colostomy

篇一：Feelings and expectations of permanent colostomy patients

永久性结肠造口患者的感受及期望

摘要

目标：原创文章，基于临床调查来描述适应永久性结肠造口治疗的这一挑战

设计: 通过半自主结构化面试及使用Bardin内容分析提取技术进行数据的分析与分类。 主体与设置：巴西Cap?o do Le?o城市卫生部门造口项目的五个参与者。

途径：由do Sul/巴西Rio Grande州Cap?o do Le?o城组织的描述性的定性研究。

结果：通过数据的分类我们设置了三个主题。第一个意为“体会到疾病后续处理也是治疗的一部分”，第二个则是“恢复有秩序的生活”，以及第三个为“在新的状态下生活”。我们得出通过复杂的思考所传递的精神反射将作为临床护理的一种可能性，且能够帮助病人做出选择并积极地参与到恢复健康与疾病治疗之中。

结论:我们得出的结论是永久造口治疗对于主体而言是困难的以及恢复生活秩序感的过程是复杂的。

关键词:结肠造口,护理,社会心理影响。

1 简介

最常见导致造口治疗的疾病是外伤，先天性疾病，炎性疾病，肿瘤和肠癌。临时或永久性肠造口术将会改变患者的生活，如胃肠功能，以及心理社会因素包括自尊和身体形象.除了造口术所带来的巨大变化，人也必须应对潜在的生理失调所带来的生理和心理的影响。

因此对于永久性造口患者而言，需要有专门的护理手段来应对这些变化。在术后早期心理反应包括疲劳或无力，违和感或切割感，悲痛，反抗和抑郁感.其特点与严重程度因人而异。一些研究指出这取决于专业的医疗保健与患者家属,或者是造口手术的术后护理及新的造口所引发的对新生活环境的适应。

专业的医护人员，包括伤口、造口和失禁护士（WOCN），在患者的生理功能和心理适应及其家属学会处理和应对肠造口术起到了决定性的作用。优化管理采用一种全面的方法，结合了心理支持，造口普及教育，以及自理能力的培养。因此，在帮助人们适应肠造口术时，我们提出了一个将患者定义为可协调性整体的跨学科研究方法。

不幸的是，并非所有患者都有机会的到专业造口治疗师的伤口、造口及失禁的治疗，导致次优的护理及风险的增加并更加难以适应戴有造口袋的生活。因此，我们的研究旨在描述适应永久性结肠造口时人所面临的挑战。具体的研究问题是：1）什么是需要适应过程永久性结肠造口的病人的感受和期望？ 2）护士和其他卫生保健专业人员如何最大限度地减少结肠造口患者所面临的问题？

2方法

do Sul/巴西Rio Grande州Cap?o do Le?o城市卫生局进行该描述和定性研究。市卫生局提供的协助人口大约是27,000。该研究参与者的选择标准是：属于市卫生局的造口项目的所有永久性肠造口患者。所有数据均通过半自主式访谈收集。研究以个人访谈的形式进行，每次面试的大致时间是大约一个小时半的时间。访谈被记录下来，然后进行转录分析。并使用Bardin内容分析提取技术进行数据的分析与分类。我们提取中心思想，分类鉴定三个主题单元，以元素的出现频率来分组，目的是逻辑性的推导出这些反应的含义，并补充说明及验证推理出的结论。

这项研究是根据巴西国家卫生局涉及人类相关的196/6决议进行的[9]。该研究项目被批准为伦理佩洛塔斯的圣诞老人之家的仁慈堂医院研究委员会。通过市卫生局书面同意并获得所有参与者签署无偿及同意，参与者的匿名与隐私也得到保障。参与者（如Rose或Azaléia）的名称用于标识参与者关于本文的谈话结果而不是他们的真实姓名。 3 结果

从该部门造口项目的五名患者参与了这项研究。三个住在雅尔丁美国的区域（城市的人口最多的区域），一个是来自BairroTeodósio，另一个则来自市区。所有受试者都曾接受了永久性结肠造口术；他们的年龄从42到75岁的不等，平均年龄为62，三名妇女和两名男性。 造口手术的时间在14个月至25年之间。平均在9.3年接触了造口手术。

三人因肠癌，一人因子宫癌，一人因外伤而接受造口手术。所有使用的造口袋均由国家提供。所有的参与者所受到的护理均是独立的，只有一人由于其他健康问题不得不由其妻子护理而除外。他是唯一一个没有前往市卫生局接受造口用品的患者。其他的四位以及此人的妻子将每月前往市卫生局进行补给并从笔者处接受护理咨询(M.T.S.B.)。在咨询护士的过程中，患者们将会解除疑虑，提出不满，得到指导乃至谈论自身和家庭并从咨询的护士那里得到专业/技术性和情感上的支持。当参与者表现出与护士间积极的关系时，他们变回说明关于物品交付延误的投诉，物资的缺乏，或由国家提供造口用品不足。所有参与者在来到市卫生局时就得到询问，而那位不得不在家的男性参与者则在家中收到采访。

通过数据的分类我们设置了三个主题。第一个意为“体会到疾病的后续处理也是疾病治疗的一部分”，第二个则是“恢复有秩序的生活”，以及第三个为“在新的状态下生活”。

3.1 体会到疾病的后续处理也是疾病治疗的一部分

造口术后患者生活的突变影响到他们对衣服的选择，饮食，药物治疗，身体形象，排便与排尿功能，乃至生理功能和心理的转变。一位受访者说，“一切都变了，变了。一些曾经习惯了的衣着方式对我而言已不再适用。举个例子，我不再穿着紧腿牛仔裤，太糟了，它一点也不舒服。”另一位受访者则表示“?这有一些小误会。我觉得很平常，很好。只是洞洞变了（笑）。”一位受访者提到了饮食结构的改变。比如“一些我不能吃的东西：玉米，豆子还有花生。我必须时常备着药，三种类型的：氟苯氧苯胺，奥美拉唑，阿普唑仑。我吃治疗抑郁症的药。我还有慢性胃炎，在医院服用过很多吗啡和狄兰汀。而现在，偶然的一次，我吃了一些不太好消化的东西，于是我又服用了狄兰汀在?”（Azaléia — 在进行采访前10年半接受造口）另一位患者评论了造口手术所导致的一些气味，“我常常给旁边的人留下带着不

好的气味的印象。”

患者对正常生活的缺失也将影响到他们的社会功能，包括对于外出打工，或参加某些社交或康乐活动的良好感知能力。一位受访者说：“我不能去（没有浴室的地方）兜风，[或]野餐。这对我来说甚至是难以忍受的。”另一位与会者说，“我无法继续工作了，我是一个手机运营商在?，我也不去所有我曾去过的地方，聚会，海滩?”

从这个意义上讲这一缺失也影响了参与者的感情生活，造成自卑心理，社会孤立和抑郁的情绪。一位患者说，“首先，我很生气。我不想接受。我觉得低人一等。我不愿离开家。我已经有一年几个月没有出过门了。”第二个患者说：“我吃治疗抑郁症的药。我有慢性胃炎，而它不会消失。”

3.2 恢复正常生活

本节通过患者的陈述说明并演示了在经历造口手术后是如何恢复人际间正常往来的，尽管处于弱势状态，内心动摇，充满了不确信心理。

“哈！一开始我非常愤怒。甚至不愿意接受。我觉得低人一等。不愿离开家?来自家人的支持是非常重要的。在这样的情况下更是如此。我女儿曾对我说，我不曾失去胳膊或者腿，甚至得到了另外的东西，多了点不太乐见的东西，我是唯一知道这件事的。人们不会看着我，知道我在使用它。这就是如何让我接受并在现在接受的原因。现在我外出，旅行。我想这就是了。在我接受手术后，我曾去过里约热内卢?”（Rosa — 在进行采访前5年接受造口）。

“我认为肠造口并不意味着痛苦，不是一个问题的产生而是一个问题的解决。我觉得医生应该先让我们做好准备。当然有时候这是不可能的，他们必须敞开心扉并进行肠造口术。但是大概是第二次左右的时候吧，他撒了谎并说这是疝气。我告诉他（医生）：别再骗我了。我想患者不得不对一切做好准备。当你从手术中醒来，你将会感触良多”（Azaléia — 在进行采访前10年半接受造口）

最后一位受访者在适应过程中面对了各种各样的困难。但是她于邻市参与的造口人群体在她克服困难中提供了很多帮助，抑郁症也在此列。在这一群体中，这位参与者收到了很大的重视并表述道，在由医疗卫生人士举办的演讲中她常常被作为一个例子展示给其他人，把她的故事告诉其他组内的患者。我们认为通过这些她感到了自身的价值并能够克服她的困难，甚至仍然能够帮助其他人。她补充道：

“我已经参加了Pelotas的造口患者群体，每当有造口患者生日时我也经常前往，也会常常参加每月的会议......我认为这很棒。那里的护士解释了有关造口人的一切。销售代表去那里展示造口袋。还有很多很棒的实情。我们曾经租用了一辆面包车去实地考察，总是在成员生日时”（Azaléia—在进行采访前10年半进行造口）。

在询问参与者们关于在他们自己的城市建立造口患者组织以及是否愿意参加，其他被采访的人回答道：

“我认为这是一件很棒的事。我不知道?不，这对我来说是缺少的。对于一个更广阔的卫生行业而言这很棒。但我能参加，我不觉得有任何问题。你曾教过我任何事。” (Lírio – 在

采访前14个月接受造口）。

值得一提的是，这位患者使用肠造口袋仅14个月却适应良好。他从未参与任何造口人组织并不知道这些组织的存在。

3.3 在新的状态下生活

参与研究的患者们清楚地表述道，在起初对于他们而言适应新的设备，习惯肠造口袋是困难的。但是，随着时间流逝，尤其是在家人的支持中，他们渐渐接受并适应了新的物件。他们在经历了疾病之后，承受着癌症，纷纷提到了关于生活的新含义。

“在接受手术后我学到了很多。我的生活曾仅是工作，工作和工作。现在我的生活变得更有价值了。无论上帝给我什么，我都得试着去接受。变得愤怒无比只会让一切变得更糟。感谢上帝我的家人是这么棒，我的孩子对我都非常好。他们没有让我堕落（由于绝望）。我有一个朋友经历了四次手术，仅仅是因为他无法接受它。在第三次手术中他经历了大肠穿孔，差一点死了。他们甚至无法把它取出来。他还是戴着造口袋。这很舒服吗？不，并不是。但我们必须试着去适应，这是唯一的解决方式。”（Rosa — 在进行采访前5年接受造口）

“哈！在刚开始时这真的很难，不过现在我有更多的经验了。一切都变得更为寻常。我的卫生情况也还可以。我几乎能完全适应它了。”（Lirio — 在进行采访的14个月前接受造口）

“起初它是一件式造口袋（一次性的）。这我花了很长的时间来适应。后来我就习惯了。现在已经没有问题了。我不觉得有什么。我已经习惯了这一切。一开始是非常困难的。但我已经适应了...”（Cravo — 在进行采访的25年前接受造口）。

4 讨论

无序性不仅仅改变了有序的生活，它也促使造口人组织的建立。它在组织建立时即存在并不断威胁着他们分类。因此，自我组织与自我分裂永不停息就好像转化与重组的过程一样。

造口在造口人的生活中引起了不同的变化，关系到肠道的生理状态、下士形象和自尊。在其他论文中曾证明道这会最终影响和调节患者们的情感、家庭和劳动生活。

对话是帮助造口术患者重新获得生活的秩序感与控制感的复杂的护理过程中重要的组成部分。对话并不会使困难消失，但它确确实实地帮助病人提高了应对现状的能力。面对造口患者曾经历过的无数局限性，家庭与医疗团队的支持，在更快更有效地使患者接受并适应她的新状况方面，从根本上而言是非常必要的。

使用肠造口袋在调整适应新的生活状态上是一个挑战，造口患者需要一些时间来面对他失去的一切，为了抹平悲伤、去寻找生活的细节并接受他的新状态。困难的解决取决于患者实际上的自我调整，家人与医疗卫生员的支持和造口人组织的出现。接受了造口的患者认为他们需要调整它，以及，一段时间过去后，开始认为这是可能的，并自主进行自我健康管理，积极地克服造口所带来的困难，在新的状态下矫正他们的生活。

The health team facing the choices of what to do and how to do it, must discuss and negotiate the choices with the patient [14, 15].

无序感一定会被可行感所替代。疾病所带来的混乱将会转变为重归有价值的生活的乐观。对于医疗团队而言，这表示将患者认可为具有道德感，自主性，上进心和期待感的社交主体，而不是被定义为由专业人士所引导指挥的被动性客体。医疗团队面对关于做什么和怎么做的选择时，必须与患者一同讨论协商。

因此，考虑到跨学科工作的管理和质量以及预算，尤其是造口护理的专业自助护理权， 基于“适用群体对于实用性，审美，人种，经验，社会政治知识多样化需求的不断更新，以及个人性格的特异性”，目前的挑战在于对患者的临床关怀，以及更大的竞争力所要求的对造口患者的护理工作。

尽管参与此次研究的只有五名永久性肠造口患者，但这就是市政府收集数据时所得到的总数。每一位患者对于肠造口的适应过程都是唯一的。但是在参与调查的患者中都有一些共同点，比如家庭收入和生活状况。尽管在年龄和性别方面有所不同，对于永久性肠造口患者的调查过程总是相似的。唯一的困难是一位在25年前接受造口的参与者，由于他的呼吸衰竭所造成其说话困难。

5 结论

造口给造口人的生活来带不同的变化，特别存在于有关对胃肠生理，自身形象和自尊等方面。造口人本人，以及他的家人，需要由医疗团队做好事先指导。因为家人是离造口人最近的及最能支持他的，在患者适应造口袋及快而有效的恢复上起着必不可少的作用。对于信息和必要情况说明、跨学科的工作及其他方面的提供，对于帮助和鼓励接受造口治疗的患者是非常重要的策略，因为大多数人没有做好在他们的生命中面对这一器具的准备。但即使没有做好充足的准备，在他们适应造口袋后，他们也将以另一种方式定义生活，尤其是当他们罹患癌症时候。

我们强调，医疗团队在安装造口术的适应过程中给患者和患者家属适当的准备和引导是必须且必要的，这样一来将减轻患者的痛苦。此外，我们建议在城市中创建造口人群体，并提供互助活动以交流患者间应对造口的方法和经验。另外，我们也建议做另一项永久性肠造口患者人数更多的研究，其中的异同之处的出现将更具有说服力。

篇二：Breath Hydrogen

Breath Hydrogen (H2) and Methane (CH4) Excretion Patterns in Normal Man and in

Clinical Practice

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3. Tadesse K., Smith Dorothy and Eastwod M. A.

Breath H2 and CH4 daily excretion patterns were studied in 20 healthy individuals whilst on their regular diets and -1-fasting. The average H2 excretion level was found to be 85 ml day on habitual meals and less than 35 ml day1–1 whilst fasting. The mean excretion in breath at any one time was less than 0·5 μmol.l and individual breath sample –1excretion rarely exceeded 0·90 μmol.l. H2 excretion followed a regular pattern, being high in the morning, falling until about mid-day and rising during the early afternoon. The pattern of excretion remained essentially similar from day to day. Fasting decreased the overall excretion level and abolished the afternoon rise. CH4 excretion did not follow any –1regular pattern over the day and was individual with a third of the participants excreting above 0·1 , μmol.l and the –1rest nothing or below 0·10 μmol.l. In 15 of the subjects mouth-to-caecum transit time was measured employing the breath H2 test and using three different oligosaccharides of different molecular weight and varying osmolalities. The mouth-to-caecum transit time (MCTT) for lactulose was found to be 90±7 min, for raffnose 168±35 min, and for stachyose 290±0 min. Fasting and different osmolalities of the same oligosaccharides did not alter the MCTT. Administering the three oligosaccharides to a patient with colostomy did not show a difference in the H2 evolution time. Using the breath H2 test as a method of detection of lactose intolerance showed that the test is relatively more reliable, non-invasive and simple when compared to blood glucose measurement of mucosal lactase activity.

篇三：fundamental procedures

Colostomy is the opening of some portion of the colon onto the abdominal face

Reasons for Performing a Colostomy

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? When feces cannot progress naturally from the colon to the anus When it is more desirable or manageable to divert the feces, as for paraplegics In any condition where the rectum or anus is nonfunctional because of disease, a birth defect or a traumatic condition. It is performed to divert the fecal flow away from an area of inflammation or around an operative area General Procedure for Changing an Ostomy Pouch

Assessment

1. Identify the type of ostomy the patient has and its location (Bowel Urinary Diversion)

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3. Assess the skin integrity around the stoma and as general appearance Note the amount and character of any fecal material or urine in the pouch

4. Determine whether the patient is being taught self-care at the moment

Planning

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2. Wash your hands Gather the equipment needed in changing a pouch or dressing

Cleansing supplies including tissues, warm water, mild soap, wash cloth and a towel

Clean pouch of the type currently being used

Seal or use tape to prevent leakage

Clean belt

Dressing materials

Receptacle for the soiled pouch or dressing (bedpan, paper bag/newspaper for wrapping)

Protective spray

Clean gloves

Determine whether the patient is to participate actively

Choose the appropriate location in performing the procedure (bathroom/ bedside) ? ? ? ? ? ? ? ? 1. 2.

Implementation

1. Identify the patient

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12. Explain the procedure to the patient Put on clean gloves for infection Assist the patient to the bathroom or provide privacy Remove the soiled dressing Using warm water and a mild soap, cleanse the skin around the stoma thoroughly. Inspect the skin for redness or irritation. Cover the stoma with a tissue to prevent feces or urine from contacting. Change tissues as necessary during the procedure Dry the skin around the stoma carefully, patting gently Apply a skin protective spray if needed Allow the skin to dry thoroughly so the pouch will adhere firmly (a hair dryer on a low setting at least 18 inches from the skin may be used) Remove the tissue from the stoma and apply the clean pouch or dressing Remove gloves and wash hands

Evaluation

1. Evaluate using the following criteria

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? Pouch or dressing secure Area clean Odor free

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1. Patient comfortable If the patient is being taught the procedure, add the following criteria: Patient is able to change pouch using correct technique Patient verbalizes understanding of key points in care Record the following information:

The amount, color, and consistency of the fecal material or urine in the pouch

The application of the clean pouch and dressing change

The knowledge and ability of the patient t participate in the procedure or ability to change independently. Documentation ? ? ?

Chest Tube Care and Monitoring

TERMINAL LEARNING OBJECTIVE

Given a scenario in a holding or ward setting, involving a patient with a chest tube, identify procedures for chest tube care and monitoring IAW the Textbook of Basic Nursing, Lippincott

Introduction

Trauma, disease, or surgery can interrupt the closed negative-pressure system of the lungs, causing the lung to collapse. Air or fluid may leak into the pleural cavity. A chest tube is

inserted and a closed chest drainage system is attached to promote drainage of air and fluid. Chest tubes are used after chest surgery and chest trauma and for pnuemothorax or

hemothorax to promote lung re-expansion

Terms and definitions

a. Pneumothorax – collection of air in the pleura space

b. Hemothorax – an accumulation of blood and fluid in the pleural cavity between the

parietal and visceral pleurae, usually as the result of trauma

c. Chest tubes – a catheter inserted through the thorax to remove air and fluids from the

pleural space and to reestablish normal intrapleural and intrapulmonic pressures

Chest Tube Systems

a. Pleur-Evac chest drainage system

(1) One-piece molded plastic unit that duplicates the three-chambered system

(2) Cost effective

(3) There must be bubbles flowing in the suction control portion of the unit to provide

suction to the patient

b. Pleur-Evac Set Up

(1) Fill water seal chamber

(2) Fill suction control chamber

(3) Attach tube to suction source

(4) Tape all the connections

(5) Provide sterile tube for connection to patient

c. Procedure for Proper Usage of the Heimlich Valve

(1) Heimlich valve is a plastic, portable one-way valve used for chest drainage,

draining into a vented bag

(2) Equipment

(a) Heimlich valve

(b) Kelly clamps - 2 (rubber-tipped)

(c) Vented drainage bag or ostomy bag

(d) Ostomy tape or rubber band

(e) Suction setup (if applicable)

(f) Clean scissors

(3) Procedure Steps

(a) Gather equipment and bring to patient area

(b) Wash hands

(c) Don gloves. Nonsterile gloves are acceptable as long as sterile technique

is maintained while the connection is being made.

(4) Heimlich Valve To Chest Tube

(a) Place rubber-tipped Kelly clamps in opposite directions on the proximal

end of the chest tube as near to the patient as possible

(b) Connect the chest tube to the blue end of the Heimlich valve using sterile

technique

CAUTION: Only the blue end of the Heimlich valve can be connected to the chest tube. If the

clear end is connected, the one-way valve will be in the wrong position and no

drainage will take place.

(c) Tape the connection site at both ends of the valve using 2 inch cloth tape.

CAUTION: When two chest tubes are present, two Heimlich valves must be used to ensure

proper functioning of chest tubes.

(d) Monitor and record character of drainage and patency of valve in nursing

progress notes.

CAUTION: Measure all drainage in a calibrated cylinder for accurate readings.

(e) Record drainage output on I & O graphic every 8 hours. If conditions

permit.

Care of patients with chest tubes

a. Assess patient for respiratory distress and chest pain, breath sounds over affected lung

area, and stable vital signs

b. Observe for increase respiratory distress

c. Observe the following:

(1) Chest tube dressing, ensure tubing is patent

(2) Tubing kinks, dependent loops or clots

(3) Chest drainage system, which should be upright and below level of tube

insertion

d. Provide two shodded hemostats for each chest tube, attached to top of patient’s bed

with adhesive tape. Chest tubes are only clamped under specific circumstances:

(1) To assess air leak

(2) To quickly empty or change collection bottle or chamber; performed by soldier

medic who has received training in procedure

(3) To change disposable systems; have new system ready to be connected before

clamping tube so that transfer can be rapid and drainage system reestablished

(4) To change a broken water-seal bottle in the event that no sterile solution

container is available

(5) To assess if patient is ready to have chest tube removed (which is done by

physician’s order); the solider medic must monitor patient for recreation of

pneumothorax

e. Position the patient to permit optimal drainage

(1) Semi-Flower’s position to evacuate air (pneumothorax)

(2) High Flower’s position to drain fluid (hemothorax)

f. Maintain tube connection between chest and drainage tubes intact and taped

(1) Water-seal vent must be without occlusion

(2) Suction-control chamber vent must be without occlusion when suction is used

g. Coil excess tubing on mattress next to patient. Secure with rubber band and safety pin

or system’s clamp

h. Adjust tubing to hang in straight line from top of mattress to drainage chamber. If chest

tube is draining fluid, indicate time (e.g., 0900) that drainage was begun on drainage

bottle’s adhesive tape or on write-on surface of disposable commercial system

(1) Strip or milk chest tube only per MD/PA orders only

(2) Follow local policy for this procedure

Problems solving with chest tubes

a. Problem: Air leak

(1) Problem: Continuous bubbling is seen in water-seal bottle/chamber, indicating

that leak is between patient and water seal

(a) Locate leak

(b) Tighten loose connection between patient and water seal

(c) Loose connections cause air to enter system.

(d) Leaks are corrected when constant bubbling stops

(2) Problem: Bubbling continues, indicating that air leak has not been corrected

(a) Cross-clamp chest tube close to patient’s chest, if bubbling stops, air leak

is inside the patient’s thorax or at chest tube insertion site

(b) Unclamp tube and notify physician immediately!

(c) Reinforce chest dressing

Warning: Leaving chest tube clamped caused a tension pneumothorax and mediastinal

shift

(3) Problem: Bubbling continues, indicating that leak is not in the patient’s chest or

at the insertion site

(a) Gradually move clamps down drainage tubing away from patient and

toward suction-control chamber, moving one clamp at a time

(b) When bubbling stops, leak is in section of tubing or connection distal to

the clamp

(c) Replace tubing or secure connection and release clamp

(4) Problem: Bubbling continues, indicating that leak is not in tubing

(a) Leak is in drainage system

(b) Change drainage system

b. Problem: Tension pneumothorax is present

(1) Problems: Severe respiratory distress or chest pain

(a) Determine that chest tubes are not clamped, kinked, or occluded. Locate

leak

(b) Obstructed chest tubes trap air in intrapleural space when air leak

originates within patient

(2) Problem: Absence of breath sounds on affected side

(a) Notify physician immediately

(3) Problems: Hyperresonance on affected side, mediastinal shift to unaffected side,

tracheal shift to unaffected side, hypotenstion or tachycardia

(a) Immediately prepare for another chest tube insertion

(b) Obtain a flutter (Heimlich) valve or large-guage needle for short-term

emergency release or air in intrapleural space

(c) Have emergency equipment (oxygen and code cart) near patient

(4) Problem: Dependent loops of drainage tubing have trapped fluid

(a) Drain tubing contents into drainage bottle

(b) Coil excess tubing on mattress and secure in place

(5) Problem: Water seal is disconnected

(a) Connect water seal

(b) Tape connection

(6) Problem: Water-seal bottle is broken

(a) Insert distal end of water-seal tube into sterile solution so that tip is 2 cm

below surface

(b) Set up new water-seal bottle

(c) If no sterile solution is available, double clamp chest tube while preparing

new bottle

(7) Problem: Water-seal tube is no longer submerged in sterile fluid

(a) Add sterile solution to water-seal bottle until distal tip is 2 cm under

surface

(b) Or set water-seal bottle upright so that tip is submerged

SUMMARY

Caring for a patient with a chest tube requires problem solving and knowledge application.

Remember, a chest tubes is a catheter inserted through the thorax to remove air and fluids from the pleural space and to reestablish normal intrapleural and intrapulmonic pressures. When

caring for and maintaining a patient with a chest tube, it is important to note the patency of chest tubes, presence of drainage, presence of fluctuations, patient's vital signs, chest dressing status, type of suction, and level of comfort.

Suctioning

The upper airway warms, cleans and moistens the air we breathe. The trach tube bypasses these mechanisms, so that the air moving through the tube is cooler, dryer and not as clean. In response to these changes, the body produces more mucus. Suctioning clears mucus from the tube and is essential for proper breathing.

篇四：Cardiovascular System

Angina pectoris: Chest pain caused by decreased blood flow to heart muscle.

Aneurysm: Local widening of an artery caused by weakness in the arterial wall or breakdown of

the wall owing to atherosclerosis.

Arrhythmia: Abnormal heart beat (rhythm) ----fibrillation and flutter are examples. Atherosclerosis: Hardening of arteries with a collection of cholesterol-like plaque.

Congestive heart failure: Inability of the heart to pump its required amount of blood. Blood

accumulates in the lungs causing pulmonary edema.

Hypertension: High blood pressure.

Essential hypertension: High blood pressure with no apparent cause.

Secondary hypertension: Another illness (kidney disease, or adrenal gland disorder) is the cause

of the high blood pressure.

Myocardial infarction: Heart attack. An infarction is an area of dead (necrotic) tissue.

Shock: A group of symptoms (paleness of skin, weak and rapid pulse, shallow breathing) that

indicate poor oxygen supply to tissues and insufficient return of blood to the heart.

Cirrhosis: Chronic disease of the liver with degeneration of liver cells.

Colonic polyposis: Polyps (small growths) protrude from the mucous membrane lining the colon. Diverticulosis: Abnormal condition of small pouches or sacs (diverticula) in the wall of the

intestine (often the colon).

Hepatitis: Inflammation of the liver.

Inflammatory bowel disease: Inflammation of the terminal (last) portion of the ileum (Crohn

disease) or inflammation of the colon (ulcerative colitis).

Jaundice: Yellow-orange coloration of the skin and other tissues.

pituitary gland after puberty.

Cushing syndrome: A group of symptoms produced by excess secretion of cortisol from the

adrenal cortex. These symptoms include obesity, moon-like fullness of the face, hyperglycemia, and osteoporosis.

Diabetes mellitus: A disorder of the pancreas that causes increase in blood sugar. Goiter: Enlargement of the thyroid gland.

Hyperthyroidism: Overactivity of the thyroid gland; also called Graves disease or exophthalmic

(eyeballs bulge outward) goiter.

Dysmenorrhea: Painful menstrual flow.

Endometriosis: Tissue from the inner lining of the uterus (endometrium) occurs abnormally in

other pelvic or abdominal location (fallopian tubes, ovaries, or peritoneum).

Ectopic pregnancy: Pregnancy that is not in the uterus; usually occurring in a fallopian tube.

Fibroids: Benign tumors in the uterus. A fibroid is also called a leiomyoma (tumor of smooth or

involuntary muscle). Lei/o means smooth.

Menorrhagia: Excessive discharge (-rrhagia) of blood from the uterus during menstruation.

Pelvic inflammatory disease: Inflammation (often caused by bacterial infection) in the region of

the pelvis. Because the condition primarily affects the fallopian tubes, it is also called salpingitis.

response (destruction of lymphocytes) caused by exposure to HIV (human

immunodeficiency virus).

Lymphoma: Malignant tumor of lymph nodes and lymphatic tissue. Hodgkin disease is an

example of a lymphoma.

Mononucleosis: Acute infectious disease with enlargement of lymph nodes and increased

numbers of lymphocytes and monocytes (white blood cells) in the bloodstream.

Sarcoidosis: Inflammatory disease in which small nodules, or tubercles, form in lymph nodes and

other organs. Sarc/o is flesh and –oid means resembling.

Cryptorchidism: Condition of undescended testis. The testis is not in the scrotal sac at birth.

Crypt/o means hidden.

Hydrocele: Sac of clear fluid in the scrotum. Hydr/o means water and –cele is a hernia (a bulging

or swelling).

Prostatic carcinoma: Cancer of the prostate gland.

Testicular carcinoma: Malignant tumor of the testis. An example is a seminoma. Variocele: Enlarged, swollen veins near a testicle. Varic/o means swollen veins.

Ankylosing spondylitis: Chronic, progressive arthritis with stiffening (ankylosis) of joints,

primarily of the spine and hip.

Carpal tunnel syndrome: Compression of the median nerve as it passes between the ligament

and the bones and tendons of the wrist.

Gouty arthritis: Inflammation of joints caused by excessive uric acid; gout.

Muscular dystrophy: An inherited disorder characterized by progressive weakness and

degeneration of muscle fibers.

Osteoporosis: Decrease in bone density with thinning and weakening of bone. Porosis means

containing passages or spaces.

Rheumatoid arthritis: Chronic inflammation of joints; pain, swelling and stiffening, especially in

the small joints of hands and feet. Rheum- means a flowing, descriptive of the swelling in joints.

Cerebrovascular accident: Damage to the blood vessels of the cerebrum, leading to loss of blood

supply to brain tissue; a stroke.

Concussion: Brief loss of consciousness due to injury to the brain.

Epilepsy: Chronic brain disorder characterized by recurrent seizure activity.

Glioblastoma: Malignant brain tumor arising from neuroglial (supportive and connective tissue in

the brain) cells. Blast- means immature.

Hemiplegia: Paralysis (-plegia) that affects the right or left half of the body.

Meningitis: Inflammation of the meninges (membranes surrounding the brain and spinal cord). Multiple sclerosis: Destruction of the myelin sheath on nerve cells in the central nervous system

篇五：Pediatrics

Use of Starion Technology in Pediatrics

Pediatric surgeons have been especially receptive to the Starion technology. By focusing heat between the jaws of the instrument, Starion devices minimize the risk of collateral damage to surrounding tissue and organs. When working in smaller cavities, the reduction of lateral thermal spread offered by the Starion technology becomes even more important.

How Starion can be used in Pediatrics

Primary Laparoscopic Endorectal Pullthrough for Hirschprung’s Disease Colon pullthrough in the treatment of Hirschprung’s Disease in infants and children has evolved from the classic approach requiring multiple procedures to the laparoscopically assisted approach requiring a single procedure. The classic multi-stage surgical approach starts with an initial diverting colostomy, followed months later by a colon pullthrough surgery and completed by a subsequent colostomy. The next stage in the evolution of the procedure was the development of a single primary colon pullthrough using open surgical techniques. This single stage surgical repair offers many advantages over the classic approach, including reduced morbidity, reduced hospital stay and elimination of the need for colostomy. The laparoscopic approach extends the benefits of the single stage surgical approach by providing further reductions in morbidity and hospital stay.

Method 1. The colon is mobilized, starting with opening a mesenteric window at the rectosigmoid

junction.

2. Division of the mesentery is performed using the Starion Instruments TLS 23C.

3. The blood supply of the proximal colon pedicle is preserved by sparing the marginal artery in the mesentery of the colon.

4. Sometimes ligation of the inferior mesenteric artery close to the takeoff from the aorta is required.

5. Using the TLS 23C helps avoid injury to the left ureter during the dissection of the mesocolon.

6. The lateral fusion fascia and portions of the gastrocolic ligament are divided using the TLS 23C to adequately mobilize the colon in some patients. 7. After the colon pedicle is evaluated for adequate length, dissection of the pelvis is

initiated at the rectosigmoid junction.

8. The superior rectal vessels are divided.

9. Using the TLS 23C allows the distal dissection plane into the pelvis to be performed as close to the rectum as possible.

10. The middle rectal vessels are divided.

11. With the completion of the rectal dissection, the transanal-perineal dissection is initiated. 12. During the transanal-perineal dissection, it may be necessary to mobilize more colon. This is accomplished by transanally dividing the short mesenteric branches of the

marginal artery and vein.

13. An anastomsosis is completed between the distal rectal mucosal cuff and ganglionated colon.

Benefits of Starion Technology Use of the TLS 23C enable surgeons to accomplish the mobilization of the colon with minimal risk of injury to the organ and adjacent sensi(来自:WWw.SmhaiDa.com 海达范文网:colostomy)tive structures like the ureter. The precise application of thermal energy to target tissues while limiting collateral thermal spread allows precise

dissection in close proximity to sensitive organs. In addition the multifunctional TLS 23C reduces instrument exchanges during the procedure.

How Starion can be used in Pediatrics

Laparoscopic Appendectomy Minimally invasive laparoscopic appendectomy in children has been demonstrated to reduce morbidity and facilitate an earlier return to normal activities in children

Method 1. The peritoneal cavity is insufflated and three 5mm laparoscopic access ports are placed

using conventional techniques.

2. The tip of the appendix is grasped and a window is established in the meso-appendix

using the tip of the Starion Instruments Corporation TLS 23C at the junction of the

appendix and cecum.

3. The meso-appendix is transected using the TLS 23C 4. Following transection of the meso-appendix, the base of the appendix is ligated using

endo-loops.

5. The appendix is transected, placed in an endo-bag and removed through the lower left

quadrant trocar.

Benefits of Starion Technology Use of Starion technology reduces risk of injury to adjacent structures (i.e. bowel), eliminates the need for using a 12mm trocar and reduces procedure cost by eliminating the need for a linear stapler.

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