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1、Unit 4Giving Intravenous InfusionsReviewing IV infusionsAssessing IV cannulasTaking a message about patient care by telephoneCharting fluid intake and output Giving an oral report of the case,翻译,第四单元静 脉 输 液核对静脉输液评估静脉输液套管电话获取患者的护理信息记录出入量单口头汇报病人病情,DESCRIPTION,DescriptionIntravenous infusion(IV infusio
2、n)is a route of administering a drug directly into the bloodstream,bypassing the need for absorption from the GI tract or transportation from the other parts of the body,such as muscle or subcutaneous tissue.,翻译,DESCRIPTION,单元描述静脉输液是将药物直接输入血液的一种给药途径。这种给药途径避免了药物经胃肠道吸收或经身体其他部位如肌肉或皮下组织输送药物。,Administrat
3、ion Administration of safe,high-quality infusion therapy today depends on a collaborative practice environment in which many members of the health care team play a key role.The nurse,in particular,plays a primary role in collaborating with other health care providers to maintain an infusion and to p
4、rotect the patient from the hazards and complications associated with routine infusion(IV)therapy.Policies regarding the responsibilities of a staff nurse in relation to therapy vary significantly among health care institutions and are often influenced by the presence or absence of a full-service in
5、fusion team.,Work Description,翻译,单元工作任务描述给药安全、高质量地静脉给药取决于协同工作的环境，在这里，医疗团队的成员们都扮演着重要的角色。尤其是护士，为维持静脉输液并保护患者避免与常规输液治疗有关的风险和并发症，在合作的过程中起着主要作用。不同的医疗机构，输液护士的职责差异很大，而且通常受到是否存在全方位输液小组的影响。,Work Description,Administration of Parenteral Fluids Infusion nurses will,on written order,initiate all IVs No more than
6、 two attempts at venipuncture will be allowed.Venipunctures should be avoided in the lower extremities except when the patients condition may necessitate this use and this location has specifically been ordered by the physician.,Work Description,翻译,胃肠外给药 输液护士应遵医嘱实施静脉输液。不允许两次以上的静脉穿刺。应该避免下肢静脉穿刺，除非患者的病
7、情所需，且穿刺部位要谨遵医嘱。,Work Description,Preparation and Administration of IV Drugs Nurses will,on written order,prepare and administer only those solutions,medications,and combinations of drugs approved in writing by the pharmacy and the therapeutics committee.Nurses must check the patients clinical record
8、 and question the patient regarding sensitivity to drugs that may cause anaphylaxis.They must observe the patient after initial administration of such drugs.,Work Description,翻译,静脉给药及其准备 护士应遵医嘱只输入药物及治疗委员会同意支持的液体、药物和混合性药物。护士必须核对患者的医疗记录，并询问患者可能导致过敏反应的药物，初次输入此类药物时护士必须观察患者。,Work Description,Nursing Care
9、 Plan A nursing care plan should be established within 24 hours of date/time of admission.Peripheral Catheter Selection The catheter selected should be of the smallest gauge and shortest length to accommodate the prescribed therapy.Only radiopaque catheters may be used.,Work Description,翻译,护理计划 护理计划
10、应该在患者入院24小时内建立。外周导管的选择 导管应选择最小规格，最短长度以满足输液治疗。只能使用非透射性的导管。,Work Description,Task 1 Reviewing IV infusionsDescriptionReviewing IV infusions is to ensure that the correct solution is infused to the correct patient.Particular attention is placed on preloaded infusions with potassium chloride because of
11、the danger of overdose which could cause severe cardiac problems.,翻译,任务一 核对静脉输液任务描述核对静脉输液是为了确保将正确的液体输入正确的患者。特别要注意过量输入钾，因其可引起严重的心脏问题。,Related InformationPotential complications with the use of IV therapyFluids may be given to patients directly into the veinintravenously(IV)in order to replace fluid l
12、ost during surgery or because of dehydration.IV therapy may also be used to administer medications which need to be absorbed as quickly as possible.There are three potential complications with the use of IV therapy:infection of the site of insertion of the IV cannula,phlebitis or irritation of the v
13、ein,and fluid overload.,翻译,Fluid overload is a dangerous complication which occurs when more fluid is introduced into the body than the body can manage.Dangerous complications like heart failure or pulmonary oedema may result.In addition,the infusion of solutions which affect the electrolyte balance
14、 of the body may also cause unpleasant side effects.For this reason,IV fluids must be prescribed by a doctor in the same way as any other medication and are checked by two nurses before administration.,翻译,相关信息使用静脉液射治疗的潜在并发症液体经静脉输液直接进入患者静脉血管补偿手术或脱水导致的液体丢失。当药物需要尽快吸收时，也会使用静脉输液治疗。使用静脉注射治疗时会有三种潜在并发症：静脉插管
15、部位的感染、静脉炎或者液体超载。液体超载是一种严重的并发症，发生于输注的液体量超过了机体能负荷的量时，也可能导致危险的并发症如心力衰竭或者肺水肿。因此，液体的输注会影响机体的电解质平衡，由此会产生令人不愉快的副作用。由于这个原因，静脉输注的液体必须由医生开出，输液前由两名护士核对。,The management of IV infusionIV fluids may be delivered through an IV line via a burette or chamber or via an infusion pump.When using a burette and IV line,n
16、urses must calculate the number of drips per minute(DPM)and adjust the flow using the IV clamp.If a volumetric pump or infusion pump is used，a different calculation is made.This information is recorded in the column marked Rate ml/hr as infusion pumps calculate the volume or mils which will be pumpe
17、d through every hour.,翻译,静脉输液的管理静脉输注的液体可能通过滴管、腔或输液泵进入静脉通路。当使用滴管和静脉通路时，护士必须计算每分钟的滴数，并通过调节器来调节滴速。如果使用微量泵或输液泵，滴速计算方法又不同。这些信息用ml/h的标识记录，表示为输液泵每小时输注的量。,InfectionAny break in the skin carries a risk of infection.Although IV insertion is an aseptic procedure,skin-dwelling organisms such as Coagulase-negati
18、ve staphylococcus or Candida albicans may enter through the insertion site around the catheter,or bacteria may be accidentally introduced inside the catheter from contaminated equipment.Moisture introduced to unprotected IV sites through washing or bathing substantially increases the infection risks
19、.Infection of IV sites is usually local,causing easily visible swelling,redness,and fever.If bacteria do not remain in one area but spread through the bloodstream,the infection is called septicemia and can be rapid and life-threatening.,翻译,感染皮肤上的任何破溃都会带来感染的风险。虽然静脉穿刺是无菌操作，寄居在皮肤上的微生物如凝固酶阴性葡萄球菌或白色念珠菌会经
20、穿刺部位进入，或者是细菌不慎从被污染的装备进入导管，而在洗手或洗澡时，水分会进入未受保护的静脉注射部位，也大大增加了感染风险。静脉注射穿刺部位的感染通常是局部的，引起易见的红、肿、热。如果细菌通过血流播散，这种感染称为败血症，病情发展迅速并会危及生命。,Infiltration/ExtravasationInfiltration occurs when an IV fluid or medication accidentally enters the surrounding tissue rather than the vein.This occurs more frequently with
21、 chemotherapeutic agents and people who have tuberculosis.It is also known as extravasation(which refers to something escaping the vein).It may occur when the vein itself ruptures(the elderly are particularly prone to fragile veins due to a paucity of supporting tissues),翻译,where the vein is damaged
22、 during insertion of the intravascular access device or the device is not sited correctly or where the entry point of the device into the vein becomes the path of least resistance(e.g.if a cannula is in a vein for some time,the vein may scar and close and the only way for fluid to leave is along the
23、 outside of the cannula where it enters the vein).It is characterized by coolness and pallor to the skin as well as localized swelling or edema.,翻译,It is usually not painful.It is treated by removing the intravenous access device and elevating the affected limb so that the collected fluids can drain
24、 away.Sometimes injections of hyaluronidase can be used to speed the dispersal of the fluid/drug.Infiltration is one of the most common adverse effects of IV therapy and is usually not serious unless the infiltrated fluid is a medication damaging to the surrounding tissue,in which case extensive nec
25、rosis can occur.,翻译,浸透/外渗发生于血管本身脆弱（老年人的血管由于缺乏组织支持尤其脆弱），在插入静脉注射装置期间，或是注射装置穿刺的位置不正确时，静脉受损处；当静脉穿刺处变成最小阻力的路径时（比如，如果套管插入静脉一段时间，静脉可能形成疤痕、阻塞，液体流出静脉的唯一通道就是沿着套管插入血管处）。,特点是皮肤冷、苍白和局部肿胀、浮肿，通常不痛。移除静脉注射装置并抬高患肢使积聚的液体流走便可消除症状。有时，注射透明质酸酶来加速液体或药物的分散。渗透是静脉输液治疗最常见的并发症，但并不严重，除非外渗的液体是一种对周围组织有损伤的药物，在这种情况下，会导致广泛性坏死。,Fluid
26、overloadThis occurs when fluids are given at a higher rate or in a larger volume than the system can absorb or excrete.Possible consequences include hypertension,heart failure,and pulmonary edema.HypothermiaThe human body is at risk of accidentally induced hypothermia when large amounts of cold flui
27、ds are infused.Rapid temperature changes in the heart may precipitate ventricular fibrillation.,翻译,液体超负荷发生于输液速度过快，或输入的液体量大于系统能吸收和排泄的量时，可导致高血压、心力衰竭和肺水肿。体温过低当输入大量的冷液体时，会不慎引起人体体温过低的危险。心脏内部体温的急剧变化可能导致心室纤颤。,Electrolyte imbalanceAdministering a too-dilute or too-concentrated solution can disrupt the patie
28、nts balance of sodium,potassium,magnesium,and other electrolytes.Hospital patients usually receive blood tests to monitor these levels.,翻译,电解质失衡输入太稀或太浓的溶液会扰乱患者的钠、钾、镁和其他电解质的平衡。住院患者通常要查血常规来监测这些水平。,EmbolismA blood clot or other solid mass,as well as an air bubble,can be delivered into the circulation t
29、hrough an IV and end up blocking a vessel;this is called embolism.Peripheral IVs have a low risk of embolism,since large solid masses cannot travel through a narrow catheter,and it is nearly impossible to inject air through a peripheral IV at a dangerous rate.The risk is greater with a central IV.,翻
30、译,Air bubbles of less than 30 microliters are thought to dissolve into the circulation harmlessly.Small volumes do not result in readily detectable symptoms,but ongoing studies hypothesize that these“micro-bubbles”may have some adverse effects.A larger amount of air,if delivered all at once,can caus
31、e life-threatening damage to pulmonary circulation,or,if extremely large(3-8 milliliters per kilogram of body weight),can stop the heart.,翻译,One reason veins are preferred over arteries for intravascular administration is because the flow will pass through the lungs before passing through the body.A
32、ir bubbles can leave the blood through the lungs.A patient with a heart defect causing a right-to-left shunt is vulnerable to embolism from smaller amounts of air.,翻译,栓塞血凝块或其他固体及气泡，通过静脉输液进入循环而阻塞血管，称为栓塞。因为大固体不能通过狭窄的导管，并且几乎不可能以危险的速度通过外周静脉注射输入空气，因此外周静脉注射引起栓塞的风险较低，中心静脉注射危险性较高。少于30微升的空气气泡溶解到血液循环中，无伤害，少量气
33、泡不会导致容易检测到的症状，但当前研究认为微小气泡可能会有一些副作用。如果大量空气同时进入，会导致危及生命的肺循环损伤，或者，极端情况下（3-8ml每公斤体重），会导致心跳骤停。首选静脉而非动脉进行静脉给药的一个原因是，血流在流经全身之前会流经肺部，空气气泡可经肺部离开血液。右向左分流缺陷的心脏病患者，即使是少量的空气也会引起栓塞。,Discussion of the nursing topic1.What is your experience of IV therapy?2.When might a patient require IV therapy?3.What complication
34、s may appear with the use of IV therapy?,(Open),When dehydrated,after surgery,to administer IV medications.,There are three potential complications with the use of IV therapy:infection of the site of insertion of the IV cannula,phlebitis or irritation of the vein,and fluid overload.,Common questions
35、 when reviewing IV infusions1.Do you want me to pass on any updates?2.What about the cannula?Do you want it left in?3.Can you take out his cannula before he goes home,please?4.Can I just check that your IV cannula is all right before I put up the next infusion?5.Can I have a look?6.What are we doing
36、 with her IV?,7.Shes quite dehydrated,isnt she?8.Can you check it out with me and Ill put it up straight away?9.How long does he want it to run over?10.Any new orders there?11.I didnt catch the patients name.Could you spell it for me,please?12.Would you mind slowing down a bit?13.Do you mind keeping
37、 an eye on fluids?14.When did she have the IV put in?15.Whats up now?,16.Have you got the Prescription Chart with you?17.Can you see the expiry date on the bag OK?18.Whats her oral intake like?19.What about her IV intake?20.What about her output?Whats that like?,Practice of the task(Dr.Robert has co
38、me to the ward to review his patients IV infusion regimes.)Dr.Robert:Hello,Sabrina.Are you looking after Mrs.Bruce today?Sabrina:No,thats Mary,but shes just taken a patient for an X-ray examination.Dr.Robert:Oh,I wanted to review Mrs.Bruces IV fluids.Sabrina:Im looking after Marys patients while she
39、s away.Would you like me to pass on any updates?,翻译,Dr.Robert:Yeah,thanks.Could you take down Mrs.Bruces IV when its finished,please?Sabrina:Sure.Ill just write a note about it for Mary.For the cannula,do you want it left in?Dr.Robert:Yes,I think so.Leave it for another day in case she needs some mo
40、re fluids.Sabrina:OK.Do you want to see Mrs.Byron in the next room,too?Dr.Robert:Yes,I need to see her.According to her blood results her potassium levels are quite low.Ill put in a cannula when I finish my rounds.Could you start her on a litre of Normal Saline with 40 millimols of KCL?,翻译,Sabrina:O
41、K.Heres the Prescription Chart for you to fill out.Dr.Robert:Thanks.That saves me a bit of leg work.Can you run it over eight hours,please?Sabrina:Sure.One litre of Normal Saline with 40 millimols KCL over eight hours.Dr.Robert:Oh,Ill have to order her some IV antibiotics,too.Sabrina:Yeah,OK.Well ru
42、n them through a secondary line.The primary line will have the KCL running through,so we wont mix the solutions in the same line.,翻译,Dr.Robert:Great.Now theres just Mr.Richards left.How is he?Sabrina:Er,hes one of Marys patients,too.Hes in a pretty good condition.He plans to go home today,I think.Dr
43、.Robert:Yes,thats right.Hes ready for discharge.Could you take out his cannula before he goes home,please?Sabrina:Yes,sure,we will do that.Ill pass on your instructions to Mary when she returns.Dr.Robert:Thanks.,翻译,(Sabrina noted down Dr.Roberts instructions and she is now passing the note to Mary.)
44、Mary:Hi.Sabrina:Hi,Mary.Youre back.Dr.Robert saw some of your patients while you were at X-ray.Mrs.Bruce first.Mary:Oh,OK.What are we doing with her IV?Sabrina:He asked if you could take the IV down when its run through.Its just about through now.Mary:Thanks.Ill take it down in a minute.Um.What abou
45、t the cannula?Does he want it left in or taken out?,翻译,Sabrina:He said its better to leave the IV cannula in for another day just in case she needs more fluids.Mary:Oh,all right.Um,and what about Mrs.Byron?Did he see her,too?Sabrina:Yeah.Shes quite dehydrated,isnt she?Mary:Yeah.And her potassium lev
46、els were pretty low,too.Sabrina:He asked if you could put up a bag of Normal Saline with 40 millimols of KCI.He just put in a cannula for it.Mary:OK.Can you check it out with me and Ill put it up straight away?,翻译,Sabrina:Yeah,Im free at the moment.Ill check it with you.Mary:How long does he want it
47、 to run over?Sabrina:Let me look at the order.Um.he wants it to run over eight hours.Mary:OK.Ill get the infusion pump and set it up.Sabrina:Oh,and hes also ordered some IV antibiotics for her.Mary:Oh,right.Ill run them through a secondary line.I dont want to run them through the primary line while
48、shes got KCI running through it.,翻译,Sabrina:Yeah,right.He also saw Mr.Richards.Youre looking after him,arent you?Mary:Yes,hes my patient.Any new orders there?Sabrina:Only that he said that Mr.Richardss IV cannula could be taken out.Mary:Oh.Sabrina:Hes just finished his course of antibiotics so he do
49、esnt need it in any more.I took it out for him and put on a light dressing because hes going home this afternoon.Mary:Oh,thanks.,翻译,任务案例（罗伯特医生已经到病房巡视患者的静脉输注的治疗情况。）罗伯特医生：你好，塞布丽娜，今天是你照顾布鲁斯太太吗？塞布丽娜：不，是玛丽，但是她刚刚送一位患者去做X光检查。罗伯特医生：噢，我想看看布鲁斯太太的静脉输注。塞布丽娜：玛丽不在时我在照顾她的患者，你需要我传达新信息吗？罗伯特医生：是的，谢谢。布鲁斯太太的静脉输液结束时，你能拔
50、针吗？,塞布丽娜：当然可以，我帮玛丽把这个记录下来吧，还有插管，要继续插着吗？罗伯特医生：是的，我想应该再留一天吧，以防她还需要输液塞布丽娜：好的，你还想看看隔壁房间的拜伦太太吗？罗伯特医生：是的，需要。根据她的血液检查结果，她的血钾水平相当低，我巡视完后给她插入一根套管。你能先输入一升生理盐水加40毫摩的氯化钾吗？塞布丽娜：好的，这是你要填写的处方单。罗伯特医生：谢谢，这省掉了我一点腿脚功夫，你能使它输入时间超过八小时以上吗？塞布丽娜：当然了。一升生理盐水加40毫摩的氯化钾输入八小时以上。,罗伯特医生：噢，我还得给她开一些抗生素塞布丽娜：是的，好的，我会用另一输液管输入抗生素。主输液管输入氯
