雾化器固定支架的设计与应用

目的自制雾化器固定支架,并探讨其临床应用效果。方法设计的雾化器固定支架包括底座、连接杆、万向软管和雾化杯固定部4个部分。便利选取2020年7月—12月合肥市某三级甲等医院急诊病房收治的63例患者作为试验组,选取2020年1月—6月收治的63例患者作为对照组。试验组采用自行设计的雾化器固定支架辅助进行雾化,对照组采用手持雾化器的方式进行雾化。比较两组雾化时间、雾化中断次数、雾化舒适率。结果试验组雾化时间为(23.05±2.86) min,对照组为(16.46±2.31) min,两组比较,差异具有统计学意义(P<0.001);试验组雾化中断次数为(0.86±0.47)次,对照组为(1.77±0.57)次,两组比较,差异具有统计学意义(P=0.013);试验组雾化舒适率为92.06%,对照组为76.19%,两组比较,差异具有统计学意义(P=0.031)。结论雾化器固定支架使用方便,可减少雾化中断次数,延长雾化时间,提高患者的雾化舒适度,有利于提升患者对雾化治疗的依从性。     

专项疼痛管理在烧伤患者舒适护理管理中的应用

目的 探讨在烧伤患者舒适护理管理中应用专项疼痛管理的效果。方法 选择2022年1月-2023年 12月于我院接受治疗的100例烧伤患者为研究对象,随机分为对照组和观察组,每组50例。对照组实施 常规护理管理,观察组在对照组基础上实施专项疼痛管理,比较两组疼痛程度、舒适度、护理满意 度、睡眠质量及生理指标。结果 观察组干预后1、6、12、24、48 h NRS评分及FPS评分均低于对照组 （P ＜0.05）;观察组干预后1、6、12、24、48 h VAS评分均高于对照组（P ＜0.05）;观察组护理满意 度高于对照组（P ＜0.05）;观察组PSQI评分低于对照组（P ＜0.05）;观察组心率、血压均优于对照组 （P＜0.05）。结论 专项疼痛管理在烧伤患者舒适护理管理中的应用效果确切,能够有效减轻患者的疼痛 程度,改善睡眠质量,有利于提高其舒适度和满意度,值得临床应用。     

Decision-making for extremely preterm infants with severe hemorrhages on head ultrasound: Science,values, and communication skills

Severe intracranial hemorrhages are not rare in extremely preterm infants. They occur early, generally when babies require life-sustaining interventions. This may lead to ethical discussions and decision-making about levels of care. Prognosis is variable and depends on the extent, location, and laterality of the lesions, and, importantly also on the subsequent occurrence of other clinical complications or progressive ventricular dilatation. Decision-making should depend on prognosis and parental values. This article will review prognosis and the uncertainty of outcomes for different lesions and provide an outline of ways to conduct an ethically appropriate discussion on the decision of whether to continue life sustaining therapy. It is possible to communicate in a compassionate and honest way with parents and engage in decision-making, focussing on personalized information and decisions, and on function, as opposed to diagnosis.     

早期多元化护理在鼻中隔偏曲位移修复术中的应用

目的 探讨早期多元化护理在鼻中隔偏曲位移修复术中的应用。方法 选取山东健康集团枣庄中 心医院2020年3月-2023年3月收治的86例行鼻中隔偏曲位移修复患者为研究对象，采取随机数字表法分为 参照组和研究组，每组43例。参照组实施常规护理，研究组实施早期多元化护理，比较两组舒适度、焦 虑情况、睡眠质量及并发症发生情况。结果 研究组护理后舒适度评分高于参照组（P＜0.05）；研究组焦 虑评分低于参照组，睡眠质量评分低于参照组（P＜0.05）；研究组并发症发生率为2.33%，低于参照组的 18.60%（P＜0.05）。结论 在鼻中隔偏曲位移修复术中对患者实施早期多元化护理，可有效提升护理舒适 度及护理质量，缓解患者焦虑，进一步提高患者睡眠质量，以及减少相关并发症发生。     

Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence

IntroductionPatient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings.MethodsThis quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression – Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation.ResultsViolent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation.DiscussionUsing an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.     

Helmet CPAP bundle: A narrative review of practical aspects and nursing interventions to improve patient’s comfort

BackgroundThe application of Continuous Positive Airway Pressure (CPAP) with a helmet is increasing around the world, both inside and outside of the intensive care unit. Current published literature focus’s on indications, contraindications and efficiency of Helmet CPAP in differing clinical scenarios. Few reports, summarising the available knowledge concerning technical characteristics and nursing interventions to improve patient’s comfort, are available.AimTo identify the crucial technical aspects in managing patients undergoing Helmet-CPAP, and what nursing interventions may increase comfort.MethodsA narrative literature review of primary research published 2002 onwards. The search strategy comprised an electronic search of three bibliographic databases (Pubmed, Embase, CINAHL).ResultsTwenty-three studies met the inclusion criteria and were included in the review. Research primarily originated from Italy. Nine key themes emerged from the review: gas flow management, noise reduction, impact of gas flow and HME filters on delivered FiO₂, filtration of exhaled gas / environmental protection, PEEP monitoring, airway pressure monitoring, active humidification of gas flow, helmet fixation and tips to implement awake prone position during Helmet-CPAP.ConclusionsA Helmet-CPAP check-list has been made of nine key interventions based on the available evidence regarding system set up, monitoring and management. Implementation of this check-list may help nurses and physicians to increase the comfort of patients treated with Helmet CPAP and enhance their compliance with long-term treatment.     

不同频率高频重复经颅磁刺激在带状疱疹后神经痛中的应用效果分析

【摘要】 目的 探究不同频率高频重复经颅磁刺激 (HF-rTMS) 在带状疱疹后神经痛 (PHN) 中的应用效果。 方法 选取 2019 年 5 月至2021 年5 月南阳市中心医院收治的102 例 PHN 患者作为研究对象, 按照不同治疗方法将其分为假刺激组 (33 例)、5 Hz 治疗组 (32 例)、10 Hz 治疗组 (37 例), 假刺激组患者予以模拟 HF-rTMS治疗, 5 Hz 治疗组患者予以 5 Hz HF-rTMS 治疗, 10 Hz 治疗组患者予以 10 Hz HF-rTMS 治疗, 对比观察 3 组患者疼痛程度、用药剂量变化情况、睡眠质量、舒适度、总体印象变化情况以及不良反应发生情况。 结果 治疗 4?8、12 周后, 5 Hz 治疗组和 10 Hz 治疗组患者视觉模拟评分法 (VAS) 评分均明显低于假刺激组, 且以 10 Hz 治疗组最低 (F = 19.401、51.201、55.031, P 均 < 0.001); 而 3 组患者药物调节情况 (MR) 评分均无明显差异(F =0.051、0.034、0.108, P =0.951、0.966、0.899)。 治疗 12 周后, 5 Hz 治疗组和 10 Hz 治疗组患者匹兹堡睡眠质量指数 (PSQI) 评分明显低于假刺激组, 且以10 Hz 治疗组最低 (F =18.825, P <0.001)。 治疗8、12 周后, 5 Hz 治疗组和 10 Hz 治疗组患者 Bruggrmann 舒适度量表 (BCS) 评分均明显高于假刺激组, 且以 10 Hz 治疗组最高 (F =30.920、79.523, P 均 <0.001); 5 Hz 治疗组和 10 Hz 治疗组患者总体印象变化量表 (PGIC) 评分均明显低于假刺激组, 且以 10 Hz 治疗组最低 (F =21.310、131.904, P 均 <0.001)。 3 组患者均未出现明显不良反应。 结论 5 Hz 与 10 Hz HF-rTMS 对 PHN 均具有一定的治疗效果, 但 10 Hz HF-rTMS 对患者疼痛、睡眠质量、自觉症状的改善效果更佳。     

舒适护理对肾病综合征患者负性情绪、护理质量的影响观察

目的 探究对肾病综合征患者采用舒适护理干预后的负性情绪、护理质量的影响。方法 选取 2021 年 5 月至 2022 年 12 月期间本院收治的肾病综合征患者 88 例作为研究对象。采用随机数字表法将患者分为观察组及对照组，每组 44 例。对照组实 施常规护理；观察组实施舒适护理。分析对比两组的负性情绪、并发症、护理依从性以及生活质量。结果 护理后，观察组的 焦虑、抑郁评分均显著低于对照组（P<0.05）。观察组的并发症发生率显著低于对照组（P<0.05）。观察组的护理依从性显著高 于对照组（P<0.05）。护理后，观察组的各项生活质量评分均显著高于观察组（P<0.05）。结论 采用舒适护理对肾病综合征患者 进行护理，能改善患者的负性情绪，提升患者的护理依从性，降低并发症的发生率。     

舒适护理在面颈部烧伤瘢痕患者瘢痕松解术中的应用价值

分析在面颈部烧伤瘢痕患者瘢痕松解术中应用舒适护理的临床效果。方法 选取宜昌市 中心人民医院西陵院区2020年1月-2022年12月收治的70例面颈部烧伤瘢痕患者，随机分为对照组与观察 组，每组35例。对照组采取常规护理，观察组采取舒适护理，比较两组瘢痕修复时间、肉芽生长时间、创 面愈合率及生活质量。结果 观察组瘢痕修复时间和肉芽生长时间均短于对照组，创面愈合率高于对照组 （P ＜0.05）；两组护理后手功能、基本生活能力、心理状态、性生活、人际关系、热敏感、体像、工作情况 和治疗依从性评分均高于护理前，且观察组高于对照组（P＜0.05）。结论 舒适护理在面颈部烧伤瘢痕患者 中具有较高的应用价值，可有效缩短瘢痕修复时间和肉芽生长时间，促进创面愈合，改善患者生活质量。