藍(lán)色醫(yī)療-脛腓骨骨折護(hù)理

NURSINGCAREOFFRACTUREOFTIBIAANDFIBULAXXX科室XXX脛腓骨骨折的護(hù)理目錄/contentsPART

01脛腓骨骨折的相關(guān)知識(shí)PART

02病情及治療經(jīng)過PART

03護(hù)理診斷及護(hù)理措施PART01脛腓骨骨折的相關(guān)知識(shí)概述是小腿部支撐體重的主要骨骼，承擔(dān)約1/6體重脛骨主要供小腿肌肉附著，并加強(qiáng)脛骨的力量，無負(fù)重功能腓骨指自脛骨平臺(tái)以下至踝上的部分發(fā)生的骨折。定義很常見，以兒童和青壯年居多。特點(diǎn)概述骨折后易產(chǎn)生成角、短縮、旋轉(zhuǎn)畸形腓骨：骨折較少，較易愈合脛骨的前內(nèi)側(cè)位于皮下，又有棱角，故骨折端極易穿破皮膚而形成開放性骨折成角側(cè)移旋轉(zhuǎn)短縮分離臨床特點(diǎn)010203概述脛骨上1/3骨折時(shí)，易造成小腿下段的嚴(yán)重缺血或壞死脛骨鐘1/3骨折時(shí)，可導(dǎo)致骨筋膜室綜合癥脛骨鐘1/3骨折時(shí)，營養(yǎng)動(dòng)脈損傷，容易發(fā)生骨折延遲愈合或不易愈合040506概述直接暴力多為打擊、撞擊、車輪碾壓等間接暴力多由高處墜落、滑倒等所致概述患肢疼痛、腫脹，可有反常活動(dòng)及畸形開放骨折可見斷端外露小兒青枝骨折表現(xiàn)為不敢負(fù)重和局部壓痛X線可明確診斷臨床表現(xiàn)常伴有腓總神經(jīng)損傷，脛前、脛后動(dòng)脈損傷，脛前區(qū)和腓腸肌區(qū)張力增加。臨床表現(xiàn)閉合性脛骨骨折1.石膏、支具制動(dòng)2.外固定架固定3.切開復(fù)位內(nèi)固定4.閉合復(fù)位髓內(nèi)針內(nèi)固定治療原則開放性骨折選用上述方法之一固定骨折，并遵循以下原則：清創(chuàng)徹底合理應(yīng)用抗生素中期閉合傷口中期植骨治療治療原則PART02病情及治療經(jīng)過患者：李XX，女，55歲否認(rèn)肝炎、結(jié)核病史，否認(rèn)高血壓、心臟病史、“冠心病”、“糖尿病”等病史，否認(rèn)手術(shù)、外傷、輸血史，否認(rèn)藥物過敏史?；拘畔⒓韧番F(xiàn)病史患者自訴于3小時(shí)前騎電動(dòng)車時(shí)被車撞傷后全身，即感左小腿疼痛，活動(dòng)受限，不能自行站立。當(dāng)時(shí)無昏迷，無頭痛頭暈、惡心嘔吐、胸悶氣促、腹痛腹脹等不適，被扶起后，急送至當(dāng)?shù)蒯t(yī)院就診，經(jīng)急診科檢查并行X線示：“左脛腓骨粉碎性骨折”，經(jīng)過輸液、止痛等處理后，轉(zhuǎn)入我院就診，遂以“脛腓骨骨折”收入我科。病程介紹體查患小腿脛前區(qū)可見1約18cm傷口，脛前肌肉顯露，可見骨折斷端，脛骨中上段內(nèi)側(cè)可見一約4cm傷口，皮膚缺損，有肌肉顯露，未見骨折斷端，內(nèi)踝可見一約8*8cm游離皮瓣，未見骨折斷端，足背動(dòng)脈搏動(dòng)可捫及，患肢趾端血運(yùn)、感覺及運(yùn)動(dòng)可，余肢體未見明顯異常。?？茩z查體溫37.0℃呼吸23次/分脈搏88次/分血壓93/62mmHg病程介紹入院診斷多發(fā)傷：失血性休克左脛腓骨開放性骨折左脛骨平臺(tái)及內(nèi)踝骨折左足第三距骨骨折左下肢血管、神經(jīng)損傷肋骨骨折病程介紹輸入日期點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字，點(diǎn)擊輸入相關(guān)文字輸入日期點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字，點(diǎn)擊輸入相關(guān)文字輸入日期點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字，點(diǎn)擊輸入相關(guān)文字輸入日期點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字，點(diǎn)擊輸入相關(guān)文字輸入日期點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字點(diǎn)擊輸入相關(guān)文字，點(diǎn)擊輸入相關(guān)文字病程經(jīng)過日期專科情況檢查結(jié)果治療處理PART03護(hù)理問題及護(hù)理診斷護(hù)理問題及診斷1.疼痛與骨折、手術(shù)創(chuàng)傷有關(guān)7.軀體移動(dòng)障礙與疼痛及術(shù)后肢體活動(dòng)受限有關(guān)2.營養(yǎng)失調(diào)低于機(jī)體需要量與食欲降低有關(guān)3.潛在并發(fā)癥下肢深靜脈血栓4.潛在并發(fā)癥骨筋膜室綜合征5.有皮膚完整性受損的危險(xiǎn)與長(zhǎng)期臥床有關(guān)6.皮膚完整性受損與左臀部燙傷有關(guān)8.焦慮擔(dān)心疾病預(yù)后及費(fèi)用有關(guān)9.知識(shí)缺乏缺乏術(shù)后功能鍛煉及恢復(fù)期注意事項(xiàng)的相關(guān)知識(shí)護(hù)理診斷與骨折、手術(shù)創(chuàng)傷有關(guān)護(hù)理目標(biāo)1.患者及家屬可以復(fù)述至少兩種緩解疼痛的方法。2.自述疼痛減輕，舒適感增加。護(hù)理措施1.定時(shí)評(píng)估患者疼痛分值、性質(zhì)、部位、起始和持續(xù)時(shí)間、發(fā)作規(guī)律、伴隨癥狀及誘發(fā)因素。2.左下肢墊軟枕，抬高患肢，消除腫脹，減輕因腫脹引起的脹痛不適。3.定時(shí)翻身，動(dòng)作輕柔，避免劇烈搬動(dòng)患者，減少因長(zhǎng)時(shí)間仰臥或俯臥引起的腰背肌肉酸痛或不舒適感。應(yīng)盡量采取健側(cè)臥位，避免壓迫傷口。4.指導(dǎo)患者床上使用便器的正確方法，避免隨意搬動(dòng)、拖拽患肢。5.心理護(hù)理，教會(huì)患者分散注意力的方法，以減輕焦慮與不適。

護(hù)理評(píng)價(jià)1.患者及家屬能夠復(fù)述至少兩種緩解疼痛的方法。2.患者疼痛減輕。護(hù)理問題及診斷護(hù)理診斷營養(yǎng)失調(diào)：低于機(jī)體需要量護(hù)理目標(biāo)病人營養(yǎng)狀況穩(wěn)定，表現(xiàn)為體重?zé)o明顯下降。護(hù)理措施1.

提供良好的進(jìn)食氛圍：飲食適合患者口味，給予營養(yǎng)豐富易消化的飲食。多食魚、肉、蛋、蔬菜水果等高蛋白、高維生素等增加抵抗力和組織修復(fù)能力的食物。2.加強(qiáng)口腔護(hù)理，保持口腔濕潤，遵循少量多餐原則，當(dāng)患者出現(xiàn)惡心、嘔吐時(shí)，暫停進(jìn)食3.定期監(jiān)測(cè)體重、血紅蛋白、紅細(xì)胞等指標(biāo)，隨時(shí)對(duì)癥處理。

護(hù)理評(píng)價(jià)患者營養(yǎng)需求基本得到滿足。護(hù)理問題及診斷護(hù)理診斷潛在并發(fā)癥：下肢深靜脈血栓護(hù)理目標(biāo)患者術(shù)后未發(fā)生深靜脈血栓。護(hù)理措施1.遵醫(yī)囑給與抗凝治療2.使用間歇充氣加壓裝置，指導(dǎo)患者進(jìn)行踝泵運(yùn)動(dòng)，抬高患肢，適當(dāng)多飲水3.術(shù)后盡早指導(dǎo)患者開始功能鍛煉，及下地活動(dòng)。

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04此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviort