重癥肝炎病人的意識(shí)評估

Evaluating the Level of Consciousness for a Patient with Severe Hepatitis

交流

護(hù)士：好的，你做得不錯(cuò)，接下來，我們來做幾道算術(shù)題好嗎？

病人：你把我當(dāng)成小朋友啦（笑著說），那好吧。

護(hù)士：3＋7等于多少？

病人：等于10。

護(hù)士：13＋18等于多少？

病人：等于20。（老張想了一會(huì)兒）

護(hù)士：6＋7等于多少？

病人：等于10。

護(hù)士：好的老張，你答得不錯(cuò)，現(xiàn)在你先休息。等一下我會(huì)來給你抽一個(gè)血，做一些化驗(yàn)。

病人：謝謝你，小林。

Interactions

Interactions

(2) 在運(yùn)營線路之間應(yīng)設(shè)置聯(lián)通線，聯(lián)通線宜采用互通道岔連接接軌站。接軌站的配線應(yīng)保證進(jìn)站車輛不會(huì)因進(jìn)站進(jìn)路被占用而停在交叉口范圍內(nèi)，車站與交叉口之間的距離應(yīng)不小于1倍車輛長度。

Nurse：Good，you did well.Now let us do some math problems，OK？

Patient：You are treating me as a child（He said with a smile），OK please.

Nurse：What is 3plus 7？

Patient：10.

Nurse：What is 13plus 18？

Patient：20.（He thought for a few seconds）

Nurse：What is 6plus 7？

Patient：10.

Nurse：OK，Mr.Zhang，your answers are fine，and take a rest now.I will draw some blood from you shortly so we can run some tests for you.

結(jié)果

護(hù)士觀察到病人有性格改變、計(jì)算能力下降，并出現(xiàn)撲翼樣震顫，結(jié)合病人有便秘、高蛋白飲食，測血氨高于正常范圍，初步確認(rèn)病人處于肝昏迷前驅(qū)期。立即匯報(bào)醫(yī)生，經(jīng)降血氨、灌腸、禁食蛋白質(zhì)等及時(shí)治療后，病人精神神經(jīng)系統(tǒng)癥狀好轉(zhuǎn)，血氨恢復(fù)正常，避免了肝昏迷的發(fā)生。

Result

The nurse detected the changes of the patient’s character，declining computing power，and having flipping tremor.Combining the patient’s constipation，high protein diet，and his elevated blood ammonia level，she affirmed that the patient was in the prodromal stage of liver coma and reported it to the doctor at once.With prompt treatments such as decreasing the level of blood ammonia，enema，stopping high protein diet，the patient’s neural symptom took a turn for the better and the occurrence of liver coma was avoided.

點(diǎn)評

觀察是一種有目的、有計(jì)劃、比較持久的知覺。敏銳的觀察能力是護(hù)士必須具備的品質(zhì)之一，源于注意、記憶、分析、判斷等心理活動(dòng)的綜合應(yīng)用。護(hù)理人員在工作中，必須養(yǎng)成運(yùn)用視、聽、觸、嗅等感官，隨時(shí)有目的地、系統(tǒng)地感知護(hù)理對象的動(dòng)作、表情、言語等外顯行為所提示的內(nèi)在變化，正確認(rèn)識(shí)和判斷他們的需求，使護(hù)理措施有預(yù)期的主動(dòng)性。

Comments

Observation is a purposive，planned and persistent perception.Keen observation is one of the necessary characters that nurses must have.It is stemmed from integrated application of mental activities such as attention，memory，analysis and judgment.Nurses must use all their sensory organs at all times to form a habit of planned and systematic perception to their patients’internal changes that can be tracked from the patients’external behaviors like actions，emotions，speeches，etc.They must correctly understand and evaluate the patients’needs，and make nursing care with proactive interventions.