? ?at? p???s? ?a? e??tas? s?st? ??s? t?? as?e???? st? ??T - PowerPoint PPT Presentation

Loading...

PPT – ? ?at? p???s? ?a? e??tas? s?st? ??s? t?? as?e???? st? ??T PowerPoint presentation | free to download - id: 1a53d2-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

? ?at? p???s? ?a? e??tas? s?st? ??s? t?? as?e???? st? ??T

Description:

? t?p???t?s? t?? a???st?? st? s?st? ?at? pe??pt?s? ??s? p??e? ?a e?t??se? t?? ... Rupert DL & Frandsen G. Timby's Fundamental Nursing Skills and Concepts, 2005 ... – PowerPoint PPT presentation

Number of Views:17
Avg rating:3.0/5.0
Slides: 30
Provided by: icuto
Learn more at: http://www.icutopics.gr
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: ? ?at? p???s? ?a? e??tas? s?st? ??s? t?? as?e???? st? ??T


1
? ?at? p???s? ?a? e??tas? s?st? ??s? t?? as?e????
st? ??T
  • ???S????S T???O??S
  • ??S??????S ??, Msc, Phd
  • ?.G.?. ???????

2
?e?????sµ??a e?e???t??? ded?µ??a ??a t??
te?µ????s? t?? s?st?? ??s?? t?? a???st??
  • ?e?µ????µ??? epa???? d??aµ??? t?? ep?d?as?? t??
    s?st?? ??s?? st? f???t?da
  • ? t?p???t?s? t?? a???st?? st? s?st? ?at?
    pe??pt?s? ??s? µp??e? ?a ße?t??se? t?? ??ßas?, ?a
    µe??se? t?? ???d??? ep?p????? ?a? ?a s?µß???e?
    st?? ep?t???a t?? ?e?ape?t???? pa?eµß?se??

3
?ate????t???a ?d???a st? f???t?da t?? ßa????
pas???t?? a???st??
  • ???a?? ??s??, ap? t?? ?pt?a ??s? ?at????s??, ???e
    d?? ??e?
  • Krishnagopalan S, Crit Care Med 2002, 30 2588

4
S?st? ??s? a???st???fa?µ??? ?a? s?µµ??f?s?
?ate????t???e? ?d???e?
S?st? ??s?
??e???? s?µµ??f?s?? pa?eµß?se??
???pe? ?a pe???aµß??eta? Se ???e
p??t?????? ?a?eµßat???? ? ?peµßat???? p?????
?f??? ap? t? s?st? ??s? ?a? ??e???t??? ded?µ??a
??a ?s????p???s? t?? ?ate????t????? ?d?????
5
S?µµ??f?s? p??s?p????
  • ???? t? 50 t?? e?d??e?µ???? p??s?p???? st?? ??T
    p?ste?e? ?t? ep?t?????eta? t? p??t?p? a??a???
    ??s?? t??????st?? st? 50 t?? pe??pt?se??
  • 3 Ge????? ??T st?? ???, 74 ????st??

Krishnagopalan S, Crit Care Med 2002, 30 2588
6
??t?e? µ? s?µµ??f?s??
  • ???e??? saf??? a???es?? t?? s???e???µ????
    ?a?????t??
  • ???e??? ?????? ?a? p??s?p????

??t?µat?p???s? µe e?d???? ????e?? ????s?
??st???
??pa?de?s? ? ???s?a??a ap?te??sµata ?????ß??a
d?ad??as?a ?p?p???? p??s?p???
Krishnagopalan S, Crit Care Med 2002, 30 2588
7
??d???? ????e? a?t?µat?? a??a??? ??s?? vs
?e???????t?? a??a??? ??s?? ???e 2 ??e?
  • ?e? ?p???e? a??????? d?af???
  • Traver GA J Crit Care 1995, 10 97
  • ??d???? ????e? ????? ?fe???
  • Gentilello L. Crit Care Med 1988,16 783
  • Summer WR J Crit Care 1989, 4 45
  • Fink MP Chest 1990, 97 132
  • Choi SC J Crit Care 1992, 7 57
  • Boisblanc BP Chest 1993, 103 1543
  • Sahn SA Chest 1991, 99 1263
  • Kelley R Stroke 1987, 18 638

?e??d??????? ???ß??µa ???? st? µe??t? t?? Traver
?a? s?? e?et?st??e ? s?µµ??f?s? t??
p??s?p???? ?a? te?µ???????e ? ?e???????t? a??a??
T?s?? gt67
8
St???? a??a??? ??s?? t?? a???st?? e?t?? t??
?pt?a? ??s?? ?at????s??
  1. ????t?p???s? ?a? pa????te?s? e????se??
  2. ??????? t?? p?e?µ???a? t?? a?ap?e?st??a
  3. ?e?t??s? t?? ??es?? t?? a???st??
  4. ??????? t?? e???? ?at????s??
  5. ?e?t??s? t?? ???????s?? t?? a?t???a??? a?µat??
  6. ?e??s? t?? ????? t?? a?ap???? a???s? t??
    ??t???? ????t???t?ta?
  7. ??e??????s? t?? ap??a?a?t?sµ?? ap? t? µ??a????
    ae??sµ?
  8. ??????? t?? ?ast????s?fa????? pa???d??µ?s??
  9. ??????? t?? e? t? ß??e? f?eß???? ???µß?s??

Thomas PJ. Aust. Crit. Care, 2006, 19 122
9
S????? ???S?S S??S ???F???S T?S??S
10
???????? pa??µet??? ??a t?? ep????? ?at???????
??s?? t?? a???st??
  1. ??t?????af?a ???a???
  2. ????as? p?e?µ????
  3. ??µ?? ae???? a?µat??
  4. ???µet??a
  5. ??µ?d??aµ??? sta?e??t?ta
  6. ????t?p???s? t?? e????se??
  • Thomas PJ. Aust. Crit. Care, 2006, 19 122

11
T?se?? a???st?? st?? ????? ??s??e?a?
  • Rupert DL Frandsen G
  • Timbys Fundamental Nursing Skills and Concepts,
    2005

12
??te?de??e?? t?p???t?s?? t?? a???st?? st??
?a??st? ??s?
  1. ?sta?? ?at??µata sp??d?????? st????
  2. ??d??????a p?es? gt 20cmH2O
  3. ?????? d?se?? ???t??p?? (Dopamine gt10mcg/kg/min,
    noradrenaline gt0,1 mcg/kg/min, dobutamine se
    ?p??ad?p?te d?s?)
  4. ??s? ??t???a?? ??es? lt 60mmHg
  5. ?a??? s???
  6. ??e?a ??a??? a????µ???
  7. ?????? ?p?st?????? µe ??

Thomas PJ. Aust. Crit. Care, 2006, 19 122
13
??te?de??e?? t?p???t?s?? t?? a???st?? st??
p????a ??s?
  1. ?sta?? ?at??µata sp??d?????? st????
  2. ??d??????a p?es? gt 20cmH2O
  3. ??s? ??t???a?? ??es? lt 60mmHg

Thomas PJ. Aust. Crit. Care, 2006, 19 122
14
SOS?? T?S? ???? ??T?S?
  • S??d??µ? ??e?a? ??ap?e?st???? ??s???e?a? (ARDS)
  • ??????? p?e?µ???a? t?? a?ap?e?st??a (VAP)
  • ?p????a?µ??? ?atap????a
  • ??a???e??efa???? ????s?

15
T?s? a???st?? µe S??d??µ? ??e?a? ??ap?e?st????
??s???e?a? (ARDS)
  • ??e??e?t?µata p?????? ??s??
  • ??a?ata??µ? ae??sµ?? a?µ?t?s??
  • ?e??s? e?d?p?e?µ?????? d?af????
  • ????s? ????? ae??sµ?? a?µ?t?s??
  • ???a??? st? ?e?t??????? ?p??e?p?µe?? ????t???t?ta
  • ??a?ata??µ? e??d??µat??
  • ?etaß???? pe???????? ????t???t?ta? t??
    d?af???µat??
  • ??te?de??e?? p?????? ??s??
  • ????µ??? e?d??????a p?es? gt25mmHg
  • ?at??µata a??e????? µ???a? t?? sp??d?????? st????
  • ??te???? ?s?a?µ?a
  • ?a???? ???µ??e?? µa?a??? µ????? t?? ß??ß??????
    ?a? ?????a??? ???a?
  • ?????t? t?a?µata, p???ap??? pa???ete?se??,
    p??sfate? ?e?????????? t?µ??

Murray TA, Crit Care Nurs 2002, 22 52 Curley MA,
Am J Crit Care 1999, 8 397
16
T?s? a???st?? µe S??d??µ? ??e?a? ??ap?e?st????
??s???e?a? (ARDS)
  • ???p?p???µ??? ??s? Fowler
  • ?e?t??s? t?? ???????s??
  • ? ????a 45º t?? p?d??? e???dete???e? t?? p?es?
    st?? ?????? ?a? st?? ß?se?? t?? p?e?µ????, ?
    ?p??a µe???e? t?? ap?te?esµat???t?ta t??
    ?µ??a??st?? ??s??
  • ??? ap?? st?? efa?µ??? ap? t?? p???? ??s?

???p?p???µ??? ??s? Fowler
Richard JCM, Intensive Care Med 2006, 32
1623 Messerole E, Am J Respir Crit Care Med 2002,
165 1359
17
T?s? a???st?? ??a t?? p?????? p?e?µ???a? t??
a?ap?e?st??a (VAP)
  • S??ep?? ?? p??te? ??e? µet? t? d?as?????s? e??a?
    ?? p?? ???s?µe? ??a t?p???t?s? t?? a???st?? se
    a?????p? ??s?
  • ?????? µe a???µ??? a???µ? pa?eµß?se?? ?a?
    a?µ?d??aµ??? ast??e?a
  • S?stas? CDC
  • ?????s? t?? ????? se ????a 30º ??? 45º
  • gt ???a??t?ta? p?e?µ???a? e?? ?pt?a ??s? t? p??t?
    24???

Tablan OC, MMWR Recomm Rep 2004, 53 1 Grap MJ,
Am J Crit Care 2005, 14 325
18
T?s? a???st?? µe ?p????a?µ??? ?atap????a
  • T?s? Trendelenburg
  • ????s? ??s?? ??t???a??? ??es??
  • ????s? ??es?? ??sf???s??
  • ????s? S?st?µat???? ???e?a??? ??t?st?se??
  • ?µet?ß??t? ?a?d?a?? ?a????
  • ?e? e??s??eta? ? F?eß??? ?p?st??f? st?? ?a?d??

???p?p???µ??? ??s? Trendelenburg
?p?p????? ?e?????sµ?? d?af?a?µat????
????s?? ??ast??? tase??p?d????? pt?s? ??
  • Marino PL. ICU 2000,
  • Proehl JA, Emergency Nursing Procedures 1999

19
T?s? a???st?? µe ??a???e??efa???? ????s?
  • ???? ??s? 30
  • ??e??????s? t?? f?eß???? ep?st??f??
  • ?d??stat??? µetat?p?s? ??? ap? t?? ??a??a??
    ?????t?ta st? ??t?a?? s????a
  • ????? gt 30
  • ?e???? ??µ?? ?s???? a???s? e?d??????a??? p?es??
    ? a???s? e?d??????a? p?es??
  • ?p??e?a a??e??????t???? t???? ??µ?as? f?eß????
    a?µat?? sta ???a ? µe??s? t?? p?es?? a?µ?t?s??
    t?? e??ef????

20
SOS?? T?S? ???? ??T?S?
?te??p?e??? p?e?µ????? p???s? ?????a ??s? ep? t?? ?????? p?e?µ??a
??? p?e?µ????? ??d?µa ?µ? Fowler ? 30
??a?µa sp??d?????? st???? ?pt?a ??s? a?st??? a????t?p???s?
???s?e?et???? pa??se?? ?????t?p???s? ?a? a????s? ?e???????µ???? ?????
21
SOS?? T?S? ???? ?????S?
  • ?a?et???asµ?? ?e?t????? f??ßa? ?a? µ?t??s? CVP
  • ??t??s? ?a?d?a??? ?a?????
  • ??t??s? p?es?? t?? p?e?µ?????? a?t???a?
  • ??e?te???? s?t?s?

22
?a?et???asµ?? ?e?t????? f??ßa? ?a? µ?t??s? CVP
  • ?a?et???asµ??
  • ???s? s?µat?? µe t? ?ef??? 15 p??? ta ??t? ??a
    ?a e?asfa??ste? µ???st? p????s? µe a?µa t??
    a??e???
  • ??t??s? ?.F.?.
  • ?s?e??? ?ata???µ???? se ?pt?a ??s? µe t?
    ?efa???? µ???? ??????t?? ? a????µ???
  • ??? p??? ap? 30

Taylor RW, Crit Care Med 2007, 35 1390
23
??t??s? ?a?d?a??? ?a?????
  • S?µa?t??? µe??s? µet???µe??? t?µ?? st?? a?????p?
    ?at? 40 ??s?.
  • ?p?te??sµata a???p?sta ??? 20
  • T?s? ep?????? ?pt?a

Driscoll A, Heart Lung 1995, 24 38 Giuliano K,
Nurs Research 2003, 52 242
24
??t??s? p?es?? t?? p?e?µ?????? a?t???a?
  • S?st? t?p???t?s? µ??f?µetat??p?a
  • T?s? f?eß?stat???? ????a
  • ?es?ste????? ep?ped? st? de??? p????a ??s?
  • ???ste?? pa?aste????? ???? st?? a??ste?? p????a
    ??s?

T?s? ep?????? ?pt?a S?µa?t??? sf??µata se ???e?
??se??
Fu Jin Shih, Intern J Nurs Stud 1999, 36 497
25
??e?te???? s?t?s?
  • ??????p? ??s? 30
  • ?µ??a??st? ??s?

Williams TA, Intens Crit Care Nurs 2004, 20 330
26
SOS?? T?S? ???? ?????S? - ???????S?
Fa??????? a?a???f?s? ?µ? Fowler
????fa??????? a?a???f?s? T?s? ?sf??s?? (sniffing position)
??????? e??tas? ?????f?????? s?st?µat?? ?µ? Fowler
?a?a?e?t?se?? ???a?a ?µ? Fowler
?a????te?s? s??????? pe??t??a???? ?????t?ta? Fowler ? ?µ? Fowler
?sf????t?a?a pa?a???t?s? ?????a ??s? (µe ??µ?? ????? ?a? ?efa???)
?pe?????a?d?????f?µa ???ste?? p????a
??d?s??p?se?? pept???? ???ste?? p????a - ?pt?a
27
S??????S????
  • ? t?p???t?s? t?? a???st?? st? s?st? ??s? st??
    ????? t?? ??T e??a? µ?a ap?? ?a? a????d? p?a?t???
    p?? µp??e? ?a ??e? s?µa?t??? ?fe??? ??a t??
    ????st?
  • ?p?te?e? ap? µ??? t?? µ?a s?µa?t??? ?e?ape?t???
    pa??µßas?
  • ???pe? ?a e?at?µ??e?eta? ?a? ?a ?aµß????ta? ?p
    ??? ap? t? ?at????s??e?t??? p??s?p??? ??
    ?d?a?te??t?te? ?a? t? pa??f?s???????? ?p?ßa???
    t?? ?p??e?µe??? ??s??

28
S??????S????
  • ? ????? ep????? ??s?? µp??e? ??? µ??? ?a µ??
    ?fe??se? st?? ??ßas? t?? a???st??, ?p??
    a?aµ??eta?, a??? ?a ?d???se? ?a? st?? eµf???s?
    ep?p?????, ?? ?p??e? ?a p???a??s??? ??? ?a?
    a?epa?????te? ß??ße?!
  • ?p?te?e? s??ep??, s?µa?t??? e?????, ?????? t??
    ??s??e?t?? ?a? p??pe? ?a e?te?e?ta? µe ap???ta
    te?µ????µ??? t??p?, ?p?? ???e pa??µßas?!

29
???a??st? p???!
About PowerShow.com