混合痔中医护理查房课件.ppt.ppt

1、With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society混 合 痔 中 医 护 理 查 房十二病区卓 悦With the improving quality of life as well as the ever-accelerating pace of life, the quality of peo

2、ples food needs and rate also changing.In order to meet the needs of society查 房 目 标With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society查 房 目 标With the improving quality of life

3、 as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society查 房 流 程一、病 例 介 绍二、存在的护理问题三、 知 识 链 接四、 查 房 小 结With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food nee

4、ds and rate also changing.In order to meet the needs of society病姓名：叶笑琴姓名：叶笑琴性别：女性性别：女性年龄：年龄：42岁岁费用类别：农保费用类别：农保住院号：住院号：63206入院时间：入院时间：2014-10-13 09 ：例 介 绍婚姻：已婚婚姻：已婚民族：汉族民族：汉族职业：农民职业：农民文化程度：初中文化程度：初中26步行入院步行入院With the improving quality of life as well as the ever-accelerating pace of life, the quality

5、 of peoples food needs and rate also changing.In order to meet the needs of society病 例 介 绍入院诊断：入院诊断：中医：混合痔中医：混合痔气滞血瘀证气滞血瘀证西医：西医：1、混合痔、混合痔2、高血压、高血压主诉：反复肛门口肿物脱出主诉：反复肛门口肿物脱出3年。年。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate

6、also changing.In order to meet the needs of society病 例 介 绍患者患者3年前排便时感肛门口有肿物脱出，质软，排便后肿块自行回年前排便时感肛门口有肿物脱出，质软，排便后肿块自行回纳消失。纳消失。3年来患者感肛门口肿物反复出现且进行性增大、增多均未正年来患者感肛门口肿物反复出现且进行性增大、增多均未正规治疗。今来我院求诊。规治疗。今来我院求诊。入院查体：入院查体：T 36.5，R 19次次/分，分，BP 134/88mmHg，P 80次次/分。神分。神志清，精神欠佳，步行入院，呼吸平稳，听诊无殊。腹平软，无压痛。志清，精神欠佳，步行入院，呼吸平

7、稳，听诊无殊。腹平软，无压痛。肛门口可见花瓣样肿物脱出，水肿明显，脱出肿块触痛明显，部分脱肛门口可见花瓣样肿物脱出，水肿明显，脱出肿块触痛明显，部分脱出粘膜破损，有新鲜渗血，无脓性液渗出。出粘膜破损，有新鲜渗血，无脓性液渗出。肛门镜检查：肛门镜检查：肛门外可见肛门外可见痔核脱出，稍水肿，齿状线上粘膜充血水肿明显。痔核脱出，稍水肿，齿状线上粘膜充血水肿明显。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and r

8、ate also changing.In order to meet the needs of society病 例 介 绍既往史：高血压病史既往史：高血压病史7年，长期口服药物治疗，现血压控年，长期口服药物治疗，现血压控制良好。制良好。个人史：长期居住丽水，无其他不良嗜好。一子一女，配个人史：长期居住丽水，无其他不良嗜好。一子一女，配偶体健。偶体健。家族史：无家族史：无过敏史：无过敏史：无With the improving quality of life as well as the ever-accelerating pace of life, the quality of people

9、s food needs and rate also changing.In order to meet the needs of society中 医 护 理 评 估BP134/88mmHg，SPO2 98%, 疼痛评分疼痛评分2分。分。生命体征：生命体征：T:36.5，P：80次次/分，分，R：20次次/分，分，1、望诊、望诊: 表情平和，面色红润，舌质红，苔白腻。表情平和，面色红润，舌质红，苔白腻。2、闻诊：心肺听诊无殊、闻诊：心肺听诊无殊3、问诊：、问诊： 寒热：无寒热：无汗：正常汗：正常头：无外伤，无头痛头：无外伤，无头痛身：无活动不利身：无活动不利二便：大便干硬，小便不畅。二便：大

10、便干硬，小便不畅。饮食：纳食香甜饮食：纳食香甜听力视力：正常听力视力：正常旧病：高血压旧病：高血压With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society中 医 护 理 评 估此次病因：无诱因此次病因：无诱因服药：无服药：无月经：规律，无不规则阴道流血月经：规律，无不规则阴道流血睡眠：夜寐不酣睡眠：夜寐

11、不酣嗜好：无特殊嗜好：无特殊4、切诊：脉弦细，腹平软，腹皖无压痛、切诊：脉弦细，腹平软，腹皖无压痛With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society中 医 辨 证 分 析患者以患者以“反复肛门口肿物脱出反复肛门口肿物脱出 3年年”为主诉，结合查体，辨为主诉，结合查体，辨证当属中医证当属中医“混合痔

12、混合痔”范畴，根据舌、脉表现，证属气滞血瘀范畴，根据舌、脉表现，证属气滞血瘀证。患者因饮食不节、过食辛辣醇酒厚味，燥热内生，下近大证。患者因饮食不节、过食辛辣醇酒厚味，燥热内生，下近大肠，以及便秘努责，致血行不畅，血液淤积，热与血相搏，气肠，以及便秘努责，致血行不畅，血液淤积，热与血相搏，气血纵横，筋脉交错，结滞不散而成。血纵横，筋脉交错，结滞不散而成。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and ra

13、te also changing.In order to meet the needs of society治疗经过? 因患者夜眠不酣，入院后予神门、心、枕耳穴压豆，以益因患者夜眠不酣，入院后予神门、心、枕耳穴压豆，以益气安神，调节睡眠。气安神，调节睡眠。? 术前晚给予白术、炒枳实、番泻叶、火麻仁等中药方剂灌术前晚给予白术、炒枳实、番泻叶、火麻仁等中药方剂灌肠，以润肠通便，减轻肠道压力。肠，以润肠通便，减轻肠道压力。? 于于2015年年10月月15日在腰硬联合麻醉下行混合痔肛垫悬吊日在腰硬联合麻醉下行混合痔肛垫悬吊术，术后诊断：术，术后诊断：1、混合痔疮；、混合痔疮；2、高血压病。术后患者生、

14、高血压病。术后患者生命体征平稳，手术创口无明显渗血，疼痛评分约命体征平稳，手术创口无明显渗血，疼痛评分约3分，术分，术后小便能自解。后小便能自解。? 术后用药：予头孢唑啉针、替硝唑针抗感染，七叶皂苷钠术后用药：予头孢唑啉针、替硝唑针抗感染，七叶皂苷钠消肿及补液对症治疗，并配合血府逐瘀汤合桃红四物汤活消肿及补液对症治疗，并配合血府逐瘀汤合桃红四物汤活血化瘀、行气止痛。血化瘀、行气止痛。? 术后为防止患者大便干结，取木香、佛手、厚朴等中药贴术后为防止患者大便干结，取木香、佛手、厚朴等中药贴敷于双侧足三里穴，以达理气通便之功。敷于双侧足三里穴，以达理气通便之功。With the improving

15、quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society现状患者神志清，精神较前稍振，呼吸调匀，无患者神志清，精神较前稍振，呼吸调匀，无畏寒发热，肛门处创口无渗血渗液，未见痔核脱畏寒发热，肛门处创口无渗血渗液，未见痔核脱出，排便后创口疼痛轻。胃纳尚佳，大便软，无出，排便后创口疼痛轻。胃纳尚佳，大便软，无便血，小便无殊。舌淡，苔白，脉细。因患

16、者要便血，小便无殊。舌淡，苔白，脉细。因患者要求出院，经何建胜主任查看后认为患者术后平稳，求出院，经何建胜主任查看后认为患者术后平稳，于于2014年年10月月18日办理出院。日办理出院。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society查 房 流 程一、病 例 介 绍二、存在的护理问题三、 知 识

17、 链 接四、 查 房 小 结With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society存 在 的 护 理 问 题一、疼痛一、疼痛术前与肛内肿物脱出、肛缘水肿有关；术后与创术前与肛内肿物脱出、肛缘水肿有关；术后与创口疼痛有关。口疼痛有关。1、观察疼痛的部位、性质、强度、伴随症状和持续时间。、观察疼痛的部位、

18、性质、强度、伴随症状和持续时间。2、协助患者取舒适卧位。、协助患者取舒适卧位。3、指导患者采取放松疗法，如缓慢深呼吸、全身肌肉放松、听舒缓的、指导患者采取放松疗法，如缓慢深呼吸、全身肌肉放松、听舒缓的音乐。音乐。4、遵医嘱给予口服或注射止痛药。、遵医嘱给予口服或注射止痛药。5、取足三里、承山穴位按摩。、取足三里、承山穴位按摩。6、取肛门、直肠、神门等耳穴贴压。、取肛门、直肠、神门等耳穴贴压。With the improving quality of life as well as the ever-accelerating pace of life, the quality of people

19、s food needs and rate also changing.In order to meet the needs of society存 在 的 护 理 问 题二、知识缺乏二、知识缺乏 缺乏本病的防治知识缺乏本病的防治知识1、疾病指导：向患者介绍本病的病因、症状、预防，自我护理、疾病指导：向患者介绍本病的病因、症状、预防，自我护理方法。方法。2、饮食有规律，宜清淡，避免辛辣刺激之物，纠正偏食习惯，、饮食有规律，宜清淡，避免辛辣刺激之物，纠正偏食习惯，达到均衡饮食，保持大便通畅。达到均衡饮食，保持大便通畅。3、用药指导：指导患者按医嘱正确用药，告知药物的作用及相、用药指导：指导患者按

20、医嘱正确用药，告知药物的作用及相关注意事项。关注意事项。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society存 在 的 护 理 问 题三、焦虑三、焦虑与患者对手术的恐惧紧张有关与患者对手术的恐惧紧张有关术前耐心向患者讲解手术的必要性，术中的配合及术术前耐心向患者讲解手术的必要性，术中的配合及术后的不

21、适等情况，以消除患者的紧张恐惧心理，使患者对后的不适等情况，以消除患者的紧张恐惧心理，使患者对疼痛有正确认识，调整心态，积极配合治疗。疼痛有正确认识，调整心态，积极配合治疗。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society存 在 的 护 理 问 题四、潜在的并发症：出血四、潜在的并发症：出血 1

22、、术后不要太早下床活动，、术后不要太早下床活动，24小时内严密监测生命体征变化，并观小时内严密监测生命体征变化，并观察创口敷料是否完整清洁。如患者出现面色苍白，头晕出汗，脉搏细察创口敷料是否完整清洁。如患者出现面色苍白，头晕出汗，脉搏细数，血压下降等情况及时报告医师。数，血压下降等情况及时报告医师。2、术后一周内指导患者避免剧烈活动。、术后一周内指导患者避免剧烈活动。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs

23、 and rate also changing.In order to meet the needs of society查 房 流 程一、病 例 介 绍二、存在的护理问题三、 知 识 链 接四、 查 房 小 结With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society什 么 是 混 合 痔？混合痔，中医

24、病名，以发生于肛门同一方位齿线上下，静脉曲张形混合痔，中医病名，以发生于肛门同一方位齿线上下，静脉曲张形成团块，内外相连、无明显分界为主要表现的痔病类疾病。临床表现为成团块，内外相连、无明显分界为主要表现的痔病类疾病。临床表现为便血及肛门部肿物，可有肛门坠胀、异物感或疼痛，可伴有局部分泌物便血及肛门部肿物，可有肛门坠胀、异物感或疼痛，可伴有局部分泌物或瘙痒。与西医病名相同。本病若早期治疗，一般预后良好。但也有部或瘙痒。与西医病名相同。本病若早期治疗，一般预后良好。但也有部分患者，病程中伴发贫血等并发症。本病多由脏腑本虚，静脉壁薄弱，分患者，病程中伴发贫血等并发症。本病多由脏腑本虚，静脉壁薄弱，

25、兼因久坐，负重远行，或长期便秘，或泻痢日久，或临厕久蹲努责，或兼因久坐，负重远行，或长期便秘，或泻痢日久，或临厕久蹲努责，或饮食不节，过食辛辣肥甘之晶，导致脏腑功能失调，风燥湿热下迫，气饮食不节，过食辛辣肥甘之晶，导致脏腑功能失调，风燥湿热下迫，气血瘀滞不行，阻于魄门，结而不散，筋脉横解面生痔。或因气血亏虚，血瘀滞不行，阻于魄门，结而不散，筋脉横解面生痔。或因气血亏虚，摄纳无力，气虚下陷，则痔核脱出。摄纳无力，气虚下陷，则痔核脱出。With the improving quality of life as well as the ever-accelerating pace of life,

26、the quality of peoples food needs and rate also changing.In order to meet the needs of society混 合 痔 的 分 型1 1、风伤肠络证：、风伤肠络证：大便带血，滴血或喷射状出血，血色鲜红，大便秘大便带血，滴血或喷射状出血，血色鲜红，大便秘结或有肛门瘙痒。舌质红，苔薄黄。结或有肛门瘙痒。舌质红，苔薄黄。2 2、湿热下注证：、湿热下注证：便血色鲜，量较多，肛内肿物外脱，可自行回纳，便血色鲜，量较多，肛内肿物外脱，可自行回纳，肛门灼热，重坠不适。舌质红，苔黄腻。肛门灼热，重坠不适。舌质红，苔黄腻。3 3、气

27、滞血瘀证：、气滞血瘀证：肛内肿物脱出，甚或嵌顿，肛门紧缩，坠胀疼痛，肛内肿物脱出，甚或嵌顿，肛门紧缩，坠胀疼痛，甚则内有血栓形成，肛缘水肿，触痛明显。舌质暗紫，苔白。甚则内有血栓形成，肛缘水肿，触痛明显。舌质暗紫，苔白。4 4、脾虚气陷证：、脾虚气陷证：肛门松弛，似有便意，内痔脱出不能自行回纳，需肛门松弛，似有便意，内痔脱出不能自行回纳，需用手法回纳。便血色鲜或淡，伴头晕、气短、面色少华，神疲自汗、用手法回纳。便血色鲜或淡，伴头晕、气短、面色少华，神疲自汗、纳少、便溏等。舌淡，苔薄白。纳少、便溏等。舌淡，苔薄白。With the improving quality of life as wel

28、l as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society治疗原则本病主要以手术治疗为主。本病主要以手术治疗为主。1 1、风伤肠络证、风伤肠络证治法：清热凉血祛风治法：清热凉血祛风代表方：凉血地黄汤。代表方：凉血地黄汤。常用药：生地养阴润燥，赤芍、归尾活血凉血常用药：生地养阴润燥，赤芍、归尾活血凉血; ;地榆、槐花地榆、槐花凉血止血凉血止血; ;升麻升提解毒以散瘀热升麻升提解毒以散瘀热

29、; ;黄芩、黄连燥湿清热解黄芩、黄连燥湿清热解毒毒; ;花粉生津泻火花粉生津泻火; ;枳壳行气导滞枳壳行气导滞; ;荆芥疏风活血止血，共同荆芥疏风活血止血，共同起到清热凉血止血，润燥疏风之作用，故对痔疮诸疾有较起到清热凉血止血，润燥疏风之作用，故对痔疮诸疾有较好疗效。好疗效。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the ne

30、eds of society治疗原则2.2.湿热下注证湿热下注证治法：清热渗湿之血治法：清热渗湿之血方药：脏连丸方药：脏连丸常用药：黄连、黄芩、猪大肠清利大肠实常用药：黄连、黄芩、猪大肠清利大肠实 ( (湿湿) )热热; ;槐槐角、地榆清肠热而止血角、地榆清肠热而止血 ; ;荆芥、防风疏风止血荆芥、防风疏风止血 ; ;当归、当归、阿胶养血止血阿胶养血止血 ; ;生地、赤芍清热凉血。诸药合用，清生地、赤芍清热凉血。诸药合用，清湿热，止便血。湿热，止便血。With the improving quality of life as well as the ever-accelerating pace

31、 of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society治疗原则3 3、 脾虚气陷证脾虚气陷证治法：健脾益气治法：健脾益气方药：补中益气汤。方药：补中益气汤。常用药：黄芪，补中益气、升阳固表，配伍人参、炙甘草、常用药：黄芪，补中益气、升阳固表，配伍人参、炙甘草、白术补气健脾，当归和营养血，陈皮理气和胃，炙甘草调白术补气健脾，当归和营养血，陈皮理气和胃，炙甘草调和诸药。诸药合用，使气虚者补气，气陷者升提，气虚者和诸药。诸药合用，使气虚者补气，气陷

32、者升提，气虚者发热，得此甘温益气而除之，元气内充，清阳得升，诸症发热，得此甘温益气而除之，元气内充，清阳得升，诸症自愈。自愈。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society治疗原则4 4、气滞血瘀证、气滞血瘀证治法：清热利湿，祛风活血治法：清热利湿，祛风活血方药：止痛如神汤。方药：止痛如神汤。

33、常用药：秦艽祛风利湿止痛为君药常用药：秦艽祛风利湿止痛为君药; ;伍以桃仁、当归、槟榔伍以桃仁、当归、槟榔理气活血，化瘀止痛，使滞者行，瘀者化，通则不痛理气活血，化瘀止痛，使滞者行，瘀者化，通则不痛; ;苍术苍术、黄柏、防风祛肠风，运水湿、黄柏、防风祛肠风，运水湿; ;大黄清热解毒，逐瘀通络，大黄清热解毒，逐瘀通络，荡涤肠腑实热荡涤肠腑实热; ;泽泻利水通淋止痛，泽泻配槟榔亦可行气利泽泻利水通淋止痛，泽泻配槟榔亦可行气利水消肿，诸药相配，共奏祛风利湿，理气活血，清热之痛水消肿，诸药相配，共奏祛风利湿，理气活血，清热之痛之功。之功。With the improving quality of li

34、fe as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society健 康 指 导（一）生活起居（一）生活起居1、保持肛门及会阴部清洁，指导患者每日便后及每晚温水清洗。、保持肛门及会阴部清洁，指导患者每日便后及每晚温水清洗。2、避免肛门局部刺激，便纸宜柔软，不穿紧身裤及粗糙内裤。、避免肛门局部刺激，便纸宜柔软，不穿紧身裤及粗糙内裤。3、指导患者养成定时排便的习惯，便秘时指导患者

35、绕脐周顺时针、指导患者养成定时排便的习惯，便秘时指导患者绕脐周顺时针按摩腹部，每日按摩腹部，每日3次，每次次，每次20-30圈。圈。4、指导患者避免增加腹压，避免用力排便、咳嗽、久站、久蹲等。、指导患者避免增加腹压，避免用力排便、咳嗽、久站、久蹲等。5、指导患者进行提肛运动。运动方法：深吸气时收缩并提肛门，、指导患者进行提肛运动。运动方法：深吸气时收缩并提肛门，呼气时将肛门缓慢放松，一收一放为呼气时将肛门缓慢放松，一收一放为1次；每日晨起及睡前各做一次；每日晨起及睡前各做一遍，每遍做遍，每遍做20-30次。次。With the improving quality of life as well

36、 as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society健 康 指 导（二）饮食指导（二）饮食指导1、风伤肠络证：宜食清热凉血的食品，如绿豆、苦瓜、芹菜、马、风伤肠络证：宜食清热凉血的食品，如绿豆、苦瓜、芹菜、马蹄等。蹄等。2、湿热下注证：宜食清热利湿的食品，如菜花、赤小豆、绿豆、湿热下注证：宜食清热利湿的食品，如菜花、赤小豆、绿豆、薏苡仁、小米等。薏苡仁、小米等。3、气滞血瘀证：宜食

37、理气活血的食品，如山楂、木耳、桃仁、番、气滞血瘀证：宜食理气活血的食品，如山楂、木耳、桃仁、番茄、黑米等。茄、黑米等。4、脾虚气陷证：宜食益气活血的食品，如茯苓、山药、薏苡仁、脾虚气陷证：宜食益气活血的食品，如茯苓、山药、薏苡仁、鸡肉等。鸡肉等。With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society健

38、 康 指 导5、便血者，进软食、多饮水，多食蔬菜水果及补血之品，忌、便血者，进软食、多饮水，多食蔬菜水果及补血之品，忌粗糙、坚硬食品。粗糙、坚硬食品。6、忌食辛辣刺激肥甘之物，术后初期避免进食产气食品。、忌食辛辣刺激肥甘之物，术后初期避免进食产气食品。（三）情志调理（三）情志调理1、指导患者保持心情舒畅，避免烦躁、恐惧等不良情绪。、指导患者保持心情舒畅，避免烦躁、恐惧等不良情绪。2、多与患者沟通，了解其心理状态，及时予以心理疏导。、多与患者沟通，了解其心理状态，及时予以心理疏导。With the improving quality of life as well as the ever-acc

39、elerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society查 房 流 程一、病 例 介 绍二、存在的护理问题三、 知 识 链 接四、 查 房 小 结With the improving quality of life as well as the ever-accelerating pace of life, the quality of peoples food needs and rate also changing.In order to meet the needs of society谢 谢 聆 听 ！