呼吸衰竭護(hù)理講課

1、,Nursing Management of respiratory failure,Jiang Shenghua,,呼吸： 機(jī)體與外界環(huán)境之間的氣 體交換過(guò)程。,,,Let’s Review: Respiratory Anatomy,Upper Respiratory Tract:Mouth, nose, throat (pharynx), larynx, tracheaLower Respiratory Tract:

2、Lungs, bronchi, alveoliMedulla OblongataControls inspiration/expirationMicrosoft clipart,Anatomy Review,,Used with permission: webschoolsolutions, 2007,Respiratory ReviewLet’s Take a Breath Together:,Air is warm

3、ed and humidified.Cilia filter out dust particles.Macrophages destroy germs.Air goes to L and R bronchi.Then to the bronchioles.Through to the Alveoli.Oxygen and CO2 exchange takes place.Used with permission

4、: Jensen M.S., Webanatomy 2007,Respiratory Review:Now your Breath is…,Alveoli fill with air.Oxygen diffuses thru alveoli walls.Oxygen diffuses to Capillaries and bloodstream.Hemoglobin for transport ofoxygen.O

5、xygen to the heart and to the body.Used with permission: Jensen, M.S., Webanatomy (2007).,Respiratory ReviewLet your air out…,Hemoglobin frees oxygen.O2 to cells.CO2 is the waste prod

6、uct.Veins return CO2 to heart.Heart pumps CO2 to lungs.CO2 passes alveoli to be exhaledUse with permission: Jensen, M.S., Webanatomy (2007),Respiratory Quiz,Respiratory Assessment:Understanding the anatomy of th

7、e lungs, where does the exchange of oxygen and CO2 occur:A. BronchiolesB. AveoliC. Bronchial TubesClick on underlined best answer.,O2,CO2,,,,,,,CO2,Externalrespiration,circulation,Internalrespiration,肺通氣(Pul

8、monary ventilation),肺通氣：肺與外界環(huán)境氣體交換的過(guò)程。,一、肺通氣的動(dòng)力,直接動(dòng)力：肺內(nèi)壓與外界大氣的壓力差,原動(dòng)力：呼吸運(yùn)動(dòng),呼吸運(yùn)動(dòng),,（一）呼吸運(yùn)動(dòng)(respiratory movement),1.概念：呼吸肌的收縮和舒張引起胸廓節(jié)律性擴(kuò)大和縮小，包括吸氣運(yùn)動(dòng)和呼氣運(yùn)動(dòng)。,吸氣肌: 膈肌和肋間外肌呼氣肌: 肋間內(nèi)肌和腹肌輔助吸氣肌: 胸鎖乳突肌 和斜角肌,呼吸運(yùn)動(dòng)

9、的調(diào)節(jié),一、 呼吸中樞與呼吸節(jié)律的形成,呼吸中樞：中樞神經(jīng)系統(tǒng)內(nèi)產(chǎn)生和調(diào)節(jié)呼吸運(yùn)動(dòng)的神經(jīng)細(xì)胞群。,Apneusis長(zhǎng)吸式呼吸,Gasping喘息樣呼吸,1.自主呼吸節(jié)律的形成,延髓：產(chǎn)生自主呼吸節(jié)律的基本中樞腦橋上部：呼吸調(diào)整中樞(促進(jìn)吸氣向呼氣轉(zhuǎn)化),2.高位腦：控制隨意呼吸(大腦皮層、邊緣系統(tǒng)、下丘腦等處),（一）呼吸中樞(respiration center),,二、呼吸運(yùn)動(dòng)的反射性調(diào)節(jié),（一）化學(xué)感受性呼吸反射,⑴外周化學(xué)

10、感受器: 頸動(dòng)脈體和主動(dòng)脈體;⑵中樞化學(xué)感受器: 延髓腹外側(cè)淺表部位。,1.化學(xué)感受器(Chemoreceptor),⑴外周化學(xué)感受器,頸動(dòng)脈體和主動(dòng)脈體,動(dòng)脈血中 PO2↓，[H+]↑，PCO2↑→頸動(dòng)脈體和主動(dòng)脈體外周化學(xué)感受器興奮→呼吸中樞興奮→呼吸加深加快。,,2.中樞化學(xué)感受器,部位：延髓腹外側(cè)區(qū)淺表部位,,中樞化學(xué)感受器的生理刺激是:,腦脊液和局部細(xì)胞外液中的H+。*注意：中樞化學(xué)感受器不感受CO2和缺O(jiān)2刺激,,2.C

11、O2、H+、O2對(duì)呼吸運(yùn)動(dòng)的調(diào)節(jié),CO2：動(dòng)脈血中一定水平PCO2是維持呼吸中樞基本活動(dòng)的必要因素。,CO2刺激呼吸運(yùn)動(dòng)的途徑：中樞化學(xué)感受器(起主要作用，但反應(yīng)慢)外周化學(xué)感受器(與快速呼吸反應(yīng)有關(guān)),吸入氣CO2濃度適當(dāng)增加(1%~7%)，呼吸運(yùn)動(dòng)加深加快；CO2排出受限或吸入氣CO2含量超標(biāo)，引起動(dòng)脈血PCO2顯著升高(>80mmHg)，將抑制中樞神經(jīng)系統(tǒng)，出現(xiàn)呼吸困難,頭痛,頭暈,甚至昏迷稱為CO2麻醉。,,CO2

12、↑(正常CO2為0.04%)對(duì)呼吸的影響,●吸入氣中CO2 1％ 時(shí)→呼吸開始加深；●4％CO2時(shí)→呼吸加深加快,通氣量↑1倍以上; ●6％CO2時(shí)→肺通氣量可增大6-7倍;●7％CO2時(shí)→血液中PC02明顯升高，可出現(xiàn)頭昏、 頭痛等癥狀；●超過(guò)15％-20％，呼吸反而被抑制,可出現(xiàn)驚厥、 昏迷，甚至呼吸停止。,H+對(duì)呼吸運(yùn)動(dòng)調(diào)節(jié)的途徑及特點(diǎn),*血液的H+不易通過(guò)血腦屏障，因此對(duì)中樞 化學(xué)感受器的影響很弱。,,低氧對(duì)呼

13、吸的興奮是通過(guò)外周化學(xué)感受器實(shí)現(xiàn)。低氧對(duì)呼吸中樞直接作用是抑制。,不同程度的低氧對(duì)呼吸的影響不同,中度低氧,外周化學(xué)感受器,,+,,+,,一,呼吸中樞,一,外周化學(xué)感受器,,+,,+,嚴(yán)重低氧,,呼吸運(yùn)動(dòng)抑制,,呼吸中樞抑制,,3.CO2、H+和O2在呼吸調(diào)節(jié)中的相互作用,●發(fā)生總和而加大對(duì)呼吸的影響: 例：PCO2↑→ [H+]↑，二者作用發(fā)生總和，肺通氣的增加比單因素PCO2↑時(shí)明顯●相互抵消而減弱對(duì)呼吸的影響: 例

14、：[H+]↑→肺通氣量↑→CO2排出↑→ PCO2↓，肺通氣的增加比單因素[H+]↑時(shí)小,三、呼吸運(yùn)動(dòng)的隨意調(diào)節(jié),●大腦皮層控制隨意呼吸運(yùn)動(dòng)?！襁@種控制是有一定限度的。如潛水需要屏氣，但不能 無(wú)限制屏氣?！衽R床上,若自主控制通路受損，可觀察到自主呼吸和隨意呼吸的分離現(xiàn)象。即自主呼吸運(yùn)動(dòng)消失，患者必須“記住”要呼吸，一旦入睡或注意力轉(zhuǎn)移，呼吸運(yùn)動(dòng)停止。,,,Definition and Classification,Definitio

15、n,Respiratory dysfunction,oxygenation,CO2 elimination,vital organs,,,,,threaten,,,Key Words,Respiratory failure(RF) Acute respiratory distress syndrome(ARDS) Hypoxemia hypercapniaRespirato

16、ry rate(RR) Respiratory SupportMechanical ventilation Positive end-expiratory pressure (PEEP),,,Contents,Definition and Classification Epidemiology Physiology pathogenesis Clinical Evaluation Initial Manage

17、ment Advanced Management,What is respiratory failure,Respiratory failure develops when the rate of gas exchange between the atmosphere and blood is unable to match the body's metabolic demands. It is diagnosed when

18、 the patient loses the ability to provide sufficient oxygen to the blood and develops hypoxemia or when the patient is unable to adequately ventilate and develops hypercarbia and hypoxemia.,,Respiratory failure is a synd

19、rome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. In practice, respiratory failure is defined as a PaO2 value of less than 60 mm Hg wh

20、ile breathing air or a PaCO2 of more than 50 mm Hg. （mmHg=millimeter hydrargyrum）,,,Definition and Classification,Definition,PaO26.66 kPa(50mmHg),,Classification,acutely or chronically,In acute respiratoryfailure, a sudd

21、en, catastrophic event leads to life-threatening respiratory insufficiency.In chronic respiratory failure, gradual worsening of respiratory function leads to progressive impairment of gas exchange, the metabolic effect

22、s of which are partially compensated by adaptations in other systems,EPIDEMIOLOGY,Respiratory failure is a common diagnosis among patients in medical intensive care units (ICUs) and is associated with a poor prognosis.

23、The incidence of respiratory failure is 137 cases per100,000 population, or 360,000 cases per year in the United States,with 36% of these individuals failing to survive the hospitalization.,,,流調(diào)城市: 7個(gè)城市14個(gè)調(diào)查點(diǎn) (北京、上海、天津

24、、沈陽(yáng)、西安、重慶、廣州),Shanghai,Tianjin,Chongqing,Shenyang,,,,,Xi’an,,Beijing,,Guangzhou,,21270 subjects investigated, response rate 83.0%. Total prevalence: 8.2% Male vs female: 12.4% vs 5.1% Rural vs urban: 8.8% vs 7.8% Rel

25、atively higher COPD prevalence in Chongqing, and lower prevalence in Shanghai and Xi’an 死亡率：100萬(wàn)/年,,Therapeutic advances in both mechanical ventilation and airway management have improved the prognosis for pati

26、ents with respiratoryfailure over the past several decades.ventilator support systemsLung transplantation,病因,1.氣道阻塞性病變2.肺組織病3.血管疾病4.胸壁及胸膜疾病5.神經(jīng)肌肉系統(tǒng)疾病,,,,,,呼吸衰竭的常見發(fā)病環(huán)節(jié),,,,Physiology- Nervous System,Dorsal & Vent

27、ral Nuclei, Medullary Respiratory Control group,Afferent & Efferent Pathways,In concert with Cerebral Cortex, determine RR and Breathing Effort,Nervous System,,Respiratory failure due to diseases that cause dysfun

28、ction of the central control system can be thought of as controller dysfunction, or central apnea.Hypoventilation can be caused by disease at any of the anatomical sites involved in ventilation. Brainstem injury or dise

29、ase may result in impaired functioning of the respiratory centre, which may also be suppressed by depressant drugs,,,Physiology-Musculature,Other Musculature Intercostals; Suprasternal; Sternocleidomastoid,,,Physiology-

30、Musculature,,,,,Neuromuscular blockers or disease of the neuromuscular junction (eg myasthenia gravis) may impair transmission of nerve impulses to respiratory muscles Or the problem may be in the muscle itself. Respira

31、tory muscle fatigue, disuse atrophy and malnutrition are important causes of respiratory muscle failure in the ICU,,,,Respiratory failure due to diseases that cause ineffective function of the respiratory pump can be tho

32、ught of as pump dysfunction. Under normal conditions, only elastic recoil is required for expiration, but during respiratory failure accessory muscles of expiration are required,,,Physiology-Airways,,Upper respiratory tr

33、act： nose、pharynx、larynx,,Lower respiratory tract： trachea、bronchus、bronchiole,,Respiratory failure involving diseases that cause marked obstruction or dysfunction of the air passages can be thought of as airway sy

34、stem dysfunctionAlternatively the problem may be a problem of increased resistance to airflow. For example due to obstruction of the upper airway or bronchospasm,,,,,,,Physiology-Alveolar Units,Alveolar Unit: bronchiole

35、s; alveolar ducts; alveoli Function: surface area; sufficient elasticity Alveolar compartment dysfunction: collapse, flooding, injury to alveolar network,O2,,CO2,,,,,,,,,,,,,Alveolar epithelium,Capillary endotheliocyte

36、,,,,Physiology-Vasculature,,,0.8,Q,V,,Respiratory failure as a result of disease involving the pulmonary vasculature can be thought of as pulmonary vascular dysfunction.三維醫(yī)學(xué)--肺栓塞.avi,4.胸壁及胸膜疾病,脊柱疾病可以引起呼吸衰竭，常伴有肺心病，胸腔積液、胸膜

37、肥厚等亦可引起，外傷、骨折、氣胸等常導(dǎo)致急性呼吸衰竭。,,,,左側(cè)液氣胸,右 側(cè) 氣 胸,發(fā)病機(jī)制分類,通氣性呼吸衰竭：泵衰竭（II型）換氣性呼吸衰竭：肺衰竭（I型）,二、缺氧和二氧化碳潴留對(duì)人體的影響,缺氧和二氧化碳潴留引起人體各個(gè)系統(tǒng)、器官的功能代謝發(fā)生一系列代償適應(yīng)反應(yīng)，嚴(yán)重時(shí)出現(xiàn)代償不全，出現(xiàn)多器官功能和代謝紊亂直至衰竭。,具體表現(xiàn),1、對(duì)中樞神經(jīng)系統(tǒng)的影響2、對(duì)循環(huán)系統(tǒng)的影響3、對(duì)呼吸系統(tǒng)的影響4、對(duì)腎功能的影響

38、5、對(duì)消化系統(tǒng)的影響6、對(duì)酸堿平衡和電解質(zhì)的影響,,,,,,,1、  對(duì)中樞神經(jīng)系統(tǒng)的影響,PaO2＜60mmHg：注意力不集中、智力和視力輕度減退；PaO240-50mmHg：一系列神經(jīng)系統(tǒng)癥狀頭痛，不安定向及記憶力障礙。PaO2＜30mmHg：神志喪失乃至昏迷PaO2＜20mmHg：數(shù)分鐘可造成神經(jīng)細(xì)胞不可逆性損傷。輕度CO2增加：間接引起皮層興奮， CO2潴留也可以引起頭痛、頭暈、嗜睡、昏迷、呼吸抑制等。,,肺

39、性腦?。╬ulmonary encephalopathy）：由缺氧和二氧化碳潴留導(dǎo)致的神經(jīng)精神障礙癥候群。又稱二氧化碳麻醉（carbon dioxide narcosis）?？赡軝C(jī)制：,低氧血癥、二氧化碳潴留、酸中毒缺氧及酸中毒 血管內(nèi)皮損傷 腦間質(zhì)水腫。缺氧 ATP酶生成減少 Na-Ka泵障礙 細(xì)胞內(nèi)Na 腦水腫。形成惡

40、性循環(huán)。,,,,,,,,2、對(duì)循環(huán)系統(tǒng)的影響：PO2↓PCO2↑反射性心率加快、心肌收縮力增強(qiáng)、心排出量增加(皮膚內(nèi)臟血管收縮，冠脈血管擴(kuò)張，局部代謝物影響）嚴(yán)重缺氧和CO2潴留抑制作用 血管擴(kuò)張、血壓下降、心律失常。嚴(yán)重缺氧 室顫、心臟驟停長(zhǎng)期慢性缺氧 心肌纖維化、心肌硬化呼吸衰竭PO2↓ 肺動(dòng)脈高壓、心肌受損 肺心病,,,,,,,3、對(duì)呼吸系統(tǒng)的影響：氧＜60mmHg 刺激頸動(dòng)脈體、主動(dòng)

41、脈體，使通氣加強(qiáng)，氧＜30mmHg 呼吸抑制作用（興奮〈抑制）PaCO2增高興奮呼吸中樞呼吸深快。當(dāng)PaCO2＞80mmHg 呼吸中樞抑制、麻醉作用，（低氧興奮呼吸中樞）注意氧療方法,,4、對(duì)腎功能的影響：功能性改變，甚至發(fā)生腎功不全。,,5、對(duì)消化系統(tǒng)的影響：缺氧直接或間接損害肝細(xì)胞導(dǎo)致丙氨酸氨基轉(zhuǎn)移酶上升呼吸衰竭引起消化功能障礙，甚至出現(xiàn)胃腸粘膜糜爛、壞死、出血、潰瘍。,,6、對(duì)酸堿平衡和電解質(zhì)的影響急性呼吸

42、衰竭Ph HCO3 - / H2CO3缺氧 無(wú)氧酵解 代謝性酸中毒高鉀血癥（能量障礙，Na-Ka泵障礙）慢性呼吸衰竭呼吸性酸中毒并代謝性堿中毒（腎排泄HCO3減少）低氯血癥,,,呼吸困難判斷：無(wú)——嚴(yán)重外周體表靜脈充盈、皮膚潮紅、溫暖多汗、球結(jié)膜充血水腫。 血壓早期升高，后期下降；心率多數(shù)增快。 部分病人可見視乳頭水腫、瞳孔縮小，腱反射減弱或消失、錐體束征陽(yáng)性等。,2.體征,,,,

43、,,血?dú)夥治?是確定有無(wú)呼衰以及進(jìn)行呼衰分型最有意義的指標(biāo)。,,血pH電解質(zhì)測(cè)定,呼吸性酸中毒合并代謝性酸中毒時(shí)，血pH明顯降低可伴高鉀血癥；呼吸性酸中毒伴代謝性堿中毒時(shí)，常有低血鉀和低血氯。,動(dòng)脈采血進(jìn)行動(dòng)脈血?dú)夥治?呼吸衰竭病人由于出現(xiàn)多器官功能障礙，特別是呼吸困難，用力呼吸不能滿足機(jī)體需要時(shí)，常表現(xiàn)為恐懼或煩躁不安，產(chǎn)生瀕死感。,隨著呼吸困難加重，采用人工氣道或機(jī)械通氣時(shí)，影響到情感交流，病人出現(xiàn)情緒低落、精神錯(cuò)亂，甚至拒絕配合

44、治療及護(hù)理。,部分病人過(guò)分依賴呼吸機(jī)，一旦脫機(jī)，可能出現(xiàn)情緒緊張，對(duì)自主呼吸缺少信心。由于病人長(zhǎng)期受慢性疾病折磨，加上病情突然加重，病人及家屬可能出現(xiàn)焦慮、恐懼等心理。,,,1.在保持呼吸道通暢的前提下,與呼吸道分泌物多而黏稠、呼吸肌疲勞、 咳嗽無(wú)力、意識(shí)障礙或人工氣道有關(guān)。,清理呼吸道無(wú)效,水、電解質(zhì)紊亂及酸堿失衡、上消化 道出血、顱內(nèi)出血,潛在并發(fā)癥,complication,problems,Ineffective

45、 Breathing Pattern,Impaired Gas Exchange,Ineffective Airway Clearance,Anxiety,Altered Nutrition,(1)ABG values within the client’s baseline;(2)baseline breath sounds;(3)no dyspnea or dyspnea at the client’s baseline

46、;(4)effectivecough and ability to clear secretions.,,一般護(hù)理,對(duì)癥護(hù)理,病情觀察,治療配合,并發(fā)癥護(hù)理,心理護(hù)理,健康指導(dǎo),,,1．休息與體位 臥床休息。協(xié)助病人取舒適且利于改善呼吸狀態(tài)的體位，一般取半臥位或坐位。 ？,一般護(hù)理,呼吸衰竭多采用半坐位,1 .Effective coughing 2 .Airway establishment3

47、.Airway clearance,Effective coughing,If Secretions are obstructing the airway，the client should be encouarged to cough.Therapeutic techniques may be benefit to these clientsHow to do so?,Airway establishment,1. Oral

48、 endotracheal intubation2. Nasal intubation3. Tracheostomy,,,,,,3 .Airway clearance,Suctioning inculde crackles and rhonchi on auscultation，frequent coughing or setting off the high-pressure alarm，increasing restless

49、ness or anxietyOthers : Percussion，vibration，and psotural drainage,,,1。Provide high--protein, high-calorie enteral or paxenteral nutrition as ordered to meet increased nutritional requirements.2。If able to take，nut

50、rition oralty provide six small meals per day to decrease oxygen energy expenditure during digestion.,,3.Provide between-meal nutritional supplements to maintain adequate caloric intake. 4 .maintain the ordered oxygen d

51、elivery system during meals to prevent shortness of breath and blood oxygen desaturation while eating. 5 .Monitor for signs of CO2 increasing with parenteral nutrition because carbohydrates may increase CO2 levels in

52、clients With hypercapnia.,,,,1 .Oxygen therapy2. Mechanical ventilation,1．Oxygen therapy,,,（1）氧療適應(yīng)證：呼吸衰竭病人PaO2＜60mmHg，是氧療的絕對(duì)適應(yīng)證，氧療的目的是使PaO2＞60mmHg。,,,（2）氧療的方法： 臨床常用、簡(jiǎn)便的方法是應(yīng)用鼻導(dǎo)管或鼻塞法吸氧，還有面罩、氣管內(nèi)和呼吸機(jī)給氧法。缺氧伴CO2潴留者，可用鼻導(dǎo)管或

53、鼻塞法給氧；缺O(jiān)2嚴(yán)重而無(wú)CO2潴留者，可用面罩給氧。 吸入氧濃度與氧流量的關(guān)系：吸入氧濃度（%）=21+氧流量（L/min）。,鼻塞法 鼻導(dǎo)管,面罩吸氧,,（3）氧療的原則： ①I型呼吸衰竭：多為急性呼吸衰竭，應(yīng)給予較高濃度（35%＜吸氧濃度＜50%）或高濃度（＞50%）氧氣吸入。急性呼吸衰竭，通常要求氧療后PaO2維持在接近正常范圍。 ②I

54、I型呼吸衰竭：給予低流量（1～2L/min）、低濃度（＜35%）持續(xù)吸氧。慢性呼吸衰竭，通常要求氧療后 PaO2維持在60mmHg或SaO2在90%以上。,,,（4）氧療療效的觀察： 若呼吸困難緩解、發(fā)紺減輕、心率減慢、尿量增多、神志清醒及皮膚轉(zhuǎn)暖，提示氧療有效。 若發(fā)紺消失、神志清楚、精神好轉(zhuǎn)、PaO2＞60mmHg、PaCO2＜50mmHg，考慮終止氧療，停止前必須間斷吸氧幾日后，方可完全停止氧療。

55、 若意識(shí)障礙加深或呼吸過(guò)度表淺、緩慢，提示CO2潴留加重，應(yīng)根據(jù)血?dú)夥治龊筒∪吮憩F(xiàn)，遵醫(yī)囑及時(shí)調(diào)整吸氧流量和氧濃度。,吸氧及停止的護(hù)理記錄,,,1.觀察呼吸困難的程度、呼吸頻率、節(jié)律和深度。 2.觀察有無(wú)發(fā)紺、球結(jié)膜充血、水腫、皮膚溫暖多汗及Bp升高等缺氧和CO2潴留表現(xiàn)。 3.監(jiān)測(cè)生命體征及意識(shí)狀態(tài)。 4.監(jiān)測(cè)并記錄出入液量，血?dú)夥治龊脱瘷z查、電解質(zhì)和酸堿平衡狀態(tài)。 5.觀察嘔吐物和糞便性狀 6.觀察

56、有無(wú)神志恍惚、煩躁、抽搐等肺性腦病表現(xiàn)，一旦發(fā)現(xiàn)，應(yīng)立即報(bào)告醫(yī)師協(xié)助處理。,病情觀察,Positive Pressure ventilation： increases lung volume，helps redistribute fluid from the alveolar to the interstitial space，helps reduce the oxygen demand caused by increased w

57、ork of breathing in many conditions leading to respiratory failure,Mechanical ventilation,,Through endorracheal or nasotracheal intubation or noninvasively through a nasal or facemask.absent respiration，excessive secr

58、etions，a decreased level of consciousness，high O2 requirements，or hemodynamic instability。(no NIPPV),呼吸機(jī),人工氣道和機(jī)械通氣,,治療配合,①做好術(shù)前準(zhǔn)備工作，減輕或消除緊張、恐懼情緒。 ②按規(guī)程連接呼吸機(jī)導(dǎo)管 ③加強(qiáng)病人監(jiān)護(hù)和呼吸機(jī)參數(shù)及功能的監(jiān)測(cè)。 ④注意吸入氣體加溫和濕化，及時(shí)吸痰。

59、⑤停用呼吸機(jī)前后做好撤機(jī)護(hù)理。,治療配合,遵醫(yī)囑選擇有效的抗生素控制呼吸道感染，對(duì)長(zhǎng)期應(yīng)用抗生素病人注意有無(wú)“二重感染”。遵醫(yī)囑使用支氣管舒張劑。,治療配合,在呼吸道通暢的前提下，遵醫(yī)囑使用呼吸興奮劑，靜脈輸液時(shí)速度不宜過(guò)快。若4～12h未見效，或出現(xiàn)肌肉抽搐等嚴(yán)重不良反應(yīng)時(shí)，應(yīng)立即報(bào)告醫(yī)師。 對(duì)煩躁不安，夜間失眠病人，禁用麻醉劑，慎用鎮(zhèn)靜劑，以防止引起呼吸抑制。,,并發(fā)癥護(hù)理,1．水、電解質(zhì)紊亂及酸堿失衡 定期

60、監(jiān)測(cè)血?dú)夥治龊脱笜?biāo)。遵醫(yī)囑給予藥物糾酸，或補(bǔ)鉀。2．上消化道出血 注意觀察嘔吐物和糞便性狀，出現(xiàn)黑糞應(yīng)給予溫涼流質(zhì)飲食，出現(xiàn)嘔血時(shí)應(yīng)暫禁食。,,心理護(hù)理,,,經(jīng)常巡視、了解和關(guān)心病人，特別是對(duì)建立人工氣道和使用機(jī)械通氣的病人。采用各項(xiàng)醫(yī)療護(hù)理措施前，向病人作簡(jiǎn)要說(shuō)明，給病人安全感，取得病人信任和合作。指導(dǎo)病人應(yīng)用放松技術(shù)、分散注意力。,健康指導(dǎo),1．疾病知識(shí)指導(dǎo) 向病人及家屬介紹疾病發(fā)生、發(fā)展與治療、護(hù)理過(guò)程，與其共同制定長(zhǎng)

61、期防治計(jì)劃。指導(dǎo)病人和家屬學(xué)會(huì)合理家庭氧療的方法以及注意事項(xiàng)。,2．疾病預(yù)防指導(dǎo) 指導(dǎo)病人呼吸功能鍛煉和耐寒鍛煉，如縮唇呼吸、腹式呼吸及冷水洗臉等；教會(huì)病人有效咳嗽、咳痰、體位引流及拍背等方法。若病情變化，應(yīng)及時(shí)就診。,健康指導(dǎo),3．生活指導(dǎo) 勸告吸煙病人戒煙，避免吸入刺激性氣體；改進(jìn)膳食，增進(jìn)營(yíng)養(yǎng)，提高機(jī)體抵抗力。指導(dǎo)病人制定合理的活動(dòng)與休息計(jì)劃，勞逸結(jié)合，以維護(hù)心、肺功能狀態(tài),4．用藥指導(dǎo) 遵醫(yī)囑正確用藥，了解藥物的用法、用量