問(wèn)題你被噎到過(guò)嗎？1你當(dāng)時(shí)的感受怎樣？2你看到別人噎到嗎？3你是如何幫助她/他的？42003年12月9日柯受良〔臺(tái)灣知名影視藝人，首創(chuàng)駕車飛越黃河〕有知情人士透露，柯受良當(dāng)晚是因飲酒過(guò)量，發(fā)生嘔吐，因嘔吐物阻塞氣管導(dǎo)致窒息，凌晨猝死于上海一賓館里，時(shí)年50歲。

典型案例典型案例小假設(shè)寧消費(fèi)者權(quán)益保護(hù)日這天，一場(chǎng)悲劇降臨到可愛(ài)的小假設(shè)寧身上，年僅1歲零7個(gè)月、因吸食果凍窒息死亡。男,4歲,江蘇南京一名4歲男孩不慎被果凍窒息死亡

1疾病知識(shí)介紹2幻燈片934討論5主要內(nèi)容〔MainContents〕護(hù)理程序健康指導(dǎo)病史回憶DiseaseknowledgeintroductionThehistoryreviewNursingprocessHealthguidance

Discussion11病史回顧患者床號(hào)：21床姓名：劉明性別：男年齡：76歲入院時(shí)間：2021年11月10日19時(shí)10分主訴:進(jìn)食中突發(fā)哽噎，出現(xiàn)意識(shí)不清10分鐘。11病史回顧簡(jiǎn)要病史：患者1年前患腦埂塞，經(jīng)住院治療好轉(zhuǎn)出院〔具體診治不祥〕。出院后因右側(cè)肢體活動(dòng)不靈長(zhǎng)期臥床，進(jìn)食、喝水易發(fā)生嗆咳。于今日下午晚飯進(jìn)食間突發(fā)哽噎，繼而呼吸困難、意識(shí)障礙，后急呼“120〞送入我科。入院查體：患者意識(shí)喪失，呼之不應(yīng)，表情痛苦，面唇紫紺，呼吸停止。雙側(cè)瞳孔等大等圓，直徑：，對(duì)光反射減弱；頸軟，無(wú)抵抗。脈搏微弱不可及。氣管居中，呼吸音消失，心音消失。腹平、軟。四肢軟癱。測(cè)P：50次/分，BP：100/64mmHg。搶救：立即予以臥位腹部沖擊法取出氣道梗阻異物，行CPR，準(zhǔn)備搶救用物，遵醫(yī)囑予以吸氧、監(jiān)護(hù)、開(kāi)通靜脈、運(yùn)用呼吸興奮劑等，經(jīng)上述搶救后患者心跳及自主呼吸恢復(fù)，面色變紅潤(rùn)，但意識(shí)障礙情況仍然存在。11病史回顧Medicalhistory

臨床診斷：1、窒息；2、腦功能損傷。2.Braindamage病因年齡因素酗酒飲食不慎老年人因咳嗽吞咽功能差全麻或昏迷者定義和病因醫(yī)源性異物定義：窒息是指氣流進(jìn)入肺臟受阻或吸入氣缺氧導(dǎo)致的呼吸停止或衰竭。臨床表現(xiàn)表現(xiàn)為吸氣性呼吸困難，出現(xiàn)“四凹征〞〔胸骨上窩、鎖骨上窩、肋間隙及劍突下軟組織〕。氣道阻塞可分為兩類：〔1〕氣道不完全阻塞：患者張口瞪目，有咳嗽、喘氣或咳嗽微弱無(wú)力，呼吸困難煩躁不安。皮膚、黏膜、甲床、面色青紫、發(fā)紺。〔2〕氣道完全阻塞：面色灰暗青紫，不能說(shuō)話及呼吸，很快失去知覺(jué)，陷入呼吸停止?fàn)顟B(tài)。

v〞形手勢(shì)顏面青紫不能發(fā)聲肢體抽搐特殊體征救治原那么(Treatmentdoctrine)

保持氣道通暢是關(guān)鍵，

其次是采取病因治療。Tokeepairwayunobstructedisthekey,thesecondistoadoptetiologicaltreatment.1、身體評(píng)估〔護(hù)理體檢〕Bodyevaluationcare(medical)2、實(shí)驗(yàn)室及其它檢查

Labandotherinspection護(hù)理評(píng)估

NursingAssessment急性意識(shí)障礙與腦組織缺氧、腦功能受損有關(guān)。有感染的危險(xiǎn)與長(zhǎng)期臥床，肺部痰液不易排出有關(guān)。氣體交換受損與氣道異物引發(fā)呼吸困難、窒息有關(guān)。護(hù)理診斷患者呼吸平穩(wěn)、氣道保持通暢。Patientsbreathesmoothlyandkeepunobstructedairway.護(hù)理目標(biāo)NursingGoals

①迅速解除窒息因素，保持呼吸道通暢；②給與高流量吸氧；③保證靜脈通路通暢，遵醫(yī)囑給予藥物治療；④監(jiān)測(cè)生命體征；⑤備好搶救物品。(1)rapidlyrelievesuffocationfactors,keeprespiratorytractunobstructed;(2)providehighflowoxygen;(3)ensurevenouschannelunobstructed,prescribedfordrugtreatment;(4)monitoringvitalsigns;5.Saveitemsready.護(hù)理措施Nursingmanagement患者意識(shí)障礙程度無(wú)加重。Patientswithdisturbanceofconsciousnessdegreeaggravating.護(hù)理目標(biāo)NursingGoals

①休息與平安：保持病房環(huán)境安靜、平安，限制探視，運(yùn)用保護(hù)性床欄；②生活護(hù)理：給予高蛋白、高維生素清淡飲食，遵醫(yī)囑予以胃管鼻飼。每2小時(shí)協(xié)助變換體位，預(yù)防壓瘡的發(fā)生，做好口腔護(hù)理和大小便的護(hù)理；③密切監(jiān)測(cè)意識(shí)和瞳孔并詳細(xì)記錄，使用脫水降顱壓藥物時(shí)注意監(jiān)測(cè)尿量與水、電解質(zhì)的變化。護(hù)理措施Nursingmanagement患者生命體征平穩(wěn)，無(wú)肺部感染的發(fā)生。Inpatientswithstablevitalsigns,withouttheoccurrenceoflunginfection.護(hù)理目標(biāo)NursingGoals

①密切監(jiān)測(cè)體溫情況；②定時(shí)協(xié)助患者翻身拍背,促進(jìn)痰液的排出；③嚴(yán)格執(zhí)行無(wú)菌操作,及時(shí)予以吸痰；(1)closemonitoringoftemperature;(2)toassistpatientsturnbackregularly,topromotetheexcretionofsputum;(3)strictasepticoperation,beinsputumsuction.護(hù)理措施Nursingmanagement1、患者呼吸通暢,未出現(xiàn)呼吸困難征象；2、患者意識(shí)障礙程度減輕；3、患者未出現(xiàn)發(fā)熱等肺部感染的征象。1,thepatientbreatheunobstructed,doesnotappeardyspneasigns;2disturbanceofconsciousness,patientswithease;3,doesnotappearinpatientswithfeverandothersignsoflunginfection評(píng)價(jià)Evaluation

健康指導(dǎo)

2．疾病知識(shí)指導(dǎo)向患者家屬講解窒息發(fā)生的原因、開(kāi)展與治療及其預(yù)后，教會(huì)家屬及身邊的人當(dāng)氣道異物梗阻時(shí)，如何應(yīng)用Heimlich手法自救。

1．疾病預(yù)防指導(dǎo)①選擇適宜的食物,對(duì)老年患者特別腦梗后容易發(fā)生嗆咳和吞咽困難者，食物以半流質(zhì)為宜，如粥、蛋羹、菜泥、面糊等。防止容易引起嗆咳的湯、水食物及容易引起吞咽困難的干食，防止進(jìn)食黏性較大的年糕等食物，水分的攝入應(yīng)盡量混在半流汁的食物中給予，以減少誤吸的可能。②采取科學(xué)的進(jìn)食體位一般采取坐位或半臥位，臥床的病人應(yīng)抬高床頭30°～40°，以利于吞咽動(dòng)作，減少誤吸時(shí)機(jī)。討論Discussion總結(jié)Summary謝謝11MedicalhistoryBedno：21Name：LiuMingSex：maleAge：76Admissiontime：OnNovember10,2021at19:00.Themaindescription:Eatinginasudden,alotofunconsciousnessfor10minutes.11MedicalhistoryAbriefhistory:Patientssufferingfrombraininsuperiortoplugayearago,werehospitalizedwithimproved(specificdiagnosisandominous).Afterdischargebecauseoftherightlimbsactivityisineffectiveinbedforalongtime,eat,drinkwaterpronetochoketocough.Thisafternooneatingdinnerbetweenbreakingalot,anddifficultybreathing,disturbanceofconsciousness,nastyshoutafter"120"intoourdepartment.Hospitalphysicalexamination:patientswithlossofconsciousness,shouldnotbe,look,lippurplepurple,breathingstops.Bilateralpupiletc.Largesuchasround,diameter4.5:4.5mm,lightreflex;Necksoft,withoutresistance.Pulseisweak.Trachealmiddleandbreathsoundsdisappeared,heartsounds.Theabdomenflat,soft.Limbpalsy.P:50times/min,BP:100/64mmHg.11DefineandcauseDefinition:asphyxiaisreferstotheairintothelungscausedbyblockedorinhaledairoxygenbreathingstopsorfailure.Pathogensis:Age、Excessivedrinking、Carelessdiet、Impairedswallowingandsoon.11Ofinspiratorydyspnea,appear"fourconcave"(sternalelevationnest,supraclavicularfossa,ribgapandxiphoidprocessunderthesofttissue).Airwayobstructioncanbedividedintotwocategories:(1)incompleteairwayobstruction:patientswithopenmouthstare,cough,weaknessofbreathorcough,dyspneafidgety.Skin,mucousmembrane,nailbed,wasblue,cyanosis(2)theairwayobstruction:completelycomplexiondarkpurple,unabletospeakandbreathing,lossofconsciousness,quicklyfallintoastatetostopbreathingClinicalManifestation11Nursingdiagnosis1、Impairedgasexchange:Associatedwithairwayforeignbodycausingdifficultyinbreathing,suffocation.2、Acuteconfusion：Relatedtobraintissuehypoxia,impairedbrainfunction.3、Riskforinfection:Relatedtolong-termlieinbed,lungsputumnoteasyeduction.1護(hù)理措施NursingmanagementRestandsecurity:(1)keepthewardenvironmentquiet,safe,limitingvisits,useprotectivebedbar;(2)lifecare:givehighprotein,highvitaminblanddiet,bestomachnasogastrictubeinaccordancewiththedoctor'sadvice.Every2hourstohelptransformposition,preventtheoccurrenceofpressureulcers,doagoodjobinoralnursingcareandurine;(3)closemonitoringofconsciousnessandthepupilanddetailedrecords,payattentiontowhenusingdehydrationofintracraninalpressuredrugmonitoringandthechangeofthewater,electrolyteofurine.11

Healthguidance1.Diseasepreventionguide(1)choosetherightfoods,particularlyaftercerebralinfarctionwaspronetochoketoelderlypatientswithcoughandswallowingdifficulty,foodwithsemifluidadvisable,suchasporridge,custard,puree,batter,etc.Avoi