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[神经重症患者。护士的护理]

[Neurologically critical patient. Nurses' care].

作者信息

López Díaz Cristina

机构信息

Unidad de Cuidados Intensivos del Hospital, Universitario de Salamanca.

出版信息

Rev Enferm. 2009 Dec;32(12):49-58.

Abstract

Handling a neurologically critical patient requires some necessary knowledge and aptitudes in order to avoid risks and complications which could worsen a patient's prognosis. To that end, in this article the author deals with two important points nursing personnel need to bear in mind: the distinct methods and catheters which can be used to monitor intracranial pressure, obtaining an important parameter for evaluation purposes and therapeutic follow-up on these patients, placing special emphasis on ventricular drainage and nursing care, and the operations nurses take when dealing with patients who present a risk of intracranial hypertension, setting up a protocol based on seven necessities in the Virginia Henderson model: breathing, elimination, temperature, hygiene and skin, feeding and hydration, mobility and safety. In each of these necessities, the author studies the problems these patients present, identifying them with a series of diagnoses according to NANDA (North American Nursing Diagnosis Association), and defining the care or nursing activities for each of them, which will prove essential to prevent cerebral ischemia after suffering a primary cerebral injury due to a "TCE"(Cranial Encephalic Trauma) hemorrhage, etc. Nurses' role in caring for neurologically critical patients proves to be of vital importance since these professionals must be capable of evaluating, preventing, controlling and identifying those risk situations which neurologically critical patients could present, avoiding possible complications, aiding their recuperation, and providing quality health care.

摘要

护理神经重症患者需要一些必要的知识和技能,以避免可能使患者预后恶化的风险和并发症。为此,在本文中,作者阐述了护理人员需要牢记的两个要点:可用于监测颅内压的不同方法和导管,颅内压是评估这些患者并进行治疗随访的重要参数,特别强调脑室引流及护理,以及护士在护理有颅内高压风险的患者时采取的操作,基于弗吉尼亚·亨德森模式中的七项基本需求制定了一个方案:呼吸、排泄、体温、卫生和皮肤护理、进食和补水、活动与安全。在每一项基本需求中,作者研究了这些患者存在的问题,根据北美护理诊断协会(NANDA)的一系列诊断对其进行识别,并为每一个问题确定护理措施或护理活动,这对于预防因“颅脑创伤”(TCE)出血等原发性脑损伤后发生脑缺血至关重要。护士在护理神经重症患者方面的作用至关重要,因为这些专业人员必须能够评估、预防、控制和识别神经重症患者可能出现的风险情况,避免可能的并发症,帮助他们康复,并提供高质量的医疗护理。

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