护理学基础_临终护理.ppt

;;;临终护理;;临终关怀 又称善终服务、安宁照顾、安息所等 ;临终关怀; Mrs H walks primarily with a walker(轮椅) and is dyspneic(呼吸困难的) with minimal exertion (稍有运动）. She leaves her apartment rarely, and always with assistance. She is able to bathe, clothe, and toilet herself independently but requires assistance with meal preparation and othe instrumental activities of daily living . Her mobility is severely limited by arthritic joints and she has difficulty with balance. She has fallen several times, requiring hospitalization for minor injuries on numerous occasions. ; MrsH has had insulin-dependent diabetes （胰岛素依赖型糖尿病）since the 1980s. She experienced a myocardial infarction（心肌梗死） in 1996 and subsequently underwent placement of a stent（支架）. Following multiple percutaneous coronary interventions,（经皮冠状动脉介入治疗） intermittent episodes of atrial fibrillation（心房颤动）, and implantation of a biventricular/ implantable cardioverter-defibrillator (除颤器) cardiac pacemaker（心脏起搏器）, she has severe coronary heart disease（冠心病）, with a left ventricular ejection fraction （左心室射血分数）of 15%. ; On recent physical examination, Mrs H looked quite well but was pale（苍白）. Her blood pressure was 110/70 mm Hg, heart rate was 50/min , and respiratory rate（呼吸率） was 16/min. 正常呼吸频率：16~20次/min。呼吸过缓：少于12次/min。呼吸过速：大于24次/min Recent laboratory findings included creatinine levels (肌酸酐)ranging from 1.2 to 2.4 mg/dL 血清肌酸酐：正常值:男0.7-1.5 mg/dl， 女0.5-1.2 mg/dl。肌酸酐的排泄反应肾小球的率过滤，反应肾脏的功能，肌酸酐上升越高，肾功能越不好。 And serum urea nitrogen levels（血清尿素氮） ranging from 27 to 63 mg/dL，and she has not had proteinuria（蛋白尿）. 血中尿素氮：正常值:7-20 mg/dl，反映肾功能状况不佳。 ; ; ; ;胰岛素依赖型糖尿病的护理; ;冠心病的含义;冠心病的典型症状;冠心病的治疗;冠心病的预防; ;临终患者生理变化和护理 ; ;临终患者的心理历程及护理;患者当得知自己病重即将面临死亡，其心理反应是“不，这不会是我”或“不可能”。 患者可能会采取复查、转院等方式试图证实诊断是错误的。 这些???应是一种防卫机制，否认是为了暂时逃避现实的压力。 ;?;;Mrs H 的心理护理; ;临终患者家属的反应主要表现为失落与悲哀 在他们感觉到自己的亲人即将离去时，他们也可能出现和患者相似的心理反应过程。 他们在感情上难以接受即将失去亲人的现实，在行动上四处求医，以求奇迹出现。 当看到亲人死亡不可避免说，他们心情十分沉重、苦恼和烦躁不安。 ;;;抢答题; ;谢谢观看