Clinical nursing of cerebral infarction model Part I: Clinical practice of evidence-based nursing in cerebral infarction nursing Abstract Evidence-based nursing is a process in which nurses combine scientific research conclusions with clinical experience and patients' wishes seriously, clearly and wisely, and obtain evidence as the basis for clinical nursing decision-making. It is an important part of evidence-based medicine and evidence-based health care. At present, evidence-based nursing is widely used in various clinical nursing, among which the nursing effect of cerebral infarction is the most significant. In this article, the author will discuss the clinical practice of evidence-based nursing in cerebral infarction nursing.
Keywords evidence-based nursing; Clinical practice of cerebral infarction; nurse
China Library Classification Number R473 Document Identification Number A1671-8801(2014) 03-0273-01.
Evidence-based nursing, also known as experiential nursing, is when nurses make clinical nursing decisions by carefully and reasonably combining clinical experience, patients' needs and scientific research conclusions in the process of planning nursing. Its main purpose is to tell people that modern nursing practice needs reliable scientific basis. It has become history to deal with the problems in nursing practice only by clinical experience or lagging and imperfect theory. Any nursing decision should follow and apply scientific and reasonable evidence to achieve the expected nursing effect. The author selected 50 patients with cerebral infarction diagnosed by 20 13 ~ 12 menstrual CT as the research object. There were 23 females and 27 males, aged 40 ~ 75 years. All patients were admitted within 24 hours of onset, and the hospitalization time was 8 ~ 60 days.
1 object
The subjects were 50 patients with cerebral infarction diagnosed by CT and admitted to hospital during 20 13 and 1 ~ 12. There were 23 females and 27 males, aged 40 ~ 75 years. All patients were admitted within 24 hours of onset, and the hospitalization time was 8 ~ 60 days.
Two steps
2. 1 With the continuous updating of contemporary nursing knowledge and the continuous improvement of the accuracy of actual analysis, it provides a more reliable and accurate basis for clinical nursing problems. We know that in order to improve the success rate of rescuing patients and reduce disability, the key to the success of thrombolytic therapy is to shorten the time from onset to thrombolysis in patients with cerebral infarction, and the premise of ensuring the safety of patients is to do a good job in nursing observation of thrombolysis. The best way to help the nervous system establish new connections as soon as possible is to carry out early rehabilitation training. Problems often encountered in nursing care of cerebral infarction mainly include cooperating with doctors to screen CT cases, inputting thrombolytic drugs strictly according to doctor's advice, reducing intracranial pressure and early rehabilitation training.
2.2 in order to find evidence from the research field, according to the questions raised, systematically query the literature. By querying the relevant literature database, the domestic and foreign literatures about the treatment and nursing of cerebral infarction were systematically searched. The results show that at present, the exact method of radical treatment for patients with cerebral infarction has not been found at home and abroad. At present, the most commonly used treatment methods are thrombolytic therapy, light quantum therapy and hemodilution, among which thrombolytic therapy may be the most effective and reliable treatment for acute cerebral infarction. The question of which route is better, intravenous administration or arterial administration, has not been solved. Some people think that arterial administration has advantages over intravenous administration, and some studies show that there is no significant difference between them. Jiang Shoubao believes that rapid infusion of mannitol is required in clinic when mannitol is used to reduce intracranial pressure. Generally, 250 ml of 20% mannitol needs to be infused within 30 minutes, so it is very necessary to establish an effective osmotic gradient. Zhang Yi and others believe that slow infusion of mannitol can not only significantly reduce blood viscosity but also last for a long time, while rapid infusion has poor viscosity reduction effect and short action time. Others believe that acupuncture can improve the elasticity of arteries in the brain and limbs, reduce their tension, dilate blood vessels and increase blood flow, thus promoting the increase of oxygen partial pressure in the brain and limbs, improving the nutrition of brain lesions and their surrounding brain cells and paralyzed limb muscle cells, and accelerating tissue repair. In addition, some people think that after cerebral infarction, the central nervous system not only has certain reorganization ability in structure, but also has certain plasticity in function. Under suitable conditions, neurons can be partially regenerated. Through the rehabilitation training of 80 patients with cerebral infarction and hemiplegia in three general hospitals in Beijing/KLOC-0, the results show that the effects of early rehabilitation and late rehabilitation are completely different.
2.3 After careful evaluation of the above-mentioned scientific evidence, combined with clinical nursing experience, professional knowledge, patients' needs and the actual situation of our department, effective and practical evidence is obtained, and a reasonable nursing plan is formulated. The rigor of scientific research design, the validity of conclusions and the limitations of scientific research in the series of literature on cerebral infarction treatment and nursing are evaluated, and the well-designed scientific research results are recommended to practical application. Combined with clinical nursing experience, professional knowledge, patients' needs and the actual situation in our department, effective and practical evidence recommendation methods are as follows: doctors should do CT for patients as soon as possible after admission, and strive for prime time for thrombolysis; Put the patient in an air-conditioned intensive care unit with appropriate temperature and humidity for monitoring, so as to prevent the patient from being agitated due to external reasons; Establish venous access for the patient as soon as possible, carry out thrombolytic therapy (drop thrombolytic drugs within 30 minutes), and monitor the patient's ECG at the same time; When inputting mannitol, special attention should be paid to patients with hypertension who drip slowly first and then quickly; Accompanied by early acupuncture and functional exercise. After the patient's condition is stable, focus on language, sitting, standing and walking training. After 2 hours of thrombolysis, we should observe whether the patients have any adverse reactions, such as headache, vomiting, slurred speech, elevated blood pressure, slow and heavy pulse, slow and deep breathing, limb movement disorder, etc., and be alert to the possibility of cerebral hemorrhage. Also pay attention to whether there is a backlog of bleeding. Once bleeding is found, stop taking the medicine immediately and control the bleeding.
2.4 Apply the most reliable and well-founded empirical results to the clinic, implement corresponding nursing programs according to the different conditions of patients, and evaluate them on time every day. After 2 days of treatment, there were 1 1 patients who could walk independently, 13 patients who were treated for 7 days, 20 patients who were treated for 14 days and 5 patients who were treated for 30 days. Among them, 1 patient was treated for 60 days and could sit up but could not walk.
3 Conclusion
With the continuous improvement of medical conditions, the requirements for hospital nurses are getting higher and higher. Nurses should have the quality of evidence-based nursing. Nurses should continue to study, read a lot of literature to find evidence, update theoretical knowledge in time, stress on evidence and theory, and correct incorrect clinical measures that have been relying on clinical experience in time, so that patients are more willing to accept the nursing measures taken and improve the implementation of the measures, which not only helps to improve the knowledge level and nursing quality of medical staff, but also helps to find the best treatment methods and reduce the medical expenses of patients.
refer to
[1] Huai Yu Town. Clinical practice of evidence-based nursing in cerebral infarction nursing [J]. Everybody's Health (Academic Edition), 20 13, 22: 266-267.
[2], Zhao,,. Practice of evidence-based nursing in early rehabilitation nursing of patients with cerebral infarction [J]. Qilu Nursing Journal, 2005,05: 440-441.
[3] Mo Yonglan. Clinical practice of evidence-based nursing in cerebral infarction nursing [J]. Selected medical works, 2003,03: 404-405
[4] Li Aiqun, Qu Meiqiong, Pan Xiujuan. Evidence-based nursing of patients with acute cerebral infarction [J]. China Medical Guide, 2008,03: 438-440.
[5] Ji Guifang. Experience of applying evidence-based nursing in coma patients with acute cerebral infarction [J]. China Ethnic and Folk Medicine, 20 10, 15: 2 14.
Wu Shuanghong, Liu Zhijun. Clinical exploration of evidence-based nursing for patients with cerebral infarction [J]. Health Vocational Education, 2006,08:147-148.
Model 2: Clinical nursing experience of patients with cerebral infarction sequelae Objective: To study the clinical effect of psychological nursing on patients with cerebral infarction sequelae. Methods: 23 elderly patients with sequela of cerebral infarction were selected as the research object to explore the clinical nursing effect of patients with sequela of cerebral infarction. Results: After clinical nursing, 23 patients with sequelae of cerebral infarction were cured 15 cases, improved in 7 cases, and died 1 case, with a mortality rate of 4.35%. Conclusion: Early rehabilitation nursing for patients with cerebral infarction and psychological and physical support intervention can greatly improve the rehabilitation effect and reduce the disability rate and mortality rate.
Sequela of cerebral infarction; Clinical nursing; Elderly patients
Clinical data of 1
Taking 23 elderly patients with sequelae of cerebral infarction admitted to our hospital from May 20 13 to February 20 13 as the research object, this paper discusses the clinical nursing experience of patients with sequelae of cerebral infarction. Among the 23 elderly patients with sequelae of cerebral infarction, there were 9 males and 4 females/kloc-0, aged 67-92 years. The longest course of the disease is 1 1 year, and the shortest is 9 months.
2 psychological characteristics
2. 1 frustration and dependence psychology
Cerebral infarction is a common serious disease in the elderly. Cerebral infarction has the characteristics of high disability rate, so the sequelae of cerebral infarction can easily lead to the decline of patients' quality of life, or even their inability to take care of themselves. Therefore, this means that the life of patients with sequelae of cerebral infarction depends on others. At the same time, cerebral infarction has the characteristics of slow recovery, so the sequelae of cerebral infarction can easily lead to frustration in patients.
2.2 Depression
Depression is caused by the emptiness and depression of the surrounding environment. Because the mutation caused by the disease will produce old useless feelings and worry about implicating relatives, it is very common for elderly patients with sequelae of cerebral infarction to have depression. [ 1]
2.3 inferiority complex
In the modern older generation, men are mostly the generation who are responsible for housework and earn money to support their families when they are young. Usually, they all have their own careers. Some cerebral infarction sequelae lead to hemiplegia, others lead to aphasia and even severe paraplegia. Physiological function or limb insufficiency will bring inferiority to patients.
3 nursing methods
3. 1 psychological intervention
For patients with resistance, patients should be aware of the seriousness of not caring after cerebral infarction to cooperate with clinical nursing work; For patients with severe inferiority complex, we should constantly encourage and actively guide them; For patients with severe depression, we should carry out happy treatment, let them pay attention to other interesting things in life besides diseases, and let them relax and treat easily. Due to physical inconvenience, patients can't take care of themselves, and there will definitely be bad psychological States such as anxiety, impatience and loss of confidence in life. Therefore, nurses should strengthen communication with patients, introduce the treatment process and effect in detail, and patiently provide psychological comfort for patients. Help patients do some functional exercises that are conducive to rehabilitation, and enhance their self-confidence and positive attitude towards life. Give patients spiritual comfort, tell them the successful cases of miraculous cure in psychotherapy, let patients understand that their recovery depends not only on drug treatment, help them establish their determination and courage to overcome the disease, and actively cooperate with doctors for treatment.
3.2 Actively establish effective communication channels.
Effective communication between nurses and patients is not only a necessary work in nursing work, but also an important secret to promote patients' rehabilitation. Therefore, actively constructing effective communication channels is the only way to do a good job in nursing and lead to patients' health. The way to establish communication channels should also be based on different patients. For example, aphasia patients may not be able to fully express what they think, so we can communicate with body language or written language. For patients with difficulty in understanding, we should try to avoid using complicated language. The so-called complex language is an academic language with a collection of professional terms, which should be replaced by an easy-to-understand life language. For patients who have difficulty in expression, they should ask questions in alternative ways, that is, whether there is a problem, yes or no, yes or no, yes or no, etc. In addition, in order to reduce patients' sense of loneliness, loss and frustration, appropriate activities suitable for patients with sequelae of cerebral infarction can be arranged. In order to facilitate the communication between nurses and patients, special symbolic memory method can be adopted, that is to say, daily activities, such as eating, taking blood pressure, infusion, urination, etc., can be recorded with special symbols or special languages. [2]
3.3 drug therapy
Patients with sequela of cerebral infarction should be closely observed. Different patients use different drugs, so the nursing methods of drugs are different. For example, intravenous drip of drugs should adopt different drip rates according to the different properties of drugs. Among them, intravenous infusion of vasodilator should be about 30 drops per minute. For another example, drugs that improve microcirculation may cause allergic reactions such as fever. Therefore, nurses should have solid pharmaceutical knowledge, combined with the professional advice of clinical pharmacists, and provide timely and reasonable medication care for patients with sequelae of cerebral infarction.
3.4 Rehabilitation nursing
Life care for patients with sequelae of cerebral infarction is mainly embodied in basic daily life care and diet care. Dietary care is the key, because most patients with cerebral infarction are elderly patients, so a low-salt and low-fat diet is the best choice for patients with cerebral infarction. For elderly patients, pasty liquid food is beneficial to swallowing and digestion. Patients with sequelae of cerebral infarction complicated with diabetes should use sugar-free food. Reasonable control of dietary nutrition, timely supplement of vitamins and calcium. General nursing should reach the standard. In general nursing, we must first ensure the quiet and tidy environment of patients. It is necessary to formulate a standardized ward cleaning system and carry out cleaning work in accordance with rules and regulations. Secondly, it is necessary to ensure the convenience of patients and their families. For example, an appropriate number of handrails and seats should be placed in the ward so that patients can exercise by themselves. Arrange simple and convenient drinking points for patients and their families to use. Third, we must ensure the quality of the ward. Don't put too many beds in a ward to avoid inconvenience to patients and their families. The height of the bed and pillow should be moderate, neither too high nor too low. Wards should be equipped with first-aid drugs. Fourth, ensure the quality of nursing service. All nursing staff should be professional nursing staff with high quality, strong service consciousness and superb nursing level.
Four results
After clinical nursing, 23 patients with cerebral infarction sequelae were cured 15 cases, improved in 7 cases, and died 1 case, with a mortality rate of 4.35%. In addition, psychological intervention nursing has effectively improved patients' psychological state, and patients' bad emotions have been reduced a lot, so they actively cooperate with nursing work. The evaluation results of the scale of daily living showed that after a series of nursing, the effective rate of improving the quality of life of all patients reached 100%.
5 conclusion
As a common sudden disease of the elderly, cerebral infarction has the characteristics of long course, easy recurrence, slow recovery and high mortality. [3] Through the analysis of patients' psychological characteristics, the research shows that early rehabilitation nursing, physical and psychological support and intervention for patients with cerebral infarction, and creating and providing comfortable and harmonious living environment for patients can greatly improve the rehabilitation effect and reduce the disability rate and mortality rate.
refer to
[1] Wang, Li Hong.2341Investigation and analysis of depressive symptoms and influencing factors in elderly patients with chronic diseases at home [J]. China Journal of Nursing, 2009,9 (44): 779-782.
[2] Ji Guifang. Application of evidence-based nursing in coma patients with acute cerebral infarction [J]. China Journal of Ethnic and Folk Medicine, 20 10/0,29 (15):124-125.