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1、The English nursing round in Emergency department,Case study of the general situation and introduction,part 1,1 General data2 Present history3 Past medical history4 Special examination 5 Auxiliary examination6 Social relationship7 Current condition,Case study of the general situation and introductio
2、n,Case study of the general situation and introduction,8 Introduction of medical treatment problem9 Pathphysiology10 Morbidity factor 11 Clinical symptoms12 Treatment13 Nursing,Case Introduction,Commonly Information Existing Case AnamnesisSpecial examinationAssist examinationSocial situation Actual
3、status,General data,Name：Li Yukui Sex：male Age：64Marital：MarriedOccupation：Dispenser Family：Widowed，Date of admission：12-12-07 Date in ICU：12-12-07Diagnoses：COPDThe reason for being in ICU：The patients condition was getting worse,Present history,Cough and phlegm without obvious inducement appeared 3
4、0 years ago,but no haemoptysis,Outbreak obviously in winter and springThe symptoms have been getting worse year after year,The patient felt suffocated and breathing hard,with the decreasing of work ability.,Present history,A month ago,the patient felt suffocated,could not lie down,anorexia,little em
5、iction and edema of his whole body,coughed with flavicant and ropy sputa that cannot be coughed out,No angina,fever and chestache,no unconsciousness,oxygen therapy with low flux at home.,Present history,When his symptoms aggravated,the patient had been sent to the first-aid room of our hospital.The
6、patient was treated by anti-inflammation,diuresis,dispelling phlegm,relieving asthma,continuously breathing in oxygen with low flux,heteropathy.,Present history,Analyse of artery blood：respiratory failures Chest X-ray：infection in lungs.Biochemical test：damaged function of liver and kidney,decreasin
7、g amount of plateletBP：80/60mmHg,wet and cold extremity,gradual unconsciousness,Considerating infected shock and carbon dioxide remains,the patient was provided an accessorial ventilation with non-traumatic model,and blood vessel active medicine to keep his blood pressure.After the treatment，the pat
8、ient was not getting better obviously,so the patient has been transfer to EICU,Present history,He had smoken for 50 years,ten cigarettes one day.Now he has kicked the habit of smoking for 1 year.4-5 hours sleeping a day,bad mental status.Defecated once every 2-3 days,peed 7-8 times a day,1-2 times o
9、ne night.,Past medical history,The patient was diagnosed as infiltrative pulmonary tuberculosis in 1988，and was cured with anti-tuberculosis.His was diagnosed as spontaneous underarachnoid bleeding、contusion and laceration of chest、extradural hematorma of left pillon.Haemorrhage was absorbed after t
10、reating.There is no sequela left.,Past medical history,In 2004,infection of lungs lead to the respiratory failures,and the patient got better after treating.He denied hepatitis，hypertension,diabetes,allergic history.,Special examination,Chest X-ray in 12-12-2007：Infection in the double lungs,obsolet
11、e pathological changes in the double upper lungs，pathogical change with pleura，auxacardia.Electrocardiogram：normal rhythm，pneumonic p wave，lower s-t.,Auxiliary examination,Analyse of artery blood in 12-12-2007：PH 7.43 PCO2:77mmHg PO2:72mmHg HCO3-:50.2 BE:23.9 Blood Routine:WBC:3.5109/LRBC:3.971012/L
12、 GR:85%HB:104g/L HCT:34.2%PLT:2.0109/LChemcial test:Glu:7.48mmol/L Bun:7.96mmol/L K:2.7mmol/L Albumin:33g/L,Social relationship,The patient is a dispenser,married at the right age,with 2 sons and a daughter,now widowed,in a warm family.,Current condition,ConsciousnessSymptomsBedsoreVital signs,Part
13、2 Introduction of medical treatment problem,COPD introduction,Pathophysiology,pathogenic factors,infection,smoking,air pollution,occupational dust and the long-term inhalation of harmful gases,allergies.,Clinical symptoms of COPD,Common symptomsSmokers cough in the morning and expectorate mucus whic
14、h may contain pus and blood frequently.Smokers usually feel dyspnea,so they are unable to obtain normal amounts of oxygen.Smokers are tired easily.,Clinical symptoms of COPD,Typical signs barrel chest,respiratory movement weakened,low-vocal fremitus.,Auxiliary examination,blood testsputum examinatio
15、nphantom examinationPulmonary function testElectrocardiogram,Treatment,Objective Its purpose is to improve the respiratory function,then improve patients work and life capability.,Specific measures,1 Apply bronchodilator drugs such as anti-cholinergic drugs2 Application of effective antibacterial dr
16、ugs3 Respiratory muscle exercise We can do abdominal breathing to strengthen the activities of respiratory muscles.4 Family oxygen therapy 10-15 hours daily(1-2L/MIN)5 Rehabilitation6 Surgical treatment,nursing,1 Monitor vital signs closely2 Respiratory care 3 Observation of the wound 4 Observation
17、of the uncomfortable situation5 Maintain stability of the circulatory system6 Nutritional supplements7 Psychological assessment,Part 3,Introduced Roy adaptation model,Introduction of Roy adaptation model,1 Main viewpoint of Roy adaptation model2 Applications of Roy adaptation model in nursing3 The r
18、easons for selecting Roy adaptation model in the case studies,Roy Adaptation Model of the key concepts,Person and corresponding concepts,Person Physiological adjustment Psychological adjustment Physiology function Self-concept Role function Interdependence,Health and related concepts,HealthAdaptive
19、Response Ineffective response,Environment and related concepts,Environment Main incitement Related to stimulate Proper stimulate,Nursing and related concepts,NursingNursing science Nursing fulfillment Nursing target Nursing activity,The main points of Roy adaptation model,1.The point of Roy adaptati
20、on model lies in the persons adaptability 2.Adaptation model has two subsystems which contact mutually,and call control process and effect,Roy Adaptation Model of application in the nursing,first class assessment,second class assessmentdiagnosissetting targets measure evaluation,In the case studies,
21、the reasons for selecting the Roy Adaptation Model,Physiological functions,first class assessment(behavior evaluation)second class assessment(stimulation evaluation),Nursing assessment,1 Diagnosis,2 Goal3 Measure 4 Appraisal,Nursing Diagnosis,Ineffective breathing patternsGas exchange,impairedCleani
22、ng respiratory ineffectivethe risk of infectionskin integrity,impairedConstipationAnxiety,1 Diagnosis,Ineffective breathing patterns:be related to bronchial obstruction,respiratory resistance increase.ObjectivePatient can keep airway unblocked and maintain adequate oxygen supply to organizations,no
23、ventilator complications.,Part 4 ROY adaptation model used in the case,Nursing procedure,Nursing procedure,Nursing procedure,Nursing procedure,Nursing procedure,Nursing procedure,Nursing procedure,Nursing procedure,Part 5 Advantages and disadvantages of applying Roy adaptation model in EICU.,Aadvant
24、ages,Provide an integrated framework is conducive to the implementation of holistic care,from the physical,psychological and social aspects for all patients with and provide support and service.Guidance of a comprehensive assessment system,including first class(behavior)assessment and second class(s
25、timulate)assessment,observation and meticulous guidance of nurses with behavioral change,which is very easy to collect relevant information.,Aadvantages,Six steps of the nursing process is continuous,the implementation of the evaluation of care measures by the new assessment,so as to continuously re
26、vise and improve the care plan,to provide patients with continuous,with the changes in the condition of patients and care.Under the guidance of Roy,nurses in EICU can observe the patients in critical cases where adaptability and ineffective response can be accumulated experience,information is condu
27、cive to the future nursing practice and nursing research.,Disadvantages,For nurses in the EICU,first Class assessment is easy,second class assessment is much more difficult,particularly the identification of key stimulation and related stimulation is not easy,thereby increasing the difficulty and ti
28、me.Roy adaptation model for use in patients with a complete assessment list nursing diagnosis,care plan developed relatively time-consuming,especially in the EICU,it is difficult to extract sufficient time.,Conclusion,Any nursing model is confined to their own values and beliefs,we can not include a
29、ll aspects of care,but have different priorities.Roy adaptation model focused on the adaptability of specified care for the sole purpose of helping sick people in the health or circumstances,by controlling the physical environment and to adapt to social and psychological state.,Conclusion,In ICU cli
30、nical practice,this model can guide the nurse to critically ill patients how to provide effective care plan,better adaptation of the critical state of health on a sound foundation.Roy adaptation model is not only the ICU nursing mode,it can be used for other aspects of nursing practice,for ICU,Roy adaptation model also has its limitations,as the nursing theory and the development of ICU care,there will definitely be specific to the ICU care mode,but also facilitate the use of ICU nurses,ICU nursing practice will play a greater role in promoting.,Thanks for your attention!,
