老年腹部手术患者围术期的护理

【】目的 ：老年腹部手术患者围手术期护理。方法 ：对近2 年来28 例老年腹部手术患者的围术期护理情况进行回顾性分析。结果：28例患者均痊愈出院,术后并发心功能不全2例、肺部感染3例(急诊手术)、心律失常2例、肺栓塞1例。结论：通过对老年患者的围术期提供全方位的护理,使患者平稳度过围手术期,缩短住院时间,减少并发症以及提高术后生活质量。     

老年患者围手术期呼吸道管理146例护理体会

2005年4月～2006年2月,我们对146例老年手术患者,加强了围术期的呼吸道管理与护理,效果满意。现将护理体会报告如下。     

高原地区体外循环围术期循环功能监测与护理

体外循环 (CPB)可引起明显的循环功能紊乱 ,肺动脉高压可进一步加重CPB手术的危险性 ,影响病人恢复及预后。我院 2 0 0 0年 9月～ 2 0 0 1年 1 0月在高原地区 (海拔 36 5 8m)先后对 5 3例病人行CPB心内直视术 ,效果满意 ,现将护理体会报道如下。1　临床资料本组 5 3例 ,男 2 0例 ,女 33例 ;藏族 2 8例 ,汉族 2 5例 ,年龄 0 .9～ 38岁 ;病人均在全麻CPB下手术治疗。术式包括房、室间隔缺损修补术 4 4例 ,法乐氏四联症矫正术 3例 ,瓣膜置换术 6例 ;4 1例合并程度不等的肺动脉高压。均存在低氧血症 (PO2 5 2～ 6 5mmHg)和酸中毒(7.32 0±…     

骨科老年患者的围术期护理

老年人由于各脏器功能逐渐衰退，生理功能下降，多数老年人存在着不同程度的心、脑、血管、肺、肾及内分泌疾病，因此老年人的术前检查、准备、护理及术后并发症的预防尤其重要。如果任何—个环节没有做好，不但达不到治疗的目的，还会给患者带来精神、身体上的痛苦，甚至危及生命。     

老年手术200例围术期舒适护理体会

2004年1月~12月,我们对200例老年手术患者实施舒适护理,效果满意。现将围术期舒适护理体会报告如下。1临床资料本组老年手术患者200例,男114例,平均65.5岁,女86例,平均61岁。其中胆囊切除术67例,肝叶切除术55例,乳腺癌根治术32例,胃癌根治术20例,直肠癌根治术16例,甲状腺次全切     

药代学药效学和围术期循环功能调控

几乎没有一种麻醉药能单独用于临床手术麻醉，尤其对那些高风险非心脏手术患者。为获得满意的麻醉效果、保持血流动力学稳定、减少心肌缺血等不良反应的发生，麻醉药选择主要基于围术期心室功能、是否需早期拔管、医生对药代学／药效学和药物相互作用的了解及使用经验等加以综合考虑。     

普外科老年患者120例围术期护理

对120例年龄〉60岁老年患者做好术前心理护理、术前准备,术后病情观察、安全护理、饮食指导、皮肤黏膜护理、并发症的预防与护理。结果本组术后发生呼吸道感染10例,肠梗阻3例,切口感染2例,切口延期愈合4例,胆瘘2例,经积极治疗与精心护理,均康复出院,无护理并发症发生。认为做好普外科老年患者的围术期护理,可确保手术顺利进行,减少并发症发生。     

普外科老年患者120例围术期护理

对120例年龄>60岁老年患者做好术前心理护理、术前准备,术后病情观察、安全护理、饮食指导、皮肤黏膜护理、并发症的预防与护理.结果本组术后发生呼吸道感染10例,肠梗阻3例,切口感染2例,切口延期愈合4例,胆痿2例,经积极治疗与精心护理,均康复出院,无护理并发症发生.认为做好普外科老年患者的围术期护理,可确保手术顺利进行,减少并发症发生.     

围术期循环稳态的构建

循环系统是维持人体生命活动的基础之一，也是各种治疗药物得以送达效应部位，从而发生治疗效应的载体。外科手术在治疗疾病的同时，手术操作对机体所造成的创伤或不良刺激以及麻醉药物和技术的应用都会导致循环系统功能不稳定。若患者自身的基础状况，特别是与循环系统功能稳定密切相关的重要脏器和系统存在异常的病理生理改变，则更容易发生血压、心率的剧烈波动，引起酸中毒、组织低灌注、吻合口瘘、肺部感染、脓毒血症、认知功能障碍等一系列问题，严重者还会产生休克、心肌缺血或（和）心脑血管意外等并发症，甚至危及患者的生命。因此，围术期循环系统功能状态的稳定对于减少并发症，缩短术后恢复时间具有至关重要的作用。     

Communication in the perioperative setting

Poor communication in the perioperative setting contributes to an unsafe OR culture and affects patient safety and employee engagement, decision making, productivity, morale, and retention. Communication breakdowns can lead to surgical delays, patient inconvenience, and serious errors. Simplification and standardization of communication processes and the use of effective communication skills (eg, clear verbal communication, awareness of the effects of nonverbal communication, use of listening and conflict management skills) are ways to improve OR interactions and minimize or prevent errors.     

Medication use in the elderly patient: Focus on the perioperative/perianesthesia setting

As the population ages, the use of multiple medications also increases. Polypharmacy (taking multiple drugs at a time) presents concerns to the perianesthesia nurse who is caring for the geriatric patient. The pharmacokinetics and pharmacodynamics of drugs are often altered in older adult patients. Adverse drug reactions and drug interactions occur more often in geriatric patients than in younger patients. For these reasons, the benefits and risks of multiple medications and the administration of certain types of drugs must be carefully considered in the elderly patient. The selection of any medication should be individually based on the benefits and risks. Adverse drug reactions play a significant role in hospitalization for the general population, and the elderly are more susceptible to these. These drug reactions often contribute to significant morbidity as well as mortality. Medications need to be considered carefully in the older adult patient, but perhaps more so in the perioperative/perianesthesia period. Drug interactions are diverse. The type of anesthesia may influence the patient's outcome, depending on the medications the patient is currently taking. The patient's response to the stress of surgery is also affected by individual medical conditions as well as medications the patient is currently receiving Polypharmacy, inappropriate medications, adverse drug reactions, drug-disease issues, and drug interactions in the geriatric population are concerns in the perioperative/perianesthesia setting.     

Dexmedetomidine overdose in the perioperative setting

OBJECTIVE: To report 3 cases of accidental dexmedetomidine overdose in the perioperative setting and review the pathophysiology of alpha2-agonist overdose. case summaries: Three patients accidentally received overdoses of dexmedetomidine, one intraoperatively (192 microg over 20 min) and 2 postoperatively (4 and 2 rather than 0.4 and 0.2 microg/kg/h; 0.5 microg/kg/min rather than 0.5 microg/kg/h). Hemodynamic parameters remained stable for all 3 patients. The most notable sign was oversedation diagnosed either clinically or using a bispectral index monitor; Naranjo criteria suggest possible or probable association of the reactions with dexmedetomidine. In all 3 cases, oversedation resolved within one hour of drug discontinuation. There were no other sequelae, and the remainder of each patient's hospital course was unremarkable. DISCUSSION: As of this writing, dexmedetomidine dosing in excess of the label recommendation has been reported, but accidental dexmedetomidine overdose in clinical practice has not been described. Excessive levels of sedation were the only significant finding in all 3 patients. Dexmedetomidine's short redistribution half-life of 6 minutes should lead to rapid resolution of oversedation induced by overdoses if the overall duration of infusion is short (< or =8 h). While the patients reported here were hemodynamically stable, dexmedetomidine may engender significant hemodynamic changes either because of sympatholysis at normal doses or vasoconstriction at higher than recommended doses. The absence of a significant hypertensive response to high dexmedetomidine concentrations suggests that dexmedetomidine-induced hypertension may be multifactorial, not simply related to plasma drug concentrations. CONCLUSIONS: Practitioners presented with dexmedetomidine overdose should be prepared to manage oversedation. While hemodynamic alterations may be seen with dexmedetomidine use, hypertension from high dexmedetomidine plasma concentrations is not a consistent response. Practitioners using dexmedetomidine should carefully note that dosing for this agent is described by the manufacturer in microg/kg/h, not microg/kg/min.     

Mechanical thromboprophylaxis in the perioperative setting

Venous thromboembolism (VTE), a term indicative of both deep vein thrombosis and pulmonary embolism, is a life-threatening condition that often can be prevented by knowledge and preparedness. Surgical patients are at a great risk for VTE due to immobility and other factors. Recent research on VTE indicates that nurses play a part in its prevention through assessment and consistent nursing care.     

Prevention of transmissible infections in the perioperative setting

Risk of infection from bloodborne pathogens makes it imperative for surgical team members to detect surgical glove punctures before skin contact with pathogens occurs. The use of a second, colored pair of gloves worn by scrubbed team members during surgical procedures provides an early indicator of an outer glove puncture while the primary glove or underglove remains intact. This practice reduces the risk of occupational exposures for health care workers and the risk of surgical site infections for patients. We conducted a quality improvement project during which we randomly observed staff members for compliance with double gloving in the OR at the Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, during a 12-month period, and we conducted a review of sharps injuries for a 45-month period after intensive education about sharps injuries and use of a hands-free neutral zone technique. We found that when staff members were compliant with double-gloving techniques, there was a decrease in skin contact breaches, and the use of a hands-free neutral zone technique decreased the rate of sharps injuries.