About 60 cases of severe hepatitis paper to write network care _

Papers to write net: severe hepatitis by liver cell necrosis and a large number of serious dysfunction in a clinical syndrome in serious condition with high mortality, serious harm to human Health in China, a variety of infections, especially hepatitis B virus infection The main cause of clinical appear extreme fatigue, severe gastrointestinal symptoms, jaundice deepened dramatically, the enzyme isolated bile, liver dullness progressive narrowing, bleeding tendency, the rapid emergence of ascites, hepatic encephalopathy, acute renal failure Clinical Composite symptoms of our hospital diagnosed 60 patients with severe hepatitis nursing experience summarized as follows.

1 Clinical data
1.1 General information: The group of patients for the January 2005 -2008 admitted to our department in January of severe hepatitis patients, 38 males and 22 females, aged 42-75 years, of which 26 cases of acute severe hepatitis, sub-acute severe hepatitis 15 cases of chronic severe hepatitis 19 cases are in line with 2000-09 Xi'an Tenth National Conference on Viral Hepatitis revised "viral hepatitis prevention and treatment programs>> diagnostic criteria [1].

1.2 Care
1.2.1 life care: patients with absolute bed rest, can increase blood flow to the liver, lower metabolism rate and help the liver cells to repair, strengthen the patient's daily care, give patients a light digestible diet, appetite improved after the make up sufficient heat , the right amount of protein, can not eat the patients given intravenous nutrition, edema, ascites can limit the intake of protein, critically ill comatose patients should wash stand, set up stand up cards, plus the balloon pressure areas to prevent bedsores and fall plot the incidence of pneumonia; incontinence care patients should be strengthened in order to reduce the chance of infection. to meet the patient's needs. do missionary to the patient in order to obtain the cooperation of patients.

1.2.2 Disinfection care: patients with severe hepatitis resistance is weak, should strengthen the work of disinfection and isolation of their environment to reduce the probability of infection of patients, the daily use of ultraviolet disinfection of air, with "84" or 5% peracetic acid wipe repeatedly Desktop and surfaces, bedpan and urinal can be 0.5% peracetic acid immersion 30min. were eating alone, and the remaining food sterilized by boiling.

1.2.3 Psychological care: a complex disease in patients with severe hepatitis, complications, patients are often depressed, so the nursing process to help patients build confidence, maintain a good attitude, a determination to overcome the disease, the treatment of patients with active .

1.2.4 medication guide care: nursing process in accordance with your doctor regularly to monitor the quantitative treatment of patients with regular medication, patients taking the drug to prevent the process of the phenomenon of non-standard medication, which reach the purpose of treatment, and after taking the drug to be asked in detail about There are no adverse drug reactions, medication after the changes in condition, adverse reactions for patients to report to a doctor for doctors to adjust treatment.

1.2.5 the prevention of complications and care
1.2.5.1 Bleeding care: If the skin cyanosis, petechiae, spontaneous bleeding gums or nose bleeding, blood coagulation system disorders should be considered, if there is severe abdominal pain, vomiting, stomach contents of brown, nurses should closely observe the patient's height vital signs, monitoring blood pressure, decreased blood pressure and other abnormalities should be promptly reported to the doctor; prompt upper gastrointestinal bleeding. Links to free download http://www.hi138.com airway should be maintained during bleeding smooth gang, you can insert the tube about the status of bleeding and bleeding with ice saline lavage, aspiration of gastric contents in time, as soon as possible remove blood, to synthetic analogs of somatostatin octapeptide, but the drugs half-life of 1-1.5 hours, can reduce the portal vein blood flow 25% -35%, so the higher the success rate of hemostasis, the process should pay attention to the infusion such as interrupt超过 5 min after the intravenous injection should be the first to re-dose 100μg, so as to maintain effective blood concentrations [2]; and accurate record of the patient's bleeding and melena number, volume and characteristics of, a large blood transfusion can. hematemesis when the patient first lateral side to prevent choking. Bleeding stopped, pay attention to non-residue liquid diet, oral tablets should be taken after grinding, keep stool, to observe the filling of veins, skin, nail color, body is warm and so on.

1.2.5.2 hepatic encephalopathy nursing: Concurrent hepatic encephalopathy, the patient is preferable to supine position, head to one side, to keep the airway open, give continuous low flow oxygen, to improve the body's oxygen situation and prevent cerebral hypoxia , nasal feeding diet, adequate nutrition to maintain the body's metabolism, while oral care, personal care when there is restlessness in this group, 18 patients had hepatic encephalopathy of prodromal phase symptoms, because early in the work of nurses found that, for doctors treatment gained valuable time, by timely treatment and care of 15 patients had improved. have been more severe symptoms, to head to one side, keeping the airway open, continuous low flow oxygen. restless patient protection should be strengthened, prevent the occurrence of falling-bed.

1.2.5.3 secondary infection care: hepatitis can occur in patients with advanced multiple organ dysfunction, often accompanied by multiple strains of multi-site infections, infection difficult to control, biliary, peritoneal, lung infection is more common to Gram negative bacilli, later in the application of broad-spectrum antibiotics, fungal infections often occur in the treatment and care should be strictly aseptic and sterile isolation system to reduce the probability of infection in patients; to strengthen the basis for patient care, and closely observe the patient's body temperature changes, abnormal timely treatment.

1.2.5.4 Care of hepatorenal syndrome: severe liver disease, hepatorenal syndrome is often end-stage performance, about half of the patients had bleeding, ascites, a large number of diuretic, serious infections and other incentives, mainly for little or no urine, nitrogen quality acidosis, electrolyte imbalance, severe hepatitis is a major cause of death in patients with one severe hepatitis patients should pay attention to replenish the plasma, albumin, strictly limit sodium intake to reduce sodium and water retention, diuretics to joint , alternating, intermittent principle should be a detailed record intake and output, to prevent hypokalemia and other electrolyte disturbances, kidney function checked regularly, so that doctors observed the patient's condition.

2 Results
60 cases after treatment and care, the cure in 13 cases (21.7%), improved in 22 patients (36.6%), disease progression discharged 12 patients (20%), death in 13 cases (21.7%). Hospitalization 9-126 days, an average of 42 days.

3 nursing
Poor prognosis of severe hepatitis, the mortality rate as high as 50% -70%, the mortality rate of chronic severe hepatitis, 80%, and survival conditions can be used repeatedly, so closely observed, well focus on monitoring, accurate and timely implementation of the doctor's advice, and actively prevention and treatment of complications, a doctor with the rescue against the clock to strengthen primary care, symptomatic care and psychological care, shortening the course of the disease, reduce nursing complications and reduce mortality, improve survival and quality of life is important.

References
[1] the Chinese Medical Association credits will be infectious and parasitic diseases, liver disease learn to co-amendments. Viral hepatitis prevention and treatment programs [J]. Journal of Hepatology, 2000, 8 (6): 324.

[2] Chen Hao Zhu. Practical in Science [M]. 12, Beijing: People's Health Press, 2006: 1842 Links to free download http://www.hi138.com