partial abdominal wound drainage pipes, are clamped, and the clamped pipes and drainage bags are fixed to the patient's abdomen.
2.2.2 during transshipment, keep the speed of flat car stable to prevent bumping, and keep the head at the end of the big wheel, which can reduce the vibration due to the slow and stable rotation speed of the big wheel. When going up and down the slope, the patient's head is always at the high end, so as not to cause discomfort to the patient. Pay attention to keep warm in winter, cover the patient in summer and rainy days, and cover the quilt. Calm and restrain patients who are agitated to prevent patients from falling and being injured.
2.2.3 treatment of complications in transit. Once serious complications occur, they should be rescued on the spot, and at the same time contact with relevant departments in order to get specialist treatment.
2.2.4 Monitoring and recording in transit. During transit, the patient's vital signs, blood oxygen saturation, patient's state of consciousness, respiratory rate and respiratory pattern should be closely monitored, and at the same time, the values of various monitoring indicators, the state of conscious activity, rescue and treatment during transit should be recorded.
2.2.5 do a good job of handover. After arriving at the receiving department, do a good job of handover with relevant personnel. The contents of the handover include the patient's diagnosis, consciousness, pupil, vital signs, oxygen flow, the names of various pipes and the depth of implantation, the situation of drainage fluid, special medication and skin conditions.
3 Discussion
3.1 The management of safe transport of critically ill patients in hospital is of great significance. The transport of critically ill patients is a very important link in the treatment process. Proper operation can not only harmonize the relationship between doctors and patients in the process of patient treatment, but also reduce legal disputes. As nursing management, nursing safety management should be put in the first place. It is reported in literature. 11. 6% of patients with acute and critical illness have different degrees of complications and accidents. The incidence of adverse events such as falling out of bed, falling off the tube, worsening of illness and cardiac arrest can be obviously reduced through predictive nursing procedures. We should pay attention to keeping the respiratory tract unobstructed, suctioning in time when there is sputum to prevent suffocation caused by sputum blockage. Patients with craniocerebral trauma should have safe and suitable positions when transporting, such as taking a supine position and leaning their heads to one side to prevent vomit from being inhaled by mistake. The head of the patient with cerebrospinal fluid otorrhea is inclined to the affected side, and the patient with cervical vertebra injury is fixed with a neck brace. When moving the patient with hemopneumothorax, the closed drainage tube of the chest should be clamped to prevent the catheter from falling off, leaking or liquid from flowing back. Pay attention to check all kinds of pipes on the patient after gastric cancer and intestinal cancer surgery, keep them unobstructed and properly fixed to prevent falling off, folding and twisting. After the patient returns to the department, the senior responsible nurse or nursing team leader will re-evaluate the patient. Observe the condition, keep the respiratory tract unobstructed, and properly fix all kinds of pipes.
3.2 Pretreatment of critically ill patients before and during in-hospital transport. Pretreatment of high-risk critically ill patients before and during transport is an important measure to reduce risks and ensure transport safety. Removal of secretions and aspiration in the airway before transport, patients with dyspnea or low oxygen saturation should be intubated in advance to keep the airway unobstructed, the bleeding site should be effectively bandaged for hemostasis and blood transfusion, the volume of patients with hemorrhagic shock should be expanded, the micro-pump adjustment of vasoactive drugs in patients with heart failure, the use of dehydrating agent in patients with intracranial hypertension, closed thoracic drainage in the state of hemopneumothorax, and the fixation of fracture sites. Observe the condition closely during transportation, deal with airway secretions in time, adjust the ventilator mode, stabilize blood pressure (such as speeding up infusion and dropping of vasoactive drugs), correct serious arrhythmia (such as ventricular fibrillation) and stabilize various pipes and splints. Through these predictive treatments, the transport safety factor of critically ill patients is obviously improved.
4 Summary
The purpose of hospital transport of critically ill patients is to provide better treatment and care. In-hospital transport may lead to changes in patients' vital signs, and even aggravate their condition, leading to different degrees of complications. Therefore, appropriate and safe nursing methods must be adopted to transport patients to ensure the safety and effectiveness of medical care services provided for patients. Successful transportation is of positive significance to reduce the mortality and disability rate of critically ill patients.
References
[1] Wang Guanmin, Liu Xiying. Safety management of hospital transport of patients undergoing thoracotomy [J]. Nursing Research, 29,23 (Supplement 1): 129.
[2] Tang Meizong. Safety management of hospital transport of critically ill patients [J]. Nursing Research, 21. 24 (1): 15 ~ 16 nursing papers on critically ill patients Model 2: Nursing experience of enteral nutrition for critically ill patients < P > Objective To study the nursing measures of enteral nutrition for critically ill patients and summarize its therapeutic effect. Methods The nursing methods of 68 critically ill patients who were hospitalized in our hospital from January 211 to January 212 and received enteral nutrition were analyzed retrospectively. Results Among the 68 critically ill patients selected in the data, 4 patients suffered from severe gastrointestinal bleeding and stopped nasal feeding, while the remaining 64 patients were well tolerated. Two weeks after receiving nutritional support therapy, the levels of blood sugar, hemoglobin and serum albumin of 68 patients were measured and returned to normal. Conclusion Early clinical gastrointestinal nutrition support and scientific and reasonable nursing measures can significantly reduce the internal environment disorder, improve the quality of life and reduce the mortality of patients.
key words: critically ill patients; Enteral nutrition; Nursing
Research has proved that reasonable nutritional support is an essential link to rescue and treat critically ill patients. Because of this, the application of enteral nutrition in critically ill patients has been greatly developed in recent years. Enteral nutrition can not only protect gastrointestinal mucosa, maintain gastrointestinal function, but also maintain normal visceral blood flow. The body state of critically ill patients is in a state of high catabolism. On-site nutrition can provide patients with sufficient energy to correct negative nitrogen balance and prevent enterogenous infection caused by bacterial translocation. In this paper, the nursing methods of 68 critically ill patients who were hospitalized in our hospital from January 211 to January 212 and received enteral nutrition were retrospectively analyzed. The details are as follows.
1 materials and methods
1.1 general materials were selected from 68 critically ill patients who were hospitalized in our hospital from January 211 to January 212 and were given enteral nutrition. Among the 68 patients, 41 were male and 27 were female. The youngest is 18 and the oldest is 88, with an average age of 47. In terms of diseases, 39 patients were diagnosed as severe thoracoabdominal compound injury, 14 patients were diagnosed as head-chest compound injury, 15 patients were diagnosed as multiple organ dysfunction syndrome, and 68 patients all had gastrointestinal problems and could not eat by mouth. After professional diagnosis, they needed nutritional support treatment for more than 7 days.
1.2 methods after the patients started enteral nutrition therapy, their serum albumin, hemoglobin and blood sugar were continuously monitored regularly.
1.3 nutritional support route ① nasogastric tube route: this nutritional support route is suitable for patients with normal gastrointestinal function, no coma during the implementation, or who can complete the transition from nasal feeding to oral diet in a short time. ② nasojejunal intubation feeding: If the patient's gastrointestinal function is in a normal state, and he is not in a coma, or he can complete the transition from nasal feeding to oral diet in a short time, then this nutritional support feeding route can be used, which can reduce the probability of aspiration and reflux caused by catheter route problems. ③ Feeding by gastrostomy and jejunostomy: This method is traumatic, so it is suitable for patients who need long-term enteral nutrition. This method requires surgical stoma to place the nutrition tube in the stomach or jejunum.
1.4 application principles of enteral nutrition The application of enteral nutrition should fully consider the gastrointestinal function of patients, and two types of enteral nutrition can be selected: element type and whole protein type. Essential enteral nutrition agents: propafenone and propafenone. Whole-protein enteral nutrition: Patients who use this kind of enteral nutrition supply should be in a good state of intestinal function because they need to use aspartame and omnipotence. In the process of enteral nutrition therapy, we should pay attention to the determination of blood sugar and electrolyte, ask the patients about their gastrointestinal tract, and adjust the dosage and concentration of enteral nutrition solution according to their different physical conditions.
1.5 feeding mode ① one-time feeding: this way is to inject the prepared enteral nutrition food at one time, which has many complications. (2) Intermittent feeding: the required enteral nutrition food is given in stages, and the injection frequency is once every 3-4 hours; if gravity drip is needed, the injection frequency is once every 3-4 minutes. ③ Continuous drip: This method needs the help of enteral nutrition pump to drip the patient continuously for 2-24 hours, because it takes a long time, which requires the patient to have good tolerance. ④ Circulating drip: This method needs the control of infusion pump to continuously pump in for a certain period of time.
2 Results
Among the 68 critically ill patients selected in the data, 4 patients suffered from severe gastrointestinal bleeding and stopped nasal feeding, while the remaining 64 patients were well tolerated. Two weeks after receiving nutritional support therapy, the levels of blood sugar, hemoglobin and serum albumin of 68 patients returned to normal.
3 Discussion
3.1 The basic concept of nutritional support refers to the dietary nutritional measures taken according to the principles of nutrition, also known as therapeutic nutrition, in order to treat or alleviate diseases and enhance the clinical effect of treatment. The diet used is called therapeutic diet, and its basic forms generally include therapeutic diet, nasal feeding, tube feeding, essential diet and intravenous nutrition. It is the main and important measure to maintain and improve the function and metabolism of organs, tissues and cells and prevent the occurrence of multiple organ failure. Indications of enteral nutrition support include: ① those who have insufficient or unable to eat orally. After surgery for oral tumor and throat tumor; nutritional requirement