倫教醫(yī)院心力衰竭患者隨訪資料試題

倫教醫(yī)院心力衰竭患者隨訪資料[復(fù)制]僅用于心內(nèi)科對慢性心力衰竭患者出院隨訪及用藥，護(hù)理指導(dǎo)。一、基本信息1.住院號[填空題]_________________________________2.姓名[填空題]_________________________________3.性別[單選題]*○男○女4.年齡[填空題]_________________________________5.門診隨訪日期[填空題]_________________________________6.聯(lián)系方式[填空題]_________________________________7.出院日期[填空題]_________________________________二、目前藥物治療情況8.利尿劑[單選題]*○呋塞米○托拉塞米○布美他尼○氫氯噻嗪○托伐普坦9.單次劑量[填空題]_________________________________10.用藥頻率[單選題]*○一次○兩次○三次○四次11.ACEI/ARB/ARNI[單選題]*○卡托普利○依那普利○貝哪普利○福辛普利○雷米普利○坎地沙坦○纈沙坦○氯沙坦○厄貝沙坦○諾欣妥12.單次劑量[填空題]_________________________________13.用藥頻率[單選題]*○一次○兩次○三次○四次14.b受體阻滯劑[單選題]*○美托洛爾○比索洛爾○卡維地洛15.單次劑量[填空題]_________________________________16.用藥頻率[單選題]*○一次○兩次○三次○四次17.螺內(nèi)酯[單選題]*○是○否18.單次劑量[填空題]_________________________________19.用藥頻率[單選題]*○一次○兩次20.抗血小板藥物[多選題]*□阿司匹林□氯吡格雷□替格瑞洛21.每次劑量[填空題]_________________________________22.每日次數(shù)[單選題]*○一次○兩次23.降壓藥[單選題]*○非洛地平○氨氯地平○硝苯地平○左旋氨氯地平24.每次劑量[填空題]_________________________________25.每日次數(shù)[單選題]*○一次○兩次○三次26.降脂藥[單選題]*○辛伐他汀○普伐他汀○阿托伐他汀○瑞書法他汀○非諾貝特27.每次劑量[填空題]_________________________________28.每日次數(shù)[單選題]*○一次○兩次29.降糖藥[單選題]*○磺脲類○促胰島素分泌劑○a糖苷酶抑制劑○雙胍類○胰島素增敏劑○胰島素30.抗凝藥[單選題]*○華法林○利伐他班○達(dá)比加群31.每次劑量[填空題]_________________________________32.每日次數(shù)[單選題]*○一次○兩次33.其他藥物[單選題]*○胺碘酮○輔酶Q10○芪藶強(qiáng)心膠囊○麝香保心丸三、本次來院情況1.生命體征及心衰體征34.心率[填空題]_________________________________35.血壓[填空題]_________________________________36.體重[填空題]_________________________________37.心衰癥狀[多選題]*□胸悶□氣短□夜間陣發(fā)性呼吸困難□水腫□腹脹□乏力/疲乏38.心衰體征[多選題]*□頸靜脈怒張□肺啰音□肝腫大□下肢水腫□全身水腫□胸腔積液□腹腔積液□平臥位□半臥位□坐位2.心衰分級分期39.心衰D期[單選題]*○是○否40.NYHA分級[單選題]*○1級○2級○3級○4級41.心衰分類[單選題]*○左心衰○右心衰○全心衰○未知六分鐘步行試驗結(jié)果42.米數(shù)[填空題]_________________________________43.步數(shù)[填空題]_________________________________44.最大心率[填空題]_________________________________45.Borg勞累分級[填空題]_________________________________46.Borg呼吸困難分級[填空題]_________________________________3.問卷量表47.健康問卷（PHQ-9）[填空題]_________________________________48.廣泛性焦慮自評量表（GAD-7）[填空題]_________________________________49.健康狀況SF-36[填空題]_________________________________50.房顫栓塞CHA2DS2評分[填空題]_________________________________51.房顫出血HAS-BLED評分[填空題]_________________________________四、門診檢查檢驗結(jié)果52.心電圖結(jié)果[多選題]*□竇性心律□房顫□房撲□完右□完左□前壁病理性Q波53.心電圖QRS間期[填空題]_________________________________54.胸片[多選題]*□正?！醴嗡[□胸腔積液□肺氣腫□肺間質(zhì)改變血常規(guī)結(jié)果55.白細(xì)胞總數(shù)[填空題]_________________________________56.紅細(xì)胞比積[填空題]_________________________________57.血紅蛋白[填空題]_________________________________生化結(jié)果58.AST[填空題]_________________________________59.ALT[填空題]_________________________________60.總膽紅素[填空題]_________________________________61.直接膽紅素[填空題]_________________________________62.白蛋白[填空題]_________________________________63.CREA[填空題]_________________________________64.BUN[填空題]_________________________________65.UA[填空題]_________________________________66.K[填空題]_________________________________67.Na[填空題]_________________________________68.CL[填空題]_________________________________69.空腹血糖[填空題]_________________________________70.糖化血紅蛋白[填空題]_________________________________71.甘油三酯[填空題]_________________________________72.總膽固醇[填空題]_________________________________73.低密度膽固醇[填空題]_________________________________74.高密度膽固醇[填空題]_________________________________75.D二聚體[填空題]_________________________________76.肌鈣蛋白[填空題]_________________________________77.NT-proBNP[填空題]_________________________________心臟彩超結(jié)果78.左心房前后徑[填空題]_________________________________79.左室舒張末內(nèi)徑[填空題]_________________________________80.室間隔厚度[填空題]_________________________________81.射血分?jǐn)?shù)[填空題]_________________________________82.左室舒張末容積[填空題]_________________________________83.左室收縮末容積[填空題]_________________________________84.右心室前后徑[填空題]_________________________________85.肺動脈壓[填空題]_________________________________86.二尖瓣狹窄[單選題]*○輕度○中度○中重度○重度87.二尖瓣返流/關(guān)閉不全[單選題]*○輕度○中度○中重度○重度88.主動脈狹窄[單選題]*○輕度○中度○中重度○重度89.主動脈返流/關(guān)閉不全[單選題]*○輕度○中度○中重度○重度90.三尖瓣狹窄[單選題]*○輕度○中度○中重度○重度91.三尖瓣返流/關(guān)閉不全[單選題]*○輕度○中度○中重度○重度92.肺動脈狹窄[單選題]*○輕度○中度○中重度○重度93.肺動脈返流/關(guān)閉不全[單選題]*○輕度○中度○中重度○重度94.室壁運(yùn)動異常[單選題]*○無○階段性運(yùn)動異?！饛浡赃\(yùn)動異?！鹗冶诹鲂纬?5.心包積液[單選題]*○無○微量○少量○中量○中大量○大量四、心力衰竭病因診斷及誘因96.主要心衰病因[單選題]*○冠心病○心肌病○瓣膜病○先心病○感染性心內(nèi)膜炎○肺動脈高壓○心律失?！鸶哐獕骸鸺谞钕偌膊　鸱嗡ㄈ鸷粑邥和＞C合征97.次要心衰病因[多選題]*□冠心病□心肌病□瓣膜病□先心病□感染性心內(nèi)膜炎□肺動脈高壓□心律失?！醺哐獕骸跫谞钕偌膊　醴嗡ㄈ跛吆粑鼤和＞C合征98.冠心病診斷[多選題]*□冠脈造型/CTA.是□冠脈造影/CTA.否□血運(yùn)重建是□血運(yùn)重建否□PCI□CABG99.心肌病[多選題]*□擴(kuò)張性心肌病□肥厚性梗阻性心肌病□肥厚性非梗阻性心肌病□限制性心肌病□酒精性心肌病□心肌致密化不全□致心律失常右室心肌病□圍生期心肌病□高血壓心肌病□心動過速性心肌病□糖尿病性心肌病□尿毒癥性心肌病□未定型心肌病□其他100.瓣膜病病因[多選題]*□風(fēng)濕性瓣膜病□先天性瓣膜病□退行性瓣膜病101.瓣膜病病變部位[多選題]*□主動脈□二尖瓣□三尖瓣□肺動脈瓣102.換瓣手術(shù)[多選題]*□主動脈瓣□二尖瓣□三尖瓣□肺動脈瓣103.先天性心臟病[多選題]*□房間隔缺損□室間隔缺損□動脈導(dǎo)管未閉□法四□已手術(shù)□未手術(shù)104.感染性心內(nèi)膜炎[多選題]*□主動脈瓣□二尖瓣□三尖瓣□肺動脈瓣105.心律失常[多選題]*□房撲□房顫□室速□室上速□頻發(fā)室早□頻發(fā)房早□二度一型房室傳導(dǎo)阻滯□二度二型房室傳導(dǎo)阻滯□三度房室傳導(dǎo)阻滯106.甲狀腺疾病[多選題]*□甲亢□甲減107.睡眠呼吸暫停綜合征[多選題]*□阻塞型□中樞型□混合型108.其他[多選題]*□高血壓□高脂血癥□糖尿病□肺栓塞□腎功能不全□缺血性卒中□出血性卒中109.心力衰竭誘因[多選題]*□感染□勞累□心律失常-快速房顫□缺血□急性血壓升高□藥物服用不規(guī)范□液體控制不當(dāng)□情緒激動□無誘因五、調(diào)整治療方案110.1.宣教[多選題]*□心衰基礎(chǔ)知識□營養(yǎng)指導(dǎo)、容量自我管理□心理量表篩查及心理疏導(dǎo)□吸煙危害及戒煙指導(dǎo)□血糖、血壓、血脂自我監(jiān)控管理□家屬護(hù)理注意事項，高危心肺復(fù)蘇培訓(xùn)運(yùn)動處方111.運(yùn)動時間（每次）[填空題]_________________________________112.運(yùn)動頻率（每周）[填空題]_________________________________113.運(yùn)動最大目標(biāo)心率[填空題]_________________________________114.運(yùn)動方式[多選題]*□有氧運(yùn)動□抗阻運(yùn)動□柔韌性運(yùn)動115.有氧運(yùn)動[多選題]*□步行□慢跑□自行車□走跑交替□跳繩□腳踏車□腳踏板走步機(jī)116.抗阻運(yùn)動[多選題]*□啞鈴□沙袋□彈力帶□握力器117.柔韌性運(yùn)動[多選題]*□瑜伽□太極拳□六段錦□健康操118.3.心理處方[多選題]*□心理疏導(dǎo)□藥物治療119.4.藥物處方[多選題]*□利尿劑□ACEI/ARB/ARNI□b受體阻滯劑□MRA□抗血小板藥物□調(diào)脂藥□降糖藥□降壓藥（其他）□抗凝藥□其他120.利尿劑[單選題]*○呋塞米○托拉塞米○布美他尼○氫氯噻嗪○托伐普坦121.每次劑量[填空題]_________________________________122.每日次數(shù)[單選題]*○一次○兩次○三次○四次123.ACEI/ARB/ARNI[單選題]*○卡托普利○依那普利○貝哪普利○福辛普利○雷米普利○坎地沙坦○纈沙坦○氯沙坦○厄貝沙坦○諾欣妥124.每次劑量[填空題]_________________________________125.每日次數(shù)[單選題]*○一次○兩次○三次○四次126.b受體阻滯劑[單選題]*○美托洛爾○比索洛爾○卡維地洛127.每次劑量[填空題]_________________________________128.每日次數(shù)[單選題]*○一次○兩次○三次○四次129.螺內(nèi)酯[單選題]*○是○否130.每次劑量[填空題]_________________________________131.每日次數(shù)[單選題]*○一次○兩次132.抗血小板藥物[多選題]*□阿司匹林□氯吡