涉外護(hù)理英語unitGivingIntravenousInfusions第1頁/共155頁Unit4GivingIntravenousInfusionsReviewingIVinfusionsAssessingIVcannulasTakingamessageaboutpatientcarebytelephoneChartingfluidintakeandoutputGivinganoralreportofthecase翻譯第2頁/共155頁第四單元靜脈輸液

核對靜脈輸液評估靜脈輸液套管電話獲取患者的護(hù)理信息記錄出入量單口頭匯報病人病情第3頁/共155頁DescriptionDescriptionIntravenousinfusion(IVinfusion)isarouteofadministeringadrugdirectlyintothebloodstream,bypassingtheneedforabsorptionfromtheGItractortransportationfromtheotherpartsofthebody,suchasmuscleorsubcutaneoustissue.翻譯第4頁/共155頁Description單元描述靜脈輸液是將藥物直接輸入血液的一種給藥途徑。這種給藥途徑避免了藥物經(jīng)胃腸道吸收或經(jīng)身體其他部位如肌肉或皮下組織輸送藥物。第5頁/共155頁AdministrationAdministrationofsafe,high-qualityinfusiontherapytodaydependsonacollaborativepracticeenvironmentinwhichmanymembersofthehealthcareteamplayakeyrole.Thenurse,inparticular,playsaprimaryroleincollaboratingwithotherhealthcareproviderstomaintainaninfusionandtoprotectthepatientfromthehazardsandcomplicationsassociatedwithroutineinfusion(IV)therapy.Policiesregardingtheresponsibilitiesofastaffnurseinrelationtotherapyvarysignificantlyamonghealthcareinstitutionsandareofteninfluencedbythepresenceorabsenceofafull-serviceinfusionteam.WorkDescription翻譯第6頁/共155頁單元工作任務(wù)描述給藥安全、高質(zhì)量地靜脈給藥取決于協(xié)同工作的環(huán)境，在這里，醫(yī)療團(tuán)隊的成員們都扮演著重要的角色。尤其是護(hù)士，為維持靜脈輸液并保護(hù)患者避免與常規(guī)輸液治療有關(guān)的風(fēng)險和并發(fā)癥，在合作的過程中起著主要作用。不同的醫(yī)療機(jī)構(gòu)，輸液護(hù)士的職責(zé)差異很大，而且通常受到是否存在全方位輸液小組的影響。WorkDescription第7頁/共155頁AdministrationofParenteralFluids●Infusionnurseswill,onwrittenorder,initiateallIVs●Nomorethantwoattemptsatvenipuncturewillbeallowed.●Venipuncturesshouldbeavoidedinthelowerextremitiesexceptwhenthepatient’sconditionmaynecessitatethisuseandthislocationhasspecificallybeenorderedbythephysician.WorkDescription翻譯第8頁/共155頁胃腸外給藥●輸液護(hù)士應(yīng)遵醫(yī)囑實施靜脈輸液?！癫辉试S兩次以上的靜脈穿刺?！駪?yīng)該避免下肢靜脈穿刺，除非患者的病情所需，且穿刺部位要謹(jǐn)遵醫(yī)囑。WorkDescription第9頁/共155頁PreparationandAdministrationofIVDrugs●Nurseswill,onwrittenorder,prepareandadministeronlythosesolutions,medications,andcombinationsofdrugsapprovedinwritingbythepharmacyandthetherapeuticscommittee.●Nursesmustcheckthepatient’sclinicalrecordandquestionthepatientregardingsensitivitytodrugsthatmaycauseanaphylaxis.Theymustobservethepatientafterinitialadministrationofsuchdrugs.WorkDescription翻譯第10頁/共155頁靜脈給藥及其準(zhǔn)備●護(hù)士應(yīng)遵醫(yī)囑只輸入藥物及治療委員會同意支持的液體、藥物和混合性藥物?！褡o(hù)士必須核對患者的醫(yī)療記錄，并詢問患者可能導(dǎo)致過敏反應(yīng)的藥物，初次輸入此類藥物時護(hù)士必須觀察患者。WorkDescription第11頁/共155頁NursingCarePlan●Anursingcareplanshouldbeestablishedwithin24hoursofdate/timeofadmission.PeripheralCatheterSelection●Thecatheterselectedshouldbeofthesmallestgaugeandshortestlengthtoaccommodatetheprescribedtherapy.●Onlyradiopaquecathetersmaybeused.WorkDescription翻譯第12頁/共155頁護(hù)理計劃●護(hù)理計劃應(yīng)該在患者入院24小時內(nèi)建立。外周導(dǎo)管的選擇●導(dǎo)管應(yīng)選擇最小規(guī)格，最短長度以滿足輸液治療。●只能使用非透射性的導(dǎo)管。WorkDescription第13頁/共155頁Task1ReviewingIVinfusionsDescriptionReviewingIVinfusionsistoensurethatthecorrectsolutionisinfusedtothecorrectpatient.Particularattentionisplacedonpreloadedinfusionswithpotassiumchloridebecauseofthedangerofoverdosewhichcouldcauseseverecardiacproblems.翻譯第14頁/共155頁任務(wù)一

核對靜脈輸液任務(wù)描述核對靜脈輸液是為了確保將正確的液體輸入正確的患者。特別要注意過量輸入鉀，因其可引起嚴(yán)重的心臟問題。第15頁/共155頁RelatedInformationPotentialcomplicationswiththeuseofIVtherapyFluidsmaybegiventopatientsdirectlyintothevein—intravenously(IV)—inordertoreplacefluidlostduringsurgeryorbecauseofdehydration.IVtherapymayalsobeusedtoadministermedicationswhichneedtobeabsorbedasquicklyaspossible.TherearethreepotentialcomplicationswiththeuseofIVtherapy:infectionofthesiteofinsertionoftheIVcannula,phlebitisorirritationofthevein,andfluidoverload.翻譯第16頁/共155頁Fluidoverloadisadangerouscomplicationwhichoccurswhenmorefluidisintroducedintothebodythanthebodycanmanage.Dangerouscomplicationslikeheartfailureorpulmonaryoedemamayresult.Inaddition,theinfusionofsolutionswhichaffecttheelectrolytebalanceofthebodymayalsocauseunpleasantsideeffects.Forthisreason,IVfluidsmustbeprescribedbyadoctorinthesamewayasanyothermedicationandarecheckedbytwonursesbeforeadministration.翻譯第17頁/共155頁相關(guān)信息使用靜脈液射治療的潛在并發(fā)癥液體經(jīng)靜脈輸液直接進(jìn)入患者靜脈血管——補(bǔ)償手術(shù)或脫水導(dǎo)致的液體丟失。當(dāng)藥物需要盡快吸收時，也會使用靜脈輸液治療。使用靜脈注射治療時會有三種潛在并發(fā)癥：靜脈插管部位的感染、靜脈炎或者液體超載。液體超載是一種嚴(yán)重的并發(fā)癥，發(fā)生于輸注的液體量超過了機(jī)體能負(fù)荷的量時，也可能導(dǎo)致危險的并發(fā)癥如心力衰竭或者肺水腫。因此，液體的輸注會影響機(jī)體的電解質(zhì)平衡，由此會產(chǎn)生令人不愉快的副作用。由于這個原因，靜脈輸注的液體必須由醫(yī)生開出，輸液前由兩名護(hù)士核對。第18頁/共155頁ThemanagementofIVinfusionIVfluidsmaybedeliveredthroughanIVlineviaaburetteorchamberorviaaninfusionpump.WhenusingaburetteandIVline,nursesmustcalculatethenumberofdripsperminute(DPM)andadjusttheflowusingtheIVclamp.Ifavolumetricpumporinfusionpumpisused，

adifferentcalculationismade.ThisinformationisrecordedinthecolumnmarkedRateml/hrasinfusionpumpscalculatethevolumeormilswhichwillbepumpedthrougheveryhour.翻譯第19頁/共155頁靜脈輸液的管理靜脈輸注的液體可能通過滴管、腔或輸液泵進(jìn)入靜脈通路。當(dāng)使用滴管和靜脈通路時，護(hù)士必須計算每分鐘的滴數(shù)，并通過調(diào)節(jié)器來調(diào)節(jié)滴速。如果使用微量泵或輸液泵，滴速計算方法又不同。這些信息用ml/h的標(biāo)識記錄，表示為輸液泵每小時輸注的量。第20頁/共155頁InfectionAnybreakintheskincarriesariskofinfection.AlthoughIVinsertionisanasepticprocedure,skin-dwellingorganismssuchasCoagulase-negativestaphylococcusorCandidaalbicansmayenterthroughtheinsertionsitearoundthecatheter,orbacteriamaybeaccidentallyintroducedinsidethecatheterfromcontaminatedequipment.MoistureintroducedtounprotectedIVsitesthroughwashingorbathingsubstantiallyincreasestheinfectionrisks.InfectionofIVsitesisusuallylocal,causingeasilyvisibleswelling,redness,andfever.Ifbacteriadonotremaininoneareabutspreadthroughthebloodstream,theinfectioniscalledsepticemiaandcanberapidandlife-threatening.翻譯第21頁/共155頁感染皮膚上的任何破潰都會帶來感染的風(fēng)險。雖然靜脈穿刺是無菌操作，寄居在皮膚上的微生物如凝固酶陰性葡萄球菌或白色念珠菌會經(jīng)穿刺部位進(jìn)入，或者是細(xì)菌不慎從被污染的裝備進(jìn)入導(dǎo)管，而在洗手或洗澡時，水分會進(jìn)入未受保護(hù)的靜脈注射部位，也大大增加了感染風(fēng)險。靜脈注射穿刺部位的感染通常是局部的，引起易見的紅、腫、熱。如果細(xì)菌通過血流播散，這種感染稱為敗血癥，病情發(fā)展迅速并會危及生命。第22頁/共155頁Infiltration/ExtravasationInfiltrationoccurswhenanIVfluidormedicationaccidentallyentersthesurroundingtissueratherthanthevein.Thisoccursmorefrequentlywithchemotherapeuticagentsandpeoplewhohavetuberculosis.Itisalsoknownasextravasation(whichreferstosomethingescapingthevein).Itmayoccurwhentheveinitselfruptures(theelderlyareparticularlypronetofragileveinsduetoapaucityofsupportingtissues),翻譯第23頁/共155頁wheretheveinisdamagedduringinsertionoftheintravascularaccessdeviceorthedeviceisnotsitedcorrectlyorwheretheentrypointofthedeviceintotheveinbecomesthepathofleastresistance(e.g.ifacannulaisinaveinforsometime,theveinmayscarandcloseandtheonlywayforfluidtoleaveisalongtheoutsideofthecannulawhereitentersthevein).Itischaracterizedbycoolnessandpallortotheskinaswellaslocalizedswellingoredema.翻譯第24頁/共155頁Itisusuallynotpainful.Itistreatedbyremovingtheintravenousaccessdeviceandelevatingtheaffectedlimbsothatthecollectedfluidscandrainaway.Sometimesinjectionsofhyaluronidasecanbeusedtospeedthedispersalofthefluid/drug.InfiltrationisoneofthemostcommonadverseeffectsofIVtherapyandisusuallynotseriousunlesstheinfiltratedfluidisamedicationdamagingtothesurroundingtissue,inwhichcaseextensivenecrosiscanoccur.翻譯第25頁/共155頁浸透/外滲發(fā)生于血管本身脆弱（老年人的血管由于缺乏組織支持尤其脆弱），在插入靜脈注射裝置期間，或是注射裝置穿刺的位置不正確時，靜脈受損處；當(dāng)靜脈穿刺處變成最小阻力的路徑時（比如，如果套管插入靜脈一段時間，靜脈可能形成疤痕、阻塞，液體流出靜脈的唯一通道就是沿著套管插入血管處）。第26頁/共155頁特點是皮膚冷、蒼白和局部腫脹、浮腫，通常不痛。移除靜脈注射裝置并抬高患肢使積聚的液體流走便可消除癥狀。有時，注射透明質(zhì)酸酶來加速液體或藥物的分散。滲透是靜脈輸液治療最常見的并發(fā)癥，但并不嚴(yán)重，除非外滲的液體是一種對周圍組織有損傷的藥物，在這種情況下，會導(dǎo)致廣泛性壞死。第27頁/共155頁FluidoverloadThisoccurswhenfluidsaregivenatahigherrateorinalargervolumethanthesystemcanabsorborexcrete.Possibleconsequencesincludehypertension,heartfailure,andpulmonaryedema.HypothermiaThehumanbodyisatriskofaccidentallyinducedhypothermiawhenlargeamountsofcoldfluidsareinfused.Rapidtemperaturechangesintheheartmayprecipitateventricularfibrillation.翻譯第28頁/共155頁液體超負(fù)荷發(fā)生于輸液速度過快，或輸入的液體量大于系統(tǒng)能吸收和排泄的量時，可導(dǎo)致高血壓、心力衰竭和肺水腫。體溫過低當(dāng)輸入大量的冷液體時，會不慎引起人體體溫過低的危險。心臟內(nèi)部體溫的急劇變化可能導(dǎo)致心室纖顫。第29頁/共155頁ElectrolyteimbalanceAdministeringatoo-diluteortoo-concentratedsolutioncandisruptthepatient’sbalanceofsodium,potassium,magnesium,andotherelectrolytes.Hospitalpatientsusuallyreceivebloodteststomonitortheselevels.翻譯第30頁/共155頁電解質(zhì)失衡輸入太稀或太濃的溶液會擾亂患者的鈉、鉀、鎂和其他電解質(zhì)的平衡。住院患者通常要查血常規(guī)來監(jiān)測這些水平。第31頁/共155頁EmbolismAbloodclotorothersolidmass,aswellasanairbubble,canbedeliveredintothecirculationthroughanIVandendupblockingavessel;thisiscalledembolism.PeripheralIVshavealowriskofembolism,sincelargesolidmassescannottravelthroughanarrowcatheter,anditisnearlyimpossibletoinjectairthroughaperipheralIVatadangerousrate.TheriskisgreaterwithacentralIV.翻譯第32頁/共155頁Airbubblesoflessthan30microlitersarethoughttodissolveintothecirculationharmlessly.Smallvolumesdonotresultinreadilydetectablesymptoms,butongoingstudieshypothesizethatthese“micro-bubbles”mayhavesomeadverseeffects.Alargeramountofair,ifdeliveredallatonce,cancauselife-threateningdamagetopulmonarycirculation,or,ifextremelylarge(3-8millilitersperkilogramofbodyweight),canstoptheheart.翻譯第33頁/共155頁Onereasonveinsarepreferredoverarteriesforintravascularadministrationisbecausetheflowwillpassthroughthelungsbeforepassingthroughthebody.Airbubblescanleavethebloodthroughthelungs.Apatientwithaheartdefectcausingaright-to-leftshuntisvulnerabletoembolismfromsmalleramountsofair.翻譯第34頁/共155頁栓塞血凝塊或其他固體及氣泡，通過靜脈輸液進(jìn)入循環(huán)而阻塞血管，稱為栓塞。因為大固體不能通過狹窄的導(dǎo)管，并且?guī)缀醪豢赡芤晕ｋU的速度通過外周靜脈注射輸入空氣，因此外周靜脈注射引起栓塞的風(fēng)險較低，中心靜脈注射危險性較高。少于30微升的空氣氣泡溶解到血液循環(huán)中，無傷害，少量氣泡不會導(dǎo)致容易檢測到的癥狀，但當(dāng)前研究認(rèn)為微小氣泡可能會有一些副作用。如果大量空氣同時進(jìn)入，會導(dǎo)致危及生命的肺循環(huán)損傷，或者，極端情況下（3-8

ml每公斤體重），會導(dǎo)致心跳驟停。首選靜脈而非動脈進(jìn)行靜脈給藥的一個原因是，血流在流經(jīng)全身之前會流經(jīng)肺部，空氣氣泡可經(jīng)肺部離開血液。右向左分流缺陷的心臟病患者，即使是少量的空氣也會引起栓塞。第35頁/共155頁Discussionofthenursingtopic1. WhatisyourexperienceofIVtherapy?2. WhenmightapatientrequireIVtherapy?3. WhatcomplicationsmayappearwiththeuseofIVtherapy?(Open)

Whendehydrated,aftersurgery,toadministerIVmedications.TherearethreepotentialcomplicationswiththeuseofIVtherapy:infectionofthesiteofinsertionoftheIVcannula,phlebitisorirritationofthevein,andfluidoverload.第36頁/共155頁CommonquestionswhenreviewingIVinfusions1. Doyouwantmetopassonanyupdates?2. Whataboutthecannula?Doyouwantitleftin?3. Canyoutakeouthiscannulabeforehegoeshome,please?4. CanIjustcheckthatyourIVcannulaisallrightbeforeIputupthenextinfusion?5. CanIhavealook?6. WhatarewedoingwithherIV?第37頁/共155頁7. She’squitedehydrated,isn’tshe?8. CanyoucheckitoutwithmeandI’llputitupstraightaway?9. Howlongdoeshewantittorunover?10. Anynewordersthere?11. Ididn’tcatchthepatient’sname.Couldyouspellitforme,please?12. Wouldyoumindslowingdownabit?13. Doyoumindkeepinganeyeon…fluids?14. WhendidshehavetheIVputin?15. What’supnow?第38頁/共155頁16. HaveyougotthePrescriptionChartwithyou?17. CanyouseetheexpirydateonthebagOK?18. What’sheroralintakelike?19. WhataboutherIVintake?20. Whataboutheroutput?What’sthatlike?第39頁/共155頁Practiceofthetask

(Dr.Roberthascometothewardtoreviewhispatients’IVinfusionregimes.)Dr.Robert: Hello,Sabrina.AreyoulookingafterMrs.Brucetoday?Sabrina: No,that’sMary,butshe’sjusttakenapatientforanX-rayexamination.Dr.Robert: Oh,IwantedtoreviewMrs.Bruce’sIVfluids.Sabrina: I’mlookingafterMary’spatientswhileshe’saway.Wouldyoulikemetopassonanyupdates?翻譯第40頁/共155頁Dr.Robert: Yeah,thanks.CouldyoutakedownMrs.Bruce’sIVwhenit’sfinished,please?Sabrina: Sure.I’lljustwriteanoteaboutitforMary.Forthecannula,doyouwantitleftin?Dr.Robert: Yes,Ithinkso.Leaveitforanotherdayincasesheneedssomemorefluids.Sabrina: OK.DoyouwanttoseeMrs.Byroninthenextroom,too?Dr.Robert: Yes,Ineedtoseeher.Accordingtoherbloodresultsherpotassiumlevelsarequitelow.I’llputinacannulawhenIfinishmyrounds.CouldyoustartheronalitreofNormalSalinewith40millimolsofKCL?翻譯第41頁/共155頁Sabrina: OK.Here’sthePrescriptionChartforyoutofillout.Dr.Robert: Thanks.Thatsavesmeabitoflegwork.Canyourunitovereighthours,please?Sabrina: Sure.OnelitreofNormalSalinewith40millimolsKCLovereighthours.Dr.Robert: Oh,I’llhavetoorderhersomeIVantibiotics,too.Sabrina: Yeah,OK.We’llrunthemthroughasecondaryline.TheprimarylinewillhavetheKCLrunningthrough,sowewon’tmixthesolutionsinthesameline.翻譯第42頁/共155頁Dr.Robert: Great.Nowthere’sjustMr.Richardsleft.Howishe?Sabrina: Er,he’soneofMary’spatients,too.He’sinaprettygoodcondition.Heplanstogohometoday,Ithink.Dr.Robert: Yes,that’sright.He’sreadyfordischarge.Couldyoutakeouthiscannulabeforehegoeshome,please?Sabrina: Yes,sure,wewilldothat.I’llpassonyourinstructionstoMarywhenshereturns.Dr.Robert: Thanks.翻譯第43頁/共155頁(SabrinanoteddownDr.Robert’sinstructionsandsheisnowpassingthenotetoMary.)Mary: Hi.Sabrina: Hi,Mary.You’reback.Dr.RobertsawsomeofyourpatientswhileyouwereatX-ray.Mrs.Brucefirst.Mary: Oh,OK.WhatarewedoingwithherIV?Sabrina: HeaskedifyoucouldtaketheIVdownwhenit’srunthrough.It’sjustaboutthroughnow.Mary: Thanks.I’lltakeitdowninaminute.Um.Whataboutthecannula?Doeshewantitleftinortakenout?翻譯第44頁/共155頁Sabrina: Hesaidit’sbettertoleavetheIVcannulainforanotherdayjustincasesheneedsmorefluids.Mary: Oh,allright.Um,andwhataboutMrs.Byron?Didheseeher,too?Sabrina: Yeah.She’squitedehydrated,isn’tshe?Mary: Yeah.Andherpotassiumlevelswereprettylow,too.Sabrina: HeaskedifyoucouldputupabagofNormalSalinewith40millimolsofKCI.Hejustputinacannulaforit.Mary: OK.CanyoucheckitoutwithmeandI’llputitupstraightaway?翻譯第45頁/共155頁Sabrina: Yeah,I’mfreeatthemoment.I’llcheckitwithyou.Mary: Howlongdoeshewantittorunover?Sabrina: Letmelookattheorder.Um...hewantsittorunovereighthours.Mary: OK.I’llgettheinfusionpumpandsetitup.Sabrina: Oh,andhe’salsoorderedsomeIVantibioticsforher.Mary: Oh,right.I’llrunthemthroughasecondaryline.Idon’twanttorunthemthroughtheprimarylinewhileshe’sgotKCIrunningthroughit.翻譯第46頁/共155頁Sabrina: Yeah,right.HealsosawMr.Richards.You’relookingafterhim,aren’tyou?Mary: Yes,he’smypatient.Anynewordersthere?Sabrina: OnlythathesaidthatMr.Richards’sIVcannulacouldbetakenout.Mary: Oh.Sabrina: He’sjustfinishedhiscourseofantibioticssohedoesn’tneeditinanymore.Itookitoutforhimandputonalightdressingbecausehe’sgoinghomethisafternoon.Mary: Oh,thanks.翻譯第47頁/共155頁任務(wù)案例（羅伯特醫(yī)生已經(jīng)到病房巡視患者的靜脈輸注的治療情況。）羅伯特醫(yī)生：

你好，塞布麗娜，今天是你照顧布魯斯太太嗎？塞布麗娜：

不，是瑪麗，但是她剛剛送一位患者去做X光檢查。羅伯特醫(yī)生：

噢，我想看看布魯斯太太的靜脈輸注。塞布麗娜：

瑪麗不在時我在照顧她的患者，你需要我傳達(dá)新信息嗎？羅伯特醫(yī)生：

是的，謝謝。布魯斯太太的靜脈輸液結(jié)束時，你能拔針嗎？第48頁/共155頁塞布麗娜：

當(dāng)然可以，我?guī)同旣惏堰@個記錄下來吧，還有插管，要繼續(xù)插著嗎？羅伯特醫(yī)生：

是的，我想應(yīng)該再留一天吧，以防她還需要輸液塞布麗娜：

好的，你還想看看隔壁房間的拜倫太太嗎？羅伯特醫(yī)生：

是的，需要。根據(jù)她的血液檢查結(jié)果，她的血鉀水平相當(dāng)?shù)?，我巡視完后給她插入一根套管。你能先輸入一升生理鹽水加40毫摩的氯化鉀嗎？塞布麗娜：

好的，這是你要填寫的處方單。羅伯特醫(yī)生：

謝謝，這省掉了我一點腿腳功夫，你能使它輸入時間超過八小時以上嗎？塞布麗娜：

當(dāng)然了。一升生理鹽水加40毫摩的氯化鉀輸入八小時以上。第49頁/共155頁羅伯特醫(yī)生：

噢，我還得給她開一些抗生素塞布麗娜：

是的，好的，我會用另一輸液管輸入抗生素。主輸液管輸入氯化鉀，這樣我們就不會將藥水混合在同一輸液管里了。羅伯特醫(yī)生：

太好了?，F(xiàn)在只剩下理查茲先生了，他怎么樣？塞布麗娜：

呃，她也是瑪麗負(fù)責(zé)的患者，他身體狀況很好，我想他計劃今天出院。羅伯特醫(yī)生：

是的，他準(zhǔn)備出院，在他回家前，請你將他的插管拔出，好嗎？塞布麗娜：

是的，當(dāng)然，我們會做的，當(dāng)瑪麗回來時我會轉(zhuǎn)達(dá)你的指令。羅伯特醫(yī)生：

謝謝。第50頁/共155頁（塞布麗娜記下了羅伯特醫(yī)生的指導(dǎo)，并將其轉(zhuǎn)告給瑪麗。）瑪麗：

你好。塞布麗娜：

你好，瑪麗，你回來了。你送病人去做X光檢查時，羅伯特醫(yī)生來看了你的幾名患者。先看一下布魯斯太太吧?，旣悾?/p>

哦，好的。我們要怎么處理她的靜脈輸液？塞布麗娜：

他問你輸液結(jié)束時你能否拔針，輸液現(xiàn)在快完了?，旣悾?/p>

謝謝，我一會兒就去拔針，嗯，插管怎么辦呢？他想讓它留在血管里還是拔掉？塞布麗娜：

他說最好將插管還留在血管里一天，以防她還需要輸液。第51頁/共155頁瑪麗：

哦，好的，嗯，拜倫太太怎么樣？他也看了她嗎？塞布麗娜：

是的，她脫水情況嚴(yán)重，對嗎？瑪麗：

是的，她的血鉀水平也相當(dāng)?shù)?。塞布麗娜?/p>

他問你能否輸上一袋一升生理鹽水加40毫摩的氯化鉀，他剛剛置入了一根插管?，旣悾?/p>

好的，你能和我一起核對嗎？我馬上輸上。塞布麗娜：

是的，我現(xiàn)在有空，和你一起核對?，旣悾?/p>

他想讓輸液多久結(jié)束？塞布麗娜：

讓我看看醫(yī)囑，嗯……他想讓她輸液八小時以上。瑪麗：

好的，我去拿輸液泵把它調(diào)好。塞布麗娜：

哦，他也開了一些抗生素給她。第52頁/共155頁瑪麗：

哦，對的。我將用另一條輸液管輸入，我不想讓她在用主輸液管輸入氯化鉀的同時也輸入抗生素。塞布麗娜：

是的，對的。他也看了理查茲先生，你在照顧他，對嗎？瑪麗：

是的，他是我的患者，有新的醫(yī)囑開出嗎？塞布麗娜：

他只說了要將理查茲先生的靜脈輸液插管取出?，旣悾?/p>

哦。塞布麗娜：

他剛剛結(jié)束了他的抗生素療程，所以他不再需要插管了。因為他今天下午要回家我為他取出來了，還貼了一個透明敷料。瑪麗：

哦，謝謝你。第53頁/共155頁A.Readtheconversationaboveandthenanswerthefollowingquestions.1.WhowantstoreviewMrs.Bruce’sIVfluids?2.IsSabrinalookingafterMrs.Brucealldaytoday?Dr.Robert.

No,SabrinaislookingafterMrs.Brucewhilehernurseisofftheward.第54頁/共155頁3.WhatordersaregivenforMrs.Byron’spotassiumlevel?4.AreMrs.Byron’santibioticstobegiventhroughaseparateline?5.WhatwillbedonebeforeMr.Richard’sdischarge?Sheistostart1lNormalSalinewithKCI40millimols.Yes.Herantibioticsaretobegiventhroughaseparateline.

Hiscannulaisgoingtoberemovedbeforehisdischarge.第55頁/共155頁B.Matchthefullnames(1-7)totheirabbreviations(a-g).1.intravenousfluidsa.mmols2.cannulab.IVABs3.potassiumc.KCL4.NormalSalined.IVlimolse.IVC6.potassiumchloridef.K7.IVantibioticsg.N/S1.

d2.

e3.

f4.

g5.

a6.

c7.

b第56頁/共155頁C. ReadthefollowingnoteswrittendownbySabrina.WritedownwhatRobertsaysaccordingtothenoteandlabelwhichtaskshavealreadybeendonebyticking.NotesforMary:CannulainsertedleaveCannulaLightdressingKlevelsTakedowntheIVwhenthr.HomethispmRunIV8hputup1LN/SwithKCI40mmolsIVAbsCannulaout第57頁/共155頁1. Cannulainserted

I’llputinacannulawhenIfinishmyrounds.2. Lightdressing

________________________________3. TakedowntheIVwhenthr.

________________________________NotesforMary:Cannulainserted√ leaveCannulaLightdressing√ KlevelsTakedowntheIVwhenthr. HomethispmRunIV8h putup1LN/SwithKCI40mmolsIVAbs Cannulaout√Iputonalightdressingforhim.

HeaskedifyoucouldtaketheIVdownwhenit’srunthrough.第58頁/共155頁4. RunIV8h

_________________________________5. LeaveCannula

_________________________________________________6. Klevels_________________________________

Hewantsittorunovereighthours.HesaidleavingtheIVcannulainforanotherdayjustincasesheneedsmorefluids.Herpotassiumlevelswereprettylow.第59頁/共155頁7. Homethispm

_____________________________________8. putup1LN/SwithKCI40mmols

_____________________________________9. Cannulaout

_____________________________________Thepatientisgoinghomethisafternoon.

HeaskedifyoucouldputupabagofNormalSalinewith40mmolsofKCI.

HesaidthatMr.Claussen’sIVcannulacouldbetakenout.第60頁/共155頁Task2AssessingIVcannulasDescriptionIVcannulasisakindofcatheterthatcanbeusedtoinsertinapatient’sveininordertogiveanesthesia,medicineorothersolutionsforintermittentdrug.Itpreventstheneedlefrombeingaccidentallydislodgedandminimizesitsexposuretopatienttampering.ItisextremelyimportanttoobserveIVsitesclosely,atleasthourly,moreoftenincasesofhighinfusionrates,causticsolutions,andsmallfragileveins.翻譯第61頁/共155頁任務(wù)二

評估靜脈輸液套管任務(wù)描述靜脈輸液套管是一種導(dǎo)管，用來置入患者的靜脈，給予麻醉劑、藥物或其他溶液以達(dá)到間歇性藥物治療的目的。它可避免針頭不慎移位，最大限度地減少受患者隨意改動的暴露面積。要密切觀察穿刺部位，至少每小時一次，這一點極其重要，尤其是在快速輸注、輸注腐蝕性溶液和血管微細(xì)脆弱時。第62頁/共155頁RelatedInformationPreventinginfectionthroughhandwashingTheaimofhandwashingistoremovemicroorganismsfromthehands,preventingtheirpotentialtransfer.Itisknownthatorganismssurviveandmultiplyonhumanhands,creatingtheopportunitytoinfectothersorthehost.Handwashingreducesthenumberoftransientorganismsontheskinsurface.Althoughhandscannotbesterilized,mosttransientorganismscanberemovedby30secondsofproperscrubbingwithsoapandwater.翻譯第63頁/共155頁Properscrubbingwouldincludevigorousmotionwiththehandsrubbingtogetherandfingersworkinginbetweenthefingerwebspaceandinclusiveofthedorsalandventralsurfacesofthehands.Microbesthatresideinsweatductsandhairfolliclesoftheskin,however,cannotbedislodgedreadily.Surveysshowthatoneinfivemedicalprofessionalscarrypotentiallypathogenicantibiotic-resistantpathogensonhis/herhands.Handwashingbymedicalprofessionalsoccursatonly30%oftheidealrate.翻譯第64頁/共155頁Failuretowashone’shandsbeforeandaftereachpatientcontactisprobablythemostimportantcontributortothespreadofinfections.Thesemicrobesposeathreattopatientswithreduceddefenses,soscrubbingwithanantisepticpriortocontactwiththesepatientsisusuallyrecommended.翻譯第65頁/共155頁相關(guān)信息洗手預(yù)防感染洗手的目的是去除手上的微生物，預(yù)防潛在的感染。眾所周知，生物體在人類的手上生存和繁殖，制造了感染其他生物體或宿主的機(jī)會。洗手減少了皮膚表面暫住菌的數(shù)量。盡管不能達(dá)到消毒的目的，但是用肥皂和水正確的洗手30秒，能清除大部分的暫住菌。正確的擦洗方法：雙手進(jìn)行強(qiáng)有力的揉搓，手指互相揉搓指縫之間，第66頁/共155頁揉搓手背和手心。寄居在皮膚汗腺管和毛囊里的微生物不易清除。調(diào)查表明1/5的醫(yī)務(wù)人員手上攜帶有潛在的致病性耐抗生素病原體。醫(yī)務(wù)人員洗手只占理想概率的30%。與患者接觸前后不洗手可能是最重要的感染傳播因素。這些微生物給抵抗力下降的患者帶來了威脅，所以通常建議在接觸患者前用消毒液洗手。第67頁/共155頁PICClines(peripherallyinsertedcentralcatheters)APICCisalong,thin,flexibletubeknownasacatheter.Itisinsertedintooneofthelargeveinsofthearmnearthebendoftheelbow.Itisthenslidintotheveinuntilthetipsitsinalargeveinjustabovetheheart.Thespaceinthemiddleofthetubeiscalledthelumen.Sometimesthetubehastwoorthreelumens,knownasdoubleortriplelumen.Thisallowsdifferenttreatmentstobegivenatthesametime.翻譯第68頁/共155頁Attheendofthetubeoutsidethebody,eachlumenhasaspecialcaporbungthat

canbeattachedtoadriporsyringe.Sometimesthereisaclamptokeepthetubeclosedwhenitisn’tinuse.

ThePICClinecanbeusedtogiveyoutreatmentssuchaschemotherapy,bloodtransfusions,antibioticsandintravenous(IV)

fluids.

Itcanalsobeusedtotakesamplesofyourbloodfortesting.PICClinescanalsobeusedtogiveliquidfoodintotheveinifthedigestivesystemisnotabletocopewithfoodforanyreason.翻譯第69頁/共155頁ApatientcangohomewithaPICClineinplace,anditcanbeleftinforweeksormonths.Itmaybehelpfulifdoctorsandnursesfinditdifficulttogetneedlesintothepatient’sveinsorifthewallsofthepatient’sveinshavebeenhardenedbypreviouschemotherapytreatment.It’salsohelpfulifthepatientdoesn’tlikeneedles.翻譯第70頁/共155頁PICC通道（經(jīng)外周中心靜脈置管輸液）PICC是一根細(xì)長的軟管，也稱為導(dǎo)管。將它插入靠近肘部外展處其中一根手臂靜脈大血管內(nèi)，然后將其插入靜脈內(nèi)直到它的尖端定位于心臟上方一根最大的靜脈內(nèi)。管道中央部分被稱為內(nèi)腔，有時管道有兩個或三個內(nèi)腔，被稱為雙腔或三腔，這種設(shè)計使不同的治療同時進(jìn)行變?yōu)榭赡堋Ｔ隗w外管道的末端，每一個內(nèi)腔有一個特殊的蓋子或塞子可以連接一個滴管或注射器。不使用時，用夾子夾住管道。第71頁/共155頁PICC導(dǎo)管可用于化療、輸血、抗生素輸入和靜脈輸液，也用來采集血標(biāo)本送檢。如果消化系統(tǒng)因某種原因不能消化食物時，PICC導(dǎo)管也能用來輸入流質(zhì)食物?；颊呖梢詭е鳳ICC管回家，它可以保留幾周到幾個月。如果醫(yī)生或護(hù)士很難在患者血管內(nèi)穿刺，或者患者血管壁因之前的化療而硬化，可使用PICC導(dǎo)管。如果患者不喜歡針頭穿刺，也可用PICC導(dǎo)管。第72頁/共155頁Discussionofthenursingtopic1. WhydoIVcannulasneedtobeassessedregularly?2. Whathappensiftheyarenotassessedregularly?TocheckthattheyarestillpositionedintheveinandthattheIVfluidisrunningintothevein;tocheckforsignsofinfection;tocheckforphlebitis(irritationofthevein);tocheckthelengthoftimetheIVcannulahasbeeninplace(checkedagainstthedatedocumentedincareplan).Thepatientmayendupwithaninfectionwhichcouldlengthenhospitalstay;thepatientsuffersdiscomfort;thepatientmaynotreceivethecorrectamountoffluid.第73頁/共155頁3. Whydonurseswashhandsbeforeputtinginacannula?Theaimofhandwashingistoremovemicroorganismsfromthehands,preventingtheirpotentialtransfer.第74頁/共155頁

Commonpatternsandquestionswhenassessingcannulas1. CouldIjustcheckthat…?2. I’dliketolookintowhyit’shurting.3. CanIhavealook?4. I’llhaveacheckonyourCarePlantoseewhenthedoctorputtheIVin.5. That’swhywecheckthecannulasiteandtakethecannulaoutatthefirstsignofinfection.6. ThenumberofdaystheIViskeptinisrecordedintheCarePlan.第75頁/共155頁Practiceofthetask(Bessie,awardnurse,isinspectingtheIVcannulasiteandMrs.FieldingiswaitingforhernextIVinfusion.)Bessie: Hello,Mrs.Fielding.CouldIjustcheckthatyourIVcannulaisallrightbeforeIputupthenextinfusion?Mrs.Fielding: Oh,thanks.Ijustplannedtobuzzyou.ThecannulahurtsalotandtheIVisnotdrippinganymore.翻譯第76頁/共155頁Bessie: OK,itsoundslikeitmighthavetissued.It’swhenthefluidleaksintothetissuesanddoesn’tdripintothevein.I’dalsoliketolookintowhyit’shurting.CanIhavealook?Hm,it’squitewarm,isn’tit?Mrs.Fielding: Yes,anditlooksred,too.Bessie: Soyou’vegotwarmth,erythema—that’stheredness—andtenderness.Mrs.Fielding: Yes,itstartedbeingsorealittlewhileago.Bessie: Soundslikeaninfection.I’llhaveacheckonyourCarePlantoseewhenthedoctorputtheIVin.Hm...threedaysago.OK,well,it’llneedtobereplacedanyway.翻譯第77頁/共155頁Mrs.Fielding: Whatdoyoumean?Bessie: ItmeansthatI’llcallthedoctortocomeandputinanewone.I’llstopthisdripnowandtakeoutyourcannula.Mrs.Fielding: Ithoughtthat’swhatyou’dhavetodo.WhydoIstillhavetohaveone?Can’ttheyleavethecannulaout?Bessie: Sorry,you’vestillgotsixdosesofIVantibioticssowe