20 18 new counseling course for nurse qualification examination
20 18 nurse qualification certificate set sail for live training!
Please pay attention to the official WeChat zghsks for nurses' preparation information.
Help patients solve the problems of diet and drinking water.
1. Drink water and choke.
Preventive measures:
(1) When feeding water, be careful not to feed it too fast, a small amount at a time.
⑵ Pay attention to the patient's reaction when feeding water, and turn your head to one side immediately when you find choking water, so as not to enter the respiratory tract by mistake.
(3) For patients with frequent choking cough, the nurse should prompt the doctor to place a gastric tube.
2. Difficulty in swallowing
Preventive measures:
(1) Eat slowly and slowly, and then continue after confirming that the patient has swallowed.
(2) Give the patient food that is easy to swallow.
(3) Sleepy patients must be fully awake when feeding, and they can't leave until there is no food in their mouth after feeding.
(4) Pay attention to communication with patients and closely observe patients' reaction when eating. If you have difficulty swallowing, stop eating immediately and take food from your mouth, and tilt your head to one side.
Problems easy to occur in oxygen inhalation
3. Air pressure injury
Preventive measures:
(1) First adjust the oxygen flow, and then insert the oxygen tube into the patient's nostril.
(2) When changing the oxygen flow, the catheter should be pulled out first, and then inserted after adjustment.
4. Oxygen poisoning
Preventive measures:
(1) Adjust the oxygen flow correctly according to the doctor's advice.
⑵ When inhaling oxygen with large flow, pay attention to the fact that the inhalation time cannot be too long.
(3) Regularly check whether the oxygen flowmeter is accurate.
5. The pipeline falls off
Preventive measures:
⑴ Double-lumen oxygen inhalation tube is adopted to facilitate fixation.
⑵ Always patrol oxygen inhalation patients, and timely block and fix the pipes when they fall off.
⑶ The conscious patient told him not to remove the oxygen tube by himself.
Common problems in oral drug distribution
6. People in the same ward mistakenly cross-distribute medicines.
Preventive measures:
(1) Strictly check for three times and seven times, and call the patient until a promise is made.
⑵ Don't take more than two medicine cups into the ward at a time and give them to patients, but push the medicine cart to the bedside for one-on-one distribution.
(3) Each medicine cup must be covered with the bed number indicated, and no omission is allowed.
(4) Oral drugs should be checked by two people and distributed by one of them.
7. The drug dosage is wrong.
Preventive measures:
(1) Copy the dictation card correctly.
⑵ Carefully check the drugs, and do not make jokes during the inspection, and do not check by yourself.
⑶ Avoid the mindset that individual patients take more or less drugs than the conventional dose, and cannot be distributed according to the conventional dose. (For example, captopril per tablet 12.5mg, and some patients take 6.25mg, so they can't give one tablet as usual. )
(4) When the dosage of certain drugs changes, the on-site nurse should inform everyone in time to attract attention.
5] There are two doses of a drug, so you should find out clearly and know fairly well.
8. Hair loss (mainly because there are no patients)
Preventive measures:
(1) Prepare a card and register the patient's bed number and name when he is away.
(2) Remind each other in class and distribute them in time when patients return to their rooms.
(3) If the class has not been sent, it shall be handed over to the next class strictly.
9. Recurrence (mainly designated drugs)
Preventive measures:
(1) Establish a designated drug distribution register, and fill it in before distributing drugs.
⑵ Fill in the medicine bag before dispensing, and carry the execution card and medicine bag when dispensing.
(3) a clear division of labor, earnestly implement the responsibilities of each class.
10. Drug failure
Preventive measures:
(1) Check the expiration date of the drug before sending.
⑵ Check the tablets for discoloration and deterioration.
(3) Check whether the water and oil agent are turbid, precipitated and discolored.
1 1. Failing to take medicine in time after dispensing.
Preventive measures:
⑴ Explain to patients the importance of taking medicine on time.
2 postpartum urge patients to take medicine on time, and leave after patients take medicine.
⑶ Check whether the patient has taken the medicine before the next medication.
12. Incorrect medication method
Preventive measures:
(1) Explain the pharmacological effects of drugs and the precautions for taking them to patients.
⑵ Nurses should correctly guide patients when distributing medicines, and send medicines to their mouths.
Problems in intramuscular injection
13. Improper injection site
Preventive measures:
(1) Assist patients to adopt correct posture.
⑵ Choose the injection site accurately.
⑶ For emaciated patients, acupuncture should not be too deep.
(4) Children should choose gluteus minimus injection.
14. Injection site bleeding
Preventive measures:
(1) Avoid large blood vessels during injection.
⑵ Whether the blood is sucked back by mistake before injecting the liquid medicine.
⑶ The time for pressing the injection site after injection should not be too short.
(4) The pressing time of patients with poor coagulation function should be prolonged.
15. Injection site induration
Preventive measures:
(1) Avoid the original induration during injection.
(2) If long-term injection is needed, multiple parts should be injected alternately.
⑶ Special drugs should be injected deeply, such as chlorpromazine, oil, iron and magnesium sulfate.
(4) Check the injection site before each injection, and handle any abnormality in time.
5] Hot compress the injection site every day.
16. Injection site infection
Preventive measures:
(1) Strictly implement aseptic technical operation procedures during injection.
⑵ Drugs that are not easily absorbed should be injected deeply to prevent infection caused by malabsorption.
(3) Keep it clean during daily hot compress.
Problems easy to appear in intravenous infusion
17. Liquid mismatch
Drugs and liquids that are easily confused in clinic, such as sugar and salt, potassium chloride and sodium bicarbonate, magnesium sulfate and concentrated sodium chloride, potassium chloride and sodium chloride.
Preventive measures:
(1) adhere to the system of "three BANCHA pairs", that is, the treatment class releases medicine, and the night shift rounds, and the treatment class rounds again.
⑵ Carefully check the names and dosages of drugs and liquids when preparing liquids to avoid subjective impression.
(3) Check carefully before infusion and liquid exchange.
18. Lost transmission
Preventive measures:
(1) Make three checks and seven pairs.
⑵ The liquid in the treatment room should be placed neatly and clearly.
(3) Strictly implement the succession system.
19. Infusion reaction
Preventive measures:
(1) Strictly implement aseptic technical operation procedures.
⑵ Before mixing, check whether the medicine and liquid are out of date, and whether the liquid is turbid and precipitated. Whether there are cracks in the bottle body and whether the bottle mouth is loose.
⑶ The treatment class strictly disinfected the infusion set and replaced it regularly.
(4) Strictly control the liquid preparation time (now).
5] continuous infusion for more than 24 hours must replace the infusion line.
[6] The infusion tube for drainage cannot be placed for a long time.
Once you master the contraindications of drug compatibility.
If there is any transfusion reaction, the liquid and infusion pipeline should be replaced immediately, and the drugs used should be kept for inspection.
20. Phlebitis
Preventive measures:
(1) Understand the degree of irritation of drugs to veins. For drugs with strong irritation, such as sugar, potassium chloride, dopamine, alamin and prostaglandin E 1, slow down the hot compress.
⑵ To know whether the patient has a history of phlebitis and diabetes.
(3) strict disinfection, continuous infusion for more than 24 hours must replace the infusion line.
(4) Observe the puncture point for signs of red pulse, and replace the infusion site in time if there is any abnormality.
2 1. Liquid extravasation
Preventive measures:
(1) Strengthen patrol and find it in time.
⑵ Scalp needle, trocar and central venous catheter should be fixed firmly.
⑶ Fixation should be strengthened for fragile blood vessels.
(4) Patients with poor skin elasticity or edema should be compared with the contralateral limb, and the puncture site should be replaced in time if it becomes thicker.
22. Fluid extravasation leads to tissue necrosis.
Preventive measures:
(1) Drugs that can cause tissue necrosis, such as dopamine, alamin, mannitol, chemotherapy drugs, etc. , should be through the thick vein infusion, puncture success and confirm the needle in the blood vessel before administration.
(2) Strengthen patrol, and regularly check the puncture site for skin whitening and swelling.
(3) Once the liquid is delivered under the skin, it should be handled in time.
23. Improper adjustment of infusion speed
Preventive measures:
(1) After successful puncture, adjust the infusion speed according to the nature of the drug and the patient's age, illness and cardiac function.
⑵ Pay attention to adjusting the dropping speed when changing the liquid.
⑶ The dropping speed of general drugs will be adjusted quickly when they enter the pot, and attention should be paid to adjusting the dropping speed to the required range after entering the pot.
(4) Strengthen patrol and tell patients not to adjust the dropping speed by themselves.
24. Wrong liquid was lost (changed)
Preventive measures:
(1) Seriously master the treatment contents of patients under your control, and be aware of them.
(2) Strictly implement the system of three checks and seven pairs.
⑶ Take the initiative to educate patients before blood transfusion.
(4) Patients should carefully check and answer questions about liquids.
25. Venous air embolism
Preventive measures:
(1) Before infusion, carefully check whether the infusion tube is successfully vented and whether there are bubbles in the tube.
(2) Strengthen patrol to prevent liquid from losing air.
(3) When changing the liquid, if the liquid is transported to the lower part of Murphy's dropper, it must be ventilated again to prevent the upper part from being ignored.
(4) When using the tee, the connection is tight.
5] Patients with indwelling central venous catheter should pay attention to prevent air from entering when replacing the pipeline.
[6] In the process of infusion, when drugs are injected intravenously, they should be pumped back before injection to prevent air from entering blood vessels.
(7) When the patient is active, tell him not to tilt or invert Murphy's dropper excessively.
26. The infusion tube is blocked.
Preventive measures:
(1) Strengthen patrol to prevent liquid dripping caused by pressure discount of infusion tube.
⑵ Put an end to needle blockage caused by blood clots when the liquid is empty and not replaced in time.
(3) Once the tube is blocked, the needle should be pulled out to replace the infusion part, and the infusion tube should not be squeezed to prevent the blood clot from falling off and causing serious consequences.
27. Improper vein selection
Preventive measures:
⑴ For patients undergoing long-term infusion, attention should be paid to the rational choice of veins, and the principle from distal to proximal should be followed.
⑵ thicker veins should be selected when importing irritant drugs.
⑶ When inputting intravenous high nutrient solution, the central vein should be selected.
(4) After radical mastectomy, it is forbidden to give blood transfusion to the affected limb to prevent edema caused by poor reflux.