完整版昏迷病人的護(hù)理

臨武縣中醫(yī)醫(yī)院ICU

朱潔娜昏迷患者的護(hù)理

學(xué)習(xí)內(nèi)容1、昏迷的概念及意識的分類。2、了解引起昏迷的原因。3、了解GCS評分。4、昏迷病人的護(hù)理措施。一、昏迷的概念昏迷是因腦功能嚴(yán)重障礙引起，以意識喪失、運(yùn)動(dòng)感覺障礙和反射消失為主的一系列臨床表現(xiàn)，是大腦皮質(zhì)和網(wǎng)狀結(jié)構(gòu)發(fā)生高度抑制的一種狀態(tài)，其病情特點(diǎn)是重而復(fù)雜，變化快，隨時(shí)有危及生命的可能，因此必須予以嚴(yán)密全面觀察和護(hù)理。二、意識的概念意識是大腦的功能，是人類反映客觀顯示的最高形式，它通過人的語言、軀體運(yùn)動(dòng)和行為表達(dá)出來。意識是機(jī)體對自身和周圍環(huán)境的感知，是機(jī)體處以覺醒狀態(tài)，并能正確認(rèn)識自己和周圍環(huán)境。三、意識障礙概念

意識障礙系指人們對自身和環(huán)境的感知發(fā)生障礙，或人們賴以感知環(huán)境的精神活動(dòng)發(fā)生障礙的一種狀態(tài)。四、引起昏迷的原因一個(gè)是由于大腦病變引起的昏迷，這包括腦血管疾?。ㄈ缒X出血、腦梗塞等）、腦外傷、腦腫瘤、腦炎、中毒性腦病等；。

另一個(gè)是由于全身疾患引起的昏迷，這包括酒精中毒、糖尿病酸中毒、尿毒癥、肝昏迷、一氧化碳中毒等。五、意識的分類

清醒：正常。

嗜睡：是程度最淺的一種意識障礙，患者經(jīng)常病理性倦睡，處于持續(xù)的、延長的睡眠狀態(tài)，給予較輕微的刺激即可被喚醒，喚醒后能作簡單對答和活動(dòng)，無刺激時(shí)，迅即入睡。

昏睡：較嗜睡更深的意識障礙，表現(xiàn)為意識范圍明顯縮小，精神活動(dòng)極遲鈍，對較強(qiáng)刺激有反應(yīng)。不易喚醒，醒時(shí)睜眼，但缺乏表情，對反復(fù)問話僅能作簡單回答，回答時(shí)含混不清，常答非所問，各種反射活動(dòng)存在。五、意識的分類五、意識的分類

淺昏迷：意識不清晰，對外界刺激無任何主動(dòng)反應(yīng)。隨意活動(dòng)消失，在強(qiáng)烈刺激下，如壓迫眶上神經(jīng)時(shí)可見痛苦表情和肢體輕微的防御反應(yīng)除腹壁與提睪反射常消失外，其他各種生理反射（吞咽、咳嗽、角膜反射、瞳孔對光反應(yīng)等）存在；體溫、脈搏、呼吸多無明顯改變，可伴譫妄或躁動(dòng)。五、意識的分類

昏迷：即意識活動(dòng)喪失，是嚴(yán)重的意識障礙。對外界各種刺激或自身內(nèi)部的需要不能感知?？捎袩o意識的活動(dòng)，任何刺激均不能被喚醒。五、意識的分類

深昏迷：是最嚴(yán)重的意識障礙。隨意活動(dòng)完全消失，對各種刺激皆無反應(yīng)，各種生理反射消失，可有呼吸不規(guī)則、血壓下降、大小便失禁全身肌肉松馳（肌張力低下）、去大腦強(qiáng)直等。僅維持呼吸與循環(huán)等生命最基本的生理功能。五、意識的分類意識模糊：表現(xiàn)為注意力減退，情感反應(yīng)淡漠，定向力障礙，活動(dòng)減少，語言缺乏連貫性，對外界刺激可有反應(yīng)，但低于正常水平。五、意識的分類譫妄：在意識模糊的同時(shí)，伴有明顯的精神運(yùn)動(dòng)興奮，如躁動(dòng)不安、喃喃自語、抗拒喊叫等。有豐富的視幻覺和錯(cuò)覺。甚至有沖動(dòng)及攻擊行為。夜間加重，白天減輕。六、GCS評分

用格拉斯哥昏迷評分法來判斷病人的意識情況，比較客觀。評分標(biāo)準(zhǔn)：15分：表示意識清楚。12分～14分：為輕度意識障礙，

9分～11分：中度意識障礙，8分以下：為昏迷，分?jǐn)?shù)越低則意識障礙越重

睜眼反應(yīng)

4-自動(dòng)睜眼3-呼之睜眼2-疼痛刺激睜眼1-不睜眼言語反應(yīng)

5-正常交談

4-應(yīng)答錯(cuò)誤

3-言語錯(cuò)亂

2-言語難辨

1-不語運(yùn)動(dòng)反應(yīng)

6-按吩咐動(dòng)作

5-對疼痛刺激定位反應(yīng)

4-對疼痛刺激回縮反應(yīng)3-刺痛肢體有屈曲反應(yīng)2-刺痛肢體有伸直反應(yīng)1-無動(dòng)作七、護(hù)理措施日常生活中，我們經(jīng)常遇到二種情況。一種是我們身邊突然出現(xiàn)病人昏迷；另一種是病人因腦血管病或顱腦外傷等已昏迷一定時(shí)期，病情穩(wěn)定后需回家中恢復(fù)和修養(yǎng)。

當(dāng)我們身邊突然出現(xiàn)疑似昏迷的病人時(shí)，鑒別病人是否昏迷最簡單的辦法是用棉芯輕觸一下病人的角膜，正常人或輕癥病人都會出現(xiàn)眨眼動(dòng)作，而昏迷，特別是深昏迷病人毫無反應(yīng)。當(dāng)確定病人昏迷時(shí)，應(yīng)盡快送病人到醫(yī)院搶救。突然昏迷病的人

（1）要使病人平臥，頭側(cè)向一側(cè)，以保持呼吸道通順。（2）病人有活動(dòng)性假牙,應(yīng)立即取出，以防誤入氣管。

（3）注意給病人保暖，防止受涼。（4）密切觀察病情變化，經(jīng)常呼喚病人，以了解意識情況。對躁動(dòng)不安的病人，要加強(qiáng)保護(hù)，防止意外損傷。長期昏迷的病人，應(yīng)做好以下護(hù)理：（1）飲食護(hù)理。應(yīng)給予病人高熱量、易消化流質(zhì)食物；不能吞咽者給予鼻飼。鼻飼食物可為牛奶、米湯、菜湯、肉湯和果汁水及腸內(nèi)營養(yǎng)等。另外，也可將牛奶、雞蛋、淀粉、菜汁等調(diào)配在一起，制成稀粥狀的混合奶，鼻飼給病人。每次鼻飼量不超過200毫升，每次間隔時(shí)間不少于2小時(shí)。鼻飼時(shí)，應(yīng)加強(qiáng)病人所用餐具的清洗、消毒。長期昏迷者每月更換鼻飼管一次。同時(shí)根據(jù)不同疾病引起的昏迷，營養(yǎng)要求不一樣選擇食物，應(yīng)根據(jù)醫(yī)囑而定。吃多少，既要根據(jù)疾病不同而異，又要根據(jù)各人情況而定，以維持昏迷前情況為原則。開始時(shí)小量試喂，逐步增加。切忌急于求成。要注意觀察其消化功能，根據(jù)情況及時(shí)調(diào)整。在每次鼻飼時(shí)一定要抽吸胃液，觀察有無呃逆、腹部飽脹、胃液呈咖啡色或解黑色便，應(yīng)立即通知醫(yī)生給予止血藥物。保持呼吸道通暢（2）防止感冒。長期昏迷的病人機(jī)體抵抗力較低，要注意給病人保暖，防止受涼、感冒。病人無論取何種臥位都要使其面部轉(zhuǎn)向一側(cè)，以利于呼吸道分泌物的引流；當(dāng)病人有痰或口中有分泌物和嘔吐物時(shí)，要及時(shí)吸出或摳出；每次翻身變換病人體位時(shí)，輕扣病人背部等，以防吸入性或墜積性肺炎的發(fā)生。預(yù)防壓瘡（3）昏迷病人預(yù)防壓瘡最根本的辦法是定時(shí)翻身，一般每2小時(shí)翻身一次，予以臥氣墊床，另外還要及時(shí)更換潮濕的床單、被褥和衣服。預(yù)防燙傷（4）長期昏迷的病人末梢循環(huán)不好，冬季時(shí)手、腳越發(fā)冰涼。在給病人使用熱水帶等取暖時(shí)，一定要注意溫度不可過高，以免發(fā)生燙傷。防止便秘（5）長期臥床的病人容易便秘，為了防止便秘，每天可給病人喂蜂蜜水和含纖維素多的食物，每日早晚給病人順時(shí)針方向按摩腹部。3天未大便者，應(yīng)服用麻仁丸或大黃蘇打片等緩瀉藥，必要時(shí)可用開塞露幫助排便。防止泌尿系感染(6)病人如能自行排尿，要及時(shí)更換尿濕的衣服、床單、被褥。如病人需用導(dǎo)尿管幫助排尿，每次清理病人尿袋時(shí)要注意無菌操作，導(dǎo)尿管要定期更換。幫助病人翻身時(shí)，不可將尿袋抬至高于病人臥位水平，以免尿液返流造成泌尿系感染。防止墜床（7）躁動(dòng)不安的病人應(yīng)安裝床擋，必要時(shí)使用約束帶，防止病人墜床、摔傷。預(yù)防結(jié)膜、角膜炎（8）對眼睛不能閉合者，可給病人涂用抗生素眼膏并加蓋濕紗布，以防結(jié)、角膜炎的發(fā)生。一般護(hù)理（9）每天早晚給病人用生理鹽水清洗口腔，每日床上擦浴1次，每日會陰擦洗2次。做好三短六潔。準(zhǔn)確的記錄病人的出入量。管路的護(hù)理

1、嚴(yán)格無菌操作原則。

2、保持引流通暢，避免扭曲折疊，妥善固定，注意觀察引流液的色和量。

3、按各類引流管護(hù)理常規(guī)進(jìn)行護(hù)理。管道標(biāo)識和腕帶的使用

1、各種管道均應(yīng)按規(guī)定貼有標(biāo)識。

2、昏迷病人都要佩戴腕帶，并注明床號姓名、性別、年齡、診斷等信息。功能鍛煉昏迷病人的攣縮畸形出現(xiàn)較早，尤其是小肌肉、小關(guān)節(jié)。開始就應(yīng)每日2-3次做四肢被動(dòng)活動(dòng)，保留關(guān)節(jié)功能。防止關(guān)節(jié)強(qiáng)直，以免發(fā)生肌肉萎縮。并及時(shí)進(jìn)行語言等各類訓(xùn)練。有肢體癱瘓者，應(yīng)防止病人足下垂，并按癱瘓病人進(jìn)行護(hù)理。病情穩(wěn)定后，即可開始床上肢體活動(dòng)。鼓勵(lì)患者加強(qiáng)肢體的功能鍛煉、按摩、針灸或被動(dòng)運(yùn)動(dòng)。從發(fā)音器官開始到發(fā)單音節(jié)、單詞，認(rèn)人、物、字，數(shù)數(shù)等。說一些簡單的日常用語，讓患者跟著說，或讓患者反復(fù)聽日常用語的磁帶，以強(qiáng)化語言刺激，逐漸恢復(fù)語言功能?？祻?fù)期護(hù)理幫助病人家屬樹立戰(zhàn)勝疾病的信心，積極配合。對植物人應(yīng)加強(qiáng)基礎(chǔ)護(hù)理和支持療法的治療護(hù)理。防止各種并發(fā)癥，注意飲食營養(yǎng)衛(wèi)生，堅(jiān)持運(yùn)動(dòng)由小到大，由弱到強(qiáng)，循序漸進(jìn)，并配合理療、針灸等措施，促進(jìn)功能恢復(fù)，直到康復(fù)。腦血管患者常因肢體癱瘓、語言障礙、大小便失禁等而產(chǎn)生痛苦、絕望、焦慮、自卑等心理，對治療缺乏信心，應(yīng)尊重患者的人格，態(tài)度和藹、語言親切，耐心地做好患者及家屬的解釋工作，幫助患者調(diào)整心理情緒，維持患者家庭和諧、社會融洽，讓患者體會到相互信任所帶來的愉快情緒，使患者保持積極樂觀的情緒，樹立戰(zhàn)勝疾病的信心。謝謝聆聽4242贈(zèng)送2套亮麗色表格可一鍵刪除折線圖/表格/數(shù)據(jù)關(guān)系Trending

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