美国医师协会压疮指南精编PPT课件.pptVIP

* Important: The aggressive management to stabilize comorbid conditions –where feasible-- may promote healing.重要的：强有力的管理让病人身体状态变的稳定,这样能够促进康复。 For adequate hydration: Adjust fluid intake to try to achieve a urinary output of approximately 50mL/hr or more, if possible. Assess for conditions that affect fluid and electrolyte imbalance. Check BMP if indicated to gauge fluid and electrolyte balance. It may be necessary to temporarily reduce or discontinue medications that cause excess fluid loss or cause anorexia. 恰当的补充水分：如果可能的话要通过补充液体让病人的排出尿量保持在50mL/hr以上。评估影响病人液体电解质平衡的因素。如果液体电解质平衡,就要检查病人的BMP指数。对于引起过多液体丢失或者厌食的药物要暂时减少或者停止使用。 For optimal nutrition: Get the patient to eat a reasonable diet. Loosen unnecessary diet restrictions. In most cases, food intake will provide enough calories and vitamins. Try to at least maintain stable weight. Consider calorie, protein or vitamin supplementation if dietary intake cannot readily be adjusted – but don’t automatically supplement everyone. 最佳的营养：给病人吃适当的食物.减少不必要饮食的限制。对于大多数病人，事物的摄入就能够提供足够的热量和维生素，尽量保持稳定的体重。如果日常饮食在热量，蛋白质或维生素方面不能满足病人身体需要才额外提供营养补充，请不要机械的为每一个病人补充营养。 * Let’s review the nutritional interventions in each level:回顾各阶段的营养干预： Level 1 第一阶段 -Review advance directives or obtain relevant care instructions.查看病人先前的医嘱或获得有关的护理指南。 -Assess possible functional reasons for reduced intake (e.g., cognitive deficits, apraxia, weakness, or dysphagia).评估导致摄入不足的功能性原因（例如，认知能力不足，意识不清，虚弱或咽下困难） -Do calorie count and reassess dietary prescription.进行热量计算以及再次评估饮食的处方。 -Remove all non-essential dietary restrictions and encourage oral intake as appropriate, or reassess tube feeding.解除不必要的饮食限制以及鼓励病人尽量的经口腔进食，或再次评估导管进食量。 -Review drug regimen for medications that may be affecting appetite or causing weight loss.检查一些可能引起食欲下降或引起体重减轻的附加药物。 -Review for common medical causes of weight loss (depression, occult infection, COPD, thyroid function, congestive heart failure)检查可能引起体重下降的病理因素（抑郁，高烧感染，慢性阻塞性肺病，甲状腺的功能异常，充血性心力衰竭） Level 2 (if Level 1 not adequate) 第二阶段（如果第一阶段