涉外护理英语unit5AssessingaPreoperativePatient

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1、涉外 护理英语,Unit 5 Assessing a Preoperative Patient,对外经济贸易大学出版社,Unit 5 Assessing a Preoperative Patient,Giving preoperative patient teaching Allaying anxiety in a patient Preparing a patient for surgery Using Pre-operative Checklists Giving an oral report of the case,患者术前评估,给予患者术前指导 减轻患者焦虑 患者术前准备 使用术前核对

2、单 口头汇报病人病情,Description,Preoperative assessment (POA) and planning, carried out prior to treatment, ensures that the patient is fully informed about the procedure and the postoperative recovery, is in optimum health and has made arrangements for admission, discharge and postoperative care at home.,De

3、scription,单元描述 手术治疗前的评估和计划，确保患者完全了解手术过程和利于术后恢复，可使患者保持最佳健康状态，并为入院、出院和家庭术后护理做好安排。,The perioperative nurse is responsible and accountable for the major nursing activities occurring in the surgical suite. These include, but are not limited to the following:Assessing the patients physiological and psycho

4、logical status before, during, and after surgeryIdentifying priorities and implementing care based on sound nursing judgment and individual patient needs.Functioning as a patient advocate by protecting the patient from incompetent, unethical, or illegal practices during the perioperative period.Coor

5、dinating all activities associated with the implementation of nursing care by other members of the health-care team,Work Description,Work Description,Demonstrating a thorough knowledge of aseptic principles and techniques to maintain a safe and therapeutic surgical environment. Directing or assistin

6、g with the care and handling of all supplies, equipment, and instruments, to ensure their economic and efficient function for the patient and personnel under both normal and hazardous conditions. Performing as a scrub or circulating nurse as needed, based on knowledge and expertise for a specific pr

7、ocedure. Participating in continuing education programs directed toward personal and professional growth and development. Participating in professional, organizational and research activities that support and enhance preoperative nursing practice.,单元工作任务描述,围手术期护士负责手术室里的主要护理活动，这些责任包括以下几个方面，但不限于以下内容：

8、评估患者手术前、手术期间和手术后的生理、心理状况。 基于正确的护理评价和患者个体需要，确定优先事项和实施护理。 担当患者代言人，保护患者围手术期免受不称职、不道德或者不法行为的干扰。 协调健康照顾团队成员实施的护理活动。 应用完整的无菌原则知识和娴熟的无菌操作技术维护安全的手术治疗环境。 指导或协助护理，保管所有物品、设备和仪器，确保这些器械在任何情况下为患者和医护人员发挥经济而有效的功能。 必要时，基于个人专长，充当洗手或巡回护士。 参加可促进个人成长和专业发展的继续教育课程。 加入专业性组织和参加研究活动以加强围手术期的护理实践。,Work Description,Task 1 Givin

9、g preoperativepatient teaching,Practice of the task,Description,Preoperative teaching is the physical and psychological preparation of a patient prior to surgery. It includes instruction about the preoperative period, the surgery itself and postoperative care.,翻译,指导或协助护理，保管所有物品、设备和仪器，确保这些器械在任何情况下为患者

10、和医护人员发挥经济而有效的功能。,任务描述,The benefits of giving preoperative patient teaching Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. Preoperative teaching can alleviate most patient fears. Patients who know more about what to expect after surgery oft

11、en cope better with pain and post-surgery lifestyle changes. Therefore, patient education plays an important role in reducing their stress and fear of post-operative pain.,Related Information,翻译,How preoperative patient teaching works Patients often fear the unknown especially if they have limited e

12、xperience of the hospital environment. Patient education plays an important role in reducing the effect of pre-operative stress. The nurses role is to present the information for the patient in a way that is not overwhelming. The nurse may also answer questions the patient may have regarding the sur

13、gery or procedures that may be done beforehand or after. The concern about postoperative pain can be diminished by explaining equipment, such as the Patient-Controlled Analgesia (PCA) machines which patients can use to control their own pain medication. Education about the prevention of Deep Vein Th

14、rombosis (DVT) is also given pre-operatively. It is important to get the patients co-operation in wearing anti-embolic stockings, consenting to anticoagulant medication and understanding the importance of early ambulation.,翻译,Who is at risk of having a deep vein thrombosis? A DVT may be developed by

15、 the immobility which causes blood flow in the veins to be slow; a surgical operation, long journeys by plane or train, damage to the inside lining of the vein, people with cancer or heart failure, older people, pregnancy and obesity also increase the risk of having a DVT. Information about PCA Pati

16、ent-controlled analgesia, or PCA, is a method of pain control that allows you to give yourself some pain relief as and when you need it. The PCA system is attached through an infusion into a vein in the arm. The system is controlled with a hand-held button. When feeling pain, the button on the PCA h

17、andset should be pushed and a small amount of painkiller will be delivered directly into the bloodstream. Pain relief should be felt within a few minutes; if not, press the button again. The patient is the only person who knows when in pain.,翻译,So the patient is the only person who should press the

18、PCA button. The PCA has alarms set to alert the nurse of any problems. It is carefully programmed to deliver only a specific amount of painkiller so the patient cannot overdose. The nurses and doctors will follow the progress carefully. There will be frequent checks on the patients blood pressure, p

19、ulse, breathing and level of sedation. Pain relief is needed after injury or surgery to ensure a quick recovery and avoid other health problems such as chest infection or deep vein thrombosis. A patient will be asked to rate the pain when moving. Use the pain assessment chart with faces, numbers, wo

20、rds or colors to indicate the amount of pain.,翻译,Culture safety Culture safety encompasses a persons socioeconomic status, age, gender, sexual orientation, ethic origin, migrant/refugee status, religious belief or disability to enable the delivery of safe, appropriate and acceptable nursing care. It

21、s important that healthcare professionals involved in care consider the culture implications of their practice on others. With the preoperative phase of a patients journey, culture safety may be demonstrated in numerous ways.,翻译,Examples may include ensuring that the patient has the appropriate supp

22、ort person of a family with them during the consultation period. Aspects of the physical examination may also require gaining the permission from the patient to touch their head, as in some cultures the head area is deemed sacred. When unsure the patients belief, the best approach is to ask the pati

23、ent if the care they are receiving is appropriate to their beliefs. While obtaining surgical consent, consideration may be required by the patient as to whether they would like their body issue/part returned to them postoperatively, regardless of whether laboratory investigations are required. The w

24、ishes of the patient are to be clearly documented on the surgical consent to treatment form.,翻译,给予患者术前指导的益处 手术对在生理上和心理上都准备好的患者往往有更好的治疗效果。术前指导能减轻大多数患者的恐惧心理。患者了解手术预期结果越多，越能应对术后疼痛和术后生活方式的改变。因此，患者健康教育对减轻压力和克服对术后疼痛的恐惧起着重要的作用。 患者术前指导 患者常常对未知感到恐惧，尤其是对医院环境认识有限时。术前健康教育在减轻术前压力上起着重要的作用。护士的作用就是用温和的方式向患者说明信息。护士也

25、要回答患者与手术有关的一切问题。为减少患者术后疼痛的焦虑，可以向患者解释某些设备的使用如自控镇痛器可以向患者解释由患者自主控制止疼药的装置。术前指导还包括预防深静脉血栓形成教育。让患者配合穿抗栓塞袜、同意抗凝药物的使用和理解早期下床的重要性。 哪些患者易患深静脉血栓 深静脉血栓可能由于不活动导致静脉内的血液流动变慢发展形成。外科手术、坐飞机或火车长途旅行、静脉内壁损伤、患有癌症或心力衰竭的患者、老年人、怀孕及肥胖也会增加患静脉血栓的风险。 病人自控镇痛 病人自控镇痛是一种患者意识到疼痛且需要镇痛时允许自我给药控制疼痛的方法。自控镇痛系统通过输液泵连接到手臂静脉且手动控制。当意识到疼痛时，按压自

26、控镇痛上的手动按钮，小剂量的镇痛药就会直接输入到血液中，几分钟内疼痛就会缓解；如果疼痛感没有减轻，可再按一,相关信息,下按钮。患者是唯一一个知道什么时候疼痛的人，所以患者是唯一一个应该按压自控镇痛按钮的人。自控镇痛有报警设置来警示护士是否存在问题。系统设计传输的镇痛药只是特定剂量，患者不会用药过量。护士和医生要小心跟进情况，他们得频繁检查患者的血压、脉搏、呼吸和镇痛水平。受伤或手术过后需要缓解疼痛，以确保快速的恢复和避免其他的健康问题，如胸腔感染和深静脉血栓。患者会被询问活动时的疼痛级别。疼痛评估单有表情型、数字型、言语型或颜色型等。 文化安全 文化安全是指了解一个人的社会经济地位、年龄、性别

27、、性取向、民族、移民/难民地位、宗教信仰或者身体缺陷，给出安全、适当、可接受的护理。涉及照护的专业人员要考虑到他们的护理实施行为给他人带来的文化意义。患者术前阶段，文化安全涉及多方面。例如，确定患者会诊期间是否有家人悉心的陪伴；身体检查也需要征得患者的同意触碰头部，有些文化认为头部是神圣不可碰的。当不确定患者的信仰时，最好的办法就是询问患者他们接受的护理是否符合他们的信仰。当签属手术同意书时，不管是否要求做实验室检查，要考虑患者是否要求术后归还切除的机体组织。患者的心愿要清楚地写在治疗表中手术知情同意栏。,Discussion of the nursing topic,Is it import

28、ant to give pre-operative patient education? Why? Yes. Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. Preoperative teaching can alleviate most patient fears. Patients who know more about what to expect after surgery often cope better with

29、pain and post-surgery lifestyle changes. Therefore, patient education plays an important role in reducing their stress and fear of post- operative pain. 2.Do you use different strategies to give a preoperative education when dealing with children or patients from different cultural backgrounds?,When

30、 dealing with children and non-native speakers of English, it is a good idea to show them any pieces of equipment or show pictures of what to expect after an operation. 3.What are the benefits of pre-op patient education, both for patients and for the healthcare system? Pre-op patient education has

31、been shown to improve patient compliance with any post-op activities, for example post-op exercises. It also decreases patient anxiety and lessens the experience of pain. Benefits to the healthcare system include reduced days in hospital and less likelihood of return to hospital with avoidable compl

32、ications.,Common questions in taking the patients history,1.Do you mind.? 2.I wanted to have a chat with you about your operation tomorrow. 3.People always feel better if they know what to expect. 4.Thats what I wanted to show you. 5.Im just going to get something to show you so I can go through the

33、 rest of the information.,Practice of the task,(Cliff Christie, 65 years old, is scheduled for elective cholecystectomy. A ward nurse, Tina, prepares him for his operation by talking about the surgery.),Tina:Hello, Im Tina. Ill be looking after you today. Er, Mr. Christie, do you mind my calling you

34、 by your first name? Cliff:No. Hi, Tina, nice to meet you. Please call me Cliff. Tina:OK, thanks. I always like to ask first. Um, I wanted to have a chat with you about your operation tomorrow. Um, I see youve brought the leaflet about keyhole surgery. Cliff:Yes, um, it was sent to me at home last w

35、eek. The only thing I know is that I wont have a big cut so the operation wont leave a big scar. Ill just have a couple of small holes in my tummy. Tina:Thats right. Um, keyhole surgery is also called minimally invasive surgery because its performed with the use of a laparoscope, using small incisio

36、ns or surgical cuts. Um, youll probably have three to four puncture sites. These are just small,翻译,holes made near your navel. And youll have a small dressing covering the holes made during surgery. Its just a light covering to keep the area clean until it heals. Cliff:Oh. Thats not bad. Tina:During

37、 the operation, the surgeon uses a laparoscope, which is passed through the holes to visualise your gallbladder. The infected gallbladder is removed through the largest puncture site. Youll have a mini-drain which will only stay in for a couple of hours. Its a small plastic container attached to som

38、e tubing which takes away any excess blood from your wound. Cliff:Ah-hah. There wont be lots of blood, will there? I cant stand the sight of blood. Tina:No, not much, but I can make a note for the rest of the staff to cover the drain for you so you dont see any of it. Cliff:Thanks. Um, what about pa

39、in? Im worried that Ill be in a lot of pain. Tina:Youll have a PCA machine to use for any discomfort after the,翻译,operation. Thats what I wanted to show you, so Ive brought one along for you to see what its like. Its patient-controlled analgesia which will be run through an IV line and a pump. The m

40、edication goes into your bloodstream whenever you push this button. Cliff:Oh. Er, so I wont be in pain. I was really worried about that. But what if I keep pushing the button? Wont I give myself an overdose? Tina:No, dont worry. We program the pump so theres a lock-out time. Even if you keep pushing

41、 the button, no more medication will go through the line. Cliff:Ah, right. Tina:The machine automatically blocks it, or locks it out. Um, the nurses will be taking your obs. I mean, your observationslike your temperature, pulse and blood pressure. Theyll also check your pain level. Erm, theyll check

42、 all these frequently, so theyll keep a good eye on you. Cliff:Thats a relief. I think the fear of being in pain was making me unable to cope with the idea of surgery. Er, will I be able to eat straight away?,翻译,Tina:Youll have had a tube down your throat for the anaesthetic, so well need to make su

43、re that your swallow reflex is working again after the tubes been removed. We check that you can swallow again by trying you with a few ice chips. As soon as you can manage the ice chips, well give you small sips of water. Um, well also need to be sure that your bowels are working again before you t

44、ry eating small amounts of food. Cliff:Oh, is that why they do that? I never knew. It makes sense to go slowly. Tina:The other tube youll have is an indwelling catheter, which theyll put in while you are in theatres. Um, it can be taken out when youre back on the ward and think you can void againum,

45、 I mean, pass urine. Um, you wont have the catheter for too long. Now, Im just going to get something to show you so I can go through the rest of the information.,翻译,任务案例 （克利夫克里斯蒂，65岁，被安排了择期胆囊切除手术。病房护士缇娜通过谈论手术帮助他作好手术准备。） 缇娜：您好，我是缇娜，今天由我来照顾您。呃，克里斯蒂先生，您介意我叫您的名字吗？ 克利夫：不介意，你好，缇娜，很高兴见到你，请叫我克利夫。 缇娜：好的，谢谢。

46、我通常会先问一下。嗯，我早就想和您谈谈您明天的手术。嗯，我看到您已经拿到了微创手术的小册子。 克利夫：是的，嗯，上周我在家时收到的。我唯一知道的就是切口不大，手术不会给我留下太大的疤痕，肚子上到时只有几个小洞。 缇娜：很正确，嗯，锁孔手术也就是微创手术，它使用腹腔镜和使用小切口或手术切口来完成。嗯，您可能会有34个穿刺部位，是靠近肚脐的小孔，手术时开出的小孔会有小片敷料覆盖，就是轻轻地盖在伤口上以保持清洁直到伤口愈合。 克利夫：哦，听起来还不错。 缇娜：手术期间，外科医生使用穿过小孔的腹腔镜，可清楚地看到您的胆囊，切除的胆囊从最大的穿刺部位移出，您的体内会安装一个,小型的引流器，会持续数小时。

47、这个引流器是一个小型塑料容器，连接着管子，引流走伤口处过多的血液。 克利夫：啊哈，不会流太多血，是吗？我怕看到血。 缇娜：不，流血不多，但是我会告诉相关工作人员要盖住引流器，这样您就看不到了。 克利夫：谢谢，嗯，疼不疼呢？我担心会很疼。 缇娜：手术后您有任何的不舒服，都可使用自控镇痛泵，就是我早就想给您看的，现在已经把它带来了，给您看看它是什么样的。它是由病人自己控制的镇痛药，通过静脉输液管和泵运行，只要您按这个按钮，药物就会进入您的血流。 克利夫：所以，呃，我不会疼了，我真担心术后疼痛，但是如果持续按这个按钮会怎样呢？会不会用药过量呢？ 缇娜：不会，别担心，我们设定了泵的程序，所以有一个锁定

48、设置。即使你不断按按钮，也不会再有药物流进通道。 克利夫：哦，好的。 缇娜：这个机器会自动关闭，也会自动解锁。嗯，护士会观察您的生命体征。您的体温、脉搏和血压。也会查看您的疼痛水平。呃，我们会频繁检查生命体征，密切观察您的病情。,克利夫：那我就放心了。对疼痛的恐惧让我一直不敢面对手术。呃，我能立即进食吗？ 缇娜：麻醉时有管子会从您的喉咙处插入，取出管子后，我们需要确定您的吞咽反射是否恢复。我们会用冰块检查您是否能吞咽，一旦您能吞咽这些冰块，您就可喝几口水。嗯，在您吃少量食物前，我们也要确定您的肠功能是否恢复。 克利夫：原来如此，要慢慢来。 缇娜：安装在您身上的另一根管子是留置导尿管，是您在手术

49、室时插上的。嗯，您回病房后认为自己可以排放时便可取出嗯，我的意思是排尿。嗯，您使用留置导尿管。现在，我要去取给您看，这样我就完成了余下的信息确认了。,A. Read the conversation above and answer the following questions.,1. What kind of surgery will be given to Cliff?,2. What is Cliff concerned about for his operation?,3. What will the nurses check frequently after the operati

50、on?,Elective cholecystectomy,He is worried that he will be in a lot of pain.,The nurses will check frequently his observations, like temperature, pulse and blood pressure.And they will also check his pain level.,A. Read the conversation above and answer the following questions.,4. What safety measur

51、e on the machine does Tina explain?,The machine automatically blocks it, or locks it out.,5. Why try out a few ice chips on Cliff after the removal of the tubes?,To check that he can swallow again.,B. Fill in the blanks with the given words in the box to practice medical terms.,1.Thrombus is the pro

52、cess of blood .,2.Anti-embolic stops an embolus from .,4.Anticoagulant usually refers to a which inhibits the formation of thromboses.,5.Coagulation is a solid mass which forms in blood , also called a blood clot.,3.DVT is the deep vein .,B. Fill in the blanks with the given words in the box to prac

53、tice medical terms. 1.clotting 2.forming 3.thrombosis 4.medication 5.vessels,C.Work in pairs. Create a conversation between a nurse and a patient. Here is some information you can use.,Information about postoperative instructions: mobilization post-op,Possible questions from the patient,Task 2 Allay

54、ing anxiety in a patient,Description Related Information The discussion of the nursing topic Common patterns and questions found in dialogue when taking a MSU Practice the task,Description,Preoperational anxiety can be described as an unpleasant state of tension or uneasiness that results from a pat

55、ients doubts or fears before an operation. Allaying anxiety in a patient is to reduce the fear of surgery in patient for better outcome.,翻译,术前焦虑是指患者术前的疑惑或恐惧而引起的紧张或不安的不适心理状态。减轻患者焦虑可以减少患者对手术的恐惧心理而得到更好的手术治疗效果。,任务描述,Related Information,Ways of allaying mild anxiety in patient 1. Establish rapport with t

56、he patient to decrease feelings of depersonalization. 2. Humor (sometimes). 3.Explain the preoperative and postoperative nursing care to decrease fear of the unknown. 4. Explain that anxiety is a normal reaction. 5. Enlist the patients active participation in learning and practicing postoperative ac

57、tivities to give control over the environment. 6. When the teaching, include family and significant others to promote support.,翻译,减轻患者轻度焦虑的方法 1.与患者建立良好的人际关系以减轻其人格解体感。 2.幽默（有时）。 3.解释术前和术后的护理以减少对未知的恐惧。 4.解释焦虑是正常的反应。 5.支持患者积极参与学习和练习术后活动。 6.健康教育的对象要把家庭成员和重要他人包括进来，以促进情感支持。,相关消息,Anxiety differences Studie

58、s indicate that women are more anxious than men pre-operatively. This appears to be partly due to factors such as education level, earning capacity and marital status. Women statistically earn less than men and are often more concerned about their ability to cope financially after an operation. It i

59、s therefore important to consider psychosocial factors during the pre-operative period as they can influence the speed of recovery from an operation and the level of anxiety felt by a patient.,翻译,In addition to gender differences, cultural differences in anxiety levels can be noted. In cultures wher

60、e expression of emotions or aggression is frowned upon, uncertainty is accepted quite readily and anxiety levels are relatively low. On the other hand, cultures which are more expressive and where showing ones emotions is acceptable tend to be more anxious. For these reasons, it is important to be a

61、ware of non-verbal cues which may indicate anxiety especially in patients from so-called “uncertainty accepting cultures”. Non-verbal cues suggesting anxiety may include sweating especially of the palms, minor muscle twitching especially around the mouth and eyes and changes in voice tone and speed.

62、,翻译,Some signals are less obvious; for instance, biting the inside of the mouth, pulling a strand of hair, putting the hands in the pockets and scratching the nose. The place of spirituality and/or religion in allaying a patients anxiety can be difficult to gauge. It is often better to allow patient

63、s to bring up any religious beliefs themselves so as to avoid any feeling that the nurse is pushing his/her own religious view. For some people, illness, faith and spirituality are closely linked. In order to assess the patient holistically, these spiritual needs must be identified and respected.,翻译

64、,焦虑差异性 调查表明女性术前要比男性更焦虑，这种差异是由教育水平、收入水平和婚姻状况等因素决定。据统计，女性比男性挣钱少，常担心术后的经济应对能力。因此术前患者的心理因素很重要，它能影响术后的康复速度和患者的焦虑水平。除了性别差异，也要评估焦虑水平上的文化差异。在不赞同表达激动情绪的文化中，容易接受事务的不确定性，并且他们的焦虑水平相对低。另一方面，在善于表达的文化里，情绪外露是可以接受的，人们往往更容易焦虑。因此，尤其要注意到来自所谓“接收不确定性的文化”患者的非言语暗示，这些提示表明了患者的焦虑程度。,表明焦虑的非言语暗示有：手心出汗、轻微的肌肉颤抖（特别是嘴巴和眼睛周围）和语音语调及速

65、度的改变。有些迹象不那么明显，如咬口腔内侧、扯头发、把手放在口袋里和挠抓鼻子等。宗教信仰在减轻患者焦虑上的地位很难估计。通常的办法是让患者自己说出宗教信仰，以避免让患者感觉护士强行实施自己的宗教观。对于有些人而言，疾病、信仰和精神紧密相连。为了整体评估患者，必须确定和尊重这些精神需要。,Discussion of the nursing topic 1.How to alleviate anxiety in a patient? Ways of allaying anxiety in patient include: a.Establish rapport with the patient t

66、o decrease feelings of depersonalization. b.Humor (sometimes). c.Explain the preoperative and postoperative nursing care to decrease fear of the unknown. d.Explain that anxiety is a normal reaction. e.Enlist patients active participation in learning and practicing postoperative activities to give control over the environment. f.When teaching, include family and significant others to promote support.,2.How do cultural differences and gender differen