Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,1,重症医学科西院周维,腹腔镜胆囊切除术后护理查房,医学压力,患者，童桂珍，女，59岁。,术中诊断：胆囊结石，急性胆囊炎,手术方式：腹腔镜胆囊切除术,麻醉方式：全麻,术后处理事项：术后转ICU监护,术后注意：生命体征及引流情况。,3,护理查房,术中简要经过：患者取仰卧位，麻醉成功后常规行手术区域消毒铺无菌巾，取脐上切口切开皮肤，气囊针穿刺入腹，进CO2气体，制造气腹，分别取剑下，右锁骨中线肋缘切口进鞘主次操作，超声刀解剖别离胆囊三角区，别离出胆囊管及胆囊动脉，切除胆囊，去除腹腔，留置腹腔引流管，关闭气腹，逐层缝合各切口。,4,护理查房,5,护理查房,入科检查：,患者于2021年4月29日21:30分在手术室行全麻下行“腹腔镜胆囊切除术后转入ICU治疗，入科体查，血压169/95，心率90次/分，呼吸：21次/分，血氧饱和度：97%，神志清楚，双肺呼吸音清，未闻及干湿性啰音，腹软，腹部伤口辅料枯燥，未见渗血渗液，急查血气分析提示轻度呼酸。考虑与麻醉有关，电解质，乳酸，血糖正常，入科予以持续吸氧，心电监护，给予抑酸护胃耐信，补液等对症支持处理。,6,术后护理方案,1，舒适的改变,2，疼痛,3，自理缺陷,护理诊断1,舒适的改变,相关因素：1，手术所致的组织创伤 和肌肉痉挛,2，伤口疼痛,3，引流管的不适应,护理措施1,协助患者取舒适卧位并定期翻身，向病人解释疼痛原因及因对方法，必要时应用疼痛剂以减轻疼痛,护理目标1，,患者自述舒适感增强,护理诊断2,疼痛,相关因素,与手术创伤，放置引流管有关,护理目标2,病人能说出疼痛的原因及应对方法，能安静入睡。,护理措施2,解释疼痛的原因，协助取舒适卧位，必要时应用镇痛剂,护理诊断3,自理缺陷,主诉咽喉、尿道口不适。,主诉腹胀、轻微腹痛，肩、背部酸痛，恶心、呕吐。,护理措施3,提供细致的生活护理，满足病人的生理需求,遵医嘱给予止痛、止呕药物，并观察药物效果,护理目标3,病人生活需要得到满足，恢复到最正确自理能力,风险评估,拔管,风险因素,与病人意识恢复不佳有关,术前健康指导不到位,约束无效,处理方法,宣教到位告诉患者引流管的重要性。,妥善固定引流管，预留活动长度,评估因素，加强巡视,操作前后，注意保护管道,必要时采取镇静和有效的约束,风险评估,呼吸暂停,风险因素,与麻醉有关,观察要点,伤口渗血渗液情况,去枕平卧，防止误吸,血氧饱和度,血压,心率,病人主诉需求,22,谢谢！,