XX醫(yī)院XX科子宮肌瘤手術(shù)期護(hù)理演講人：某某某時(shí)間：20XX.X.X

目錄臨床表現(xiàn)術(shù)前術(shù)后護(hù)理病情觀察CONTENTSPart01臨床表現(xiàn)女性生殖器官最常見(jiàn)的良性腫瘤多見(jiàn)于育齡婦女：30～50歲由子宮平滑肌組織增生而形成病因：可能與體內(nèi)雌激素水平過(guò)高或長(zhǎng)期刺激有關(guān)。分類：按肌瘤生長(zhǎng)部位分為子宮體部肌瘤和子宮頸部肌瘤。按肌瘤和子宮肌層關(guān)系分為漿膜下肌瘤、肌壁間肌瘤和粘膜下肌瘤。概述癥狀1、月經(jīng)改變2、白帶增多3、腹部腫塊4、不孕5、腹痛、腰酸、下腹墜脹、壓迫癥狀6、繼發(fā)性貧血臨床表現(xiàn)Part02術(shù)前術(shù)后護(hù)理應(yīng)根據(jù)患者年齡，生育要求，癥狀及肌瘤的部位，大小，數(shù)目全面考慮。隨訪觀察：肌瘤小，無(wú)癥狀。一般不需治療，特別是近絕經(jīng)期婦女。絕經(jīng)后肌瘤多可萎縮或逐漸消失，每3~6個(gè)月隨訪一次。藥物治療：肌瘤小于2個(gè)月妊娠子宮大小，癥狀輕，近絕經(jīng)年齡或全身情況不宜手術(shù)者。手術(shù)治療：子宮大于10周妊娠大小;月經(jīng)過(guò)多，繼發(fā)貧血;有膀胱、直腸壓迫癥狀或肌瘤生長(zhǎng)較快;保守治療失敗;不孕或反復(fù)流產(chǎn)排除其他原因。手術(shù)途徑可經(jīng)腹、經(jīng)陰道或?qū)m腔鏡及腹腔鏡下手術(shù)，術(shù)式有：肌瘤挖除術(shù)，子宮切除術(shù)。子宮肌瘤的治療圍手術(shù)期：是包括手術(shù)前手術(shù)中和手術(shù)后的一段時(shí)間，一般擇期性大手術(shù)圍手術(shù)期是從入院開(kāi)始到手術(shù)后一月左右。圍手術(shù)期護(hù)理目的：在于提高病人對(duì)手術(shù)的耐受力，減少術(shù)后并發(fā)癥的發(fā)生，促進(jìn)機(jī)體較順利的康復(fù)子宮肌瘤圍手術(shù)期護(hù)理子宮肌瘤圍手術(shù)期護(hù)理子宮肌瘤圍手術(shù)期護(hù)理術(shù)前護(hù)理自病人入院到接受手術(shù)的這段時(shí)間，稱為手術(shù)前期。這段時(shí)間的主要護(hù)理工作是：身心狀態(tài)評(píng)估及指導(dǎo)，局部皮膚的準(zhǔn)備，消化道的準(zhǔn)備，膀胱及陰道的準(zhǔn)備。心理支持：手術(shù)前患者必然會(huì)產(chǎn)生各種思想顧慮，常表現(xiàn)為失眠、焦慮、心率加快、體溫升高、血壓升高，患者總希望術(shù)者水平較高。針對(duì)此心理，筆者主動(dòng)給患者介紹術(shù)者的資歷，認(rèn)真回答和解釋患者提出的各種問(wèn)題，使其消除緊張、恐懼等不安情緒，以良好的心理狀態(tài)迎接手術(shù)。術(shù)前處理1.術(shù)前必須使子宮切除者了解術(shù)后不再出現(xiàn)月經(jīng)，且因手術(shù)原因影響卵巢血運(yùn)暫時(shí)性引起性激素水平波動(dòng)而出現(xiàn)停經(jīng)(肌瘤挖除術(shù)者),或者不能再生育。2.用通俗易懂的語(yǔ)言向病人說(shuō)明灌腸、備皮、陰道準(zhǔn)備、TCT檢查，必要的分段性診刮、術(shù)前禁食、術(shù)前用藥、保留導(dǎo)尿、早期活動(dòng)等必要性以及對(duì)預(yù)防術(shù)后并發(fā)癥促進(jìn)康復(fù)的作用。3.認(rèn)真做好術(shù)前合并癥的處理例如：貧血，營(yíng)養(yǎng)不良，低蛋白血癥等。因術(shù)前營(yíng)養(yǎng)狀況直接影響術(shù)后康復(fù)過(guò)程，要注意指導(dǎo)病人攝入高蛋白、高維生素、高熱量及低脂肪全營(yíng)養(yǎng)飲食，及含鐵量高的食物，如豬肝、雞蛋、紅棗、綠葉菜等。護(hù)士可根據(jù)患者的飲食習(xí)慣，協(xié)助制定飲食計(jì)劃或食譜。以保證機(jī)體處于術(shù)前最佳的營(yíng)養(yǎng)狀況。術(shù)前指導(dǎo)1.備皮的范圍應(yīng)上自劍突下，下至大腿上1/3,兩側(cè)至腋中線，外陰部（注意肚臍）。應(yīng)注意要用肥皂、熱水洗凈，剃毛時(shí)切勿劃破皮膚。2.胃腸道準(zhǔn)備：術(shù)前1日晚上應(yīng)進(jìn)易消化的流質(zhì)飲食如小米粥，術(shù)日晨應(yīng)禁止飲食，以防術(shù)中因惡心、嘔吐發(fā)生窒息及吸入性肺炎，還可以防止術(shù)后腹脹。術(shù)前1日晚用溫肥皂水清潔灌腸(根據(jù)病人的耐受程度，量約500～1000ml)，排空腸道，以利于手術(shù)。3.其他：根據(jù)患者的身體狀況做血型鑒定、血交叉、配血。術(shù)前1日晚睡前按醫(yī)囑服用鎮(zhèn)定催眠藥物，保證患者在手術(shù)前能充足地睡眠和休息。術(shù)前一天認(rèn)真核對(duì)醫(yī)囑，做好如下準(zhǔn)備：手術(shù)前一天護(hù)理一般準(zhǔn)備宜盡早看望病人，核查生命體征的變化，詢問(wèn)病人的自我感受，如有月經(jīng)來(lái)潮等異常情況，應(yīng)及時(shí)通知醫(yī)師。取下病人可活動(dòng)的義齒、發(fā)卡、首飾及貴重物品交家屬保管，長(zhǎng)發(fā)者應(yīng)梳成辮子。陰道準(zhǔn)備：術(shù)晨用碘伏原液棉球擦洗陰道。常規(guī)安置導(dǎo)尿管，保持引流通暢。術(shù)前30分遵醫(yī)囑給基礎(chǔ)麻醉藥物，病人至手術(shù)室后，根據(jù)病人手術(shù)種類及麻醉方式，鋪好麻醉床，準(zhǔn)備好監(jiān)護(hù)用具及急救用物。手術(shù)日晨護(hù)理1.密切觀察和記錄病情變化，及時(shí)發(fā)現(xiàn)問(wèn)題，配合醫(yī)生的檢查，做到及時(shí)處理。2.采取護(hù)理措施，減輕病人的痛苦和不適，使盡快恢復(fù)健康。3.有預(yù)見(jiàn)性(預(yù)見(jiàn)性護(hù)理)防止各種手術(shù)后可能出現(xiàn)的并發(fā)癥。4.幫助病人解決術(shù)后暫時(shí)的困難。術(shù)后護(hù)理基本要求術(shù)后常見(jiàn)癥狀和并發(fā)癥傷口疼痛、惡心、嘔吐、腹脹、尿潴留、便秘、食欲不振、頭昏失眠、咳嗽、發(fā)熱、陰道出血流液、腹部切口感染血腫裂開(kāi)、陰道殘端感染、內(nèi)出血、呼吸道感染、泌尿道感染、盆腔炎癥、血栓性靜脈炎、褥瘡。1、一般護(hù)理：檢查傷口敷料，靜脈通路，受壓皮膚情況，接好引流管，保持引流通暢，了解術(shù)中情況。2、臥位：按麻醉方式安置病人于適當(dāng)體位，一般術(shù)后次晨采取半臥位。半臥位有利于腹腔引流，能使腹壁肌肉松弛，降低切口張力，減輕疼痛。半臥位后，腹腔臟器下移，膈肌活動(dòng)中幅度加大，增加肺活量，有利于咳嗽排痰。半臥位使尿道口正處于膀胱最低位，減少膀胱殘余尿量，從而減少尿路感染因素。無(wú)論哪種臥位，當(dāng)麻醉消失，病人清醒后，應(yīng)協(xié)助病人勤翻身，至少每2小時(shí)翻身一次，減少粘連機(jī)會(huì)。一般護(hù)理Part03病情觀察1.注意觀察病人的面色、神志、表情、生命體征變化，每15-30分鐘巡視一次至病情穩(wěn)定。2.觀察切口有無(wú)出血、滲血滲液或敷料脫落，如有，應(yīng)及時(shí)尋找原因。病情觀察3.觀察尿量變化：術(shù)中分離粘連時(shí)，牽拉膀胱及輸尿管都將影響術(shù)后排尿功能。為此，術(shù)后應(yīng)注意保持留置導(dǎo)尿管通暢并認(rèn)真觀察尿量及性質(zhì)，術(shù)后病人每小時(shí)尿量至少50ml以上，通常次全子宮切除術(shù)后48小時(shí)拔除尿管，全子宮切除術(shù)后72小時(shí)拔除尿管，肌瘤挖除24小時(shí)后拔除尿管，拔管前應(yīng)指導(dǎo)病人定時(shí)夾閉尿管，鍛煉膀胱功能，防止尿潴留的發(fā)生。如每小時(shí)尿量少于30ml，伴血壓逐漸下降，脈搏細(xì)速，病人煩躁不安或訴說(shuō)腰背疼痛或肛門(mén)處下墜感，應(yīng)考慮有腹腔內(nèi)出血。病情觀察4.陰道出血：術(shù)后2~3天可有少量陰道流血，色暗紅;行子宮切除術(shù)患者，術(shù)后10~14天因陰道殘端羊腸線吸收化線，可有少量淡紅色出血，持續(xù)一周左右時(shí)間，無(wú)需特殊處理。病情觀察觀察中無(wú)論發(fā)現(xiàn)任何病情異常，均應(yīng)及時(shí)與醫(yī)師聯(lián)系，以便采取相應(yīng)措施。術(shù)后6小時(shí)無(wú)惡心嘔吐者可給清流質(zhì)，以后根據(jù)腸功能恢復(fù)情況改半流質(zhì)或軟食，腸功能未恢復(fù)前禁食牛奶豆?jié){，以防腸道產(chǎn)氣，發(fā)生腹脹。術(shù)后早期活動(dòng)有助于促進(jìn)整個(gè)機(jī)體的恢復(fù)，促進(jìn)血液循環(huán)，防止血栓形成，促進(jìn)胃腸蠕動(dòng)，防止腹脹便秘，促進(jìn)排尿功能的恢復(fù)，防止尿潴留等。第一次起床活動(dòng)時(shí)，家屬或護(hù)士要攙扶站立并注意觀察患者的面色脈搏，防止直立性低血壓(起床三步曲)術(shù)后禁性生活、盆浴2個(gè)月，3個(gè)月內(nèi)避免劇烈運(yùn)動(dòng)、重體力勞動(dòng)及長(zhǎng)時(shí)間蹲立位，保持大便通暢，術(shù)后1月返院復(fù)查。任何時(shí)間出現(xiàn)不適或異常癥狀應(yīng)及時(shí)隨診。早期活動(dòng)和出院指導(dǎo)XX醫(yī)院XX科非常感謝您的收看演講人：某某某時(shí)間：20XX.X.X

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01此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.

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03此處添加相關(guān)標(biāo)題關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題2020202220242026專業(yè)團(tuán)隊(duì)專屬定制Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.此處添加相關(guān)標(biāo)題添加標(biāo)題添加標(biāo)題關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

04此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)