口腔護理icu護士新認識

1、口腔護理,蚌醫(yī)一附院重癥醫(yī)學科,ICU護士新認識,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,你、我、他 每個人... 每天......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,一般

2、患者...,ICU患者...,口腔護理,口腔護理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,方法一樣嗎...?,達到效果一樣嗎...?,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,方法一樣嗎...?,達到效果一

3、樣嗎...?,你懂得...,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,皮膚護理氣道護理口腔護理毛發(fā)護理眼部護理腸內營養(yǎng)護理胃腸功能護理個人衛(wèi)生護理......,The First Affiliated Hospital of Bengbu Medical College in intensive medic

4、ine,,皮膚護理氣道護理口腔護理毛發(fā)護理眼部護理腸內營養(yǎng)護理胃腸功能護理個人衛(wèi)生護理......,護士心中重要性,排序,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,,J Bras Pneumol. 2008;34(9):707-714,The First Affiliated Hospital of Ben

5、gbu Medical College in intensive medicine,口咽部分泌物的吸入是VAP發(fā)生的最主要途徑,,,J Bras Pneumol. 2008;34(9):707-714,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,中華內科雜志2013年6月第52卷第6期,The First Affiliate

6、d Hospital of Bengbu Medical College in intensive medicine,,,AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2010, Volume 19, No. 2,顯示：50%的護士認為每2小時一次口腔護理，42%的護士認為每4小時一次口腔護理,The First Affiliated Hospital of Bengbu Medical

7、College in intensive medicine,,有報道：應用0.2%的氯己定葡萄酸糖溶液和安慰劑進行的前瞻性多中心雙盲試驗，每天3次應用，開始時沒有統計學差異，第10天時，0.2%氯己定葡萄酸糖溶液組牙周致病菌29%，而對照組達66%（P<0.05）。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,生理鹽水

8、稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,q12hq8hq6hq4hq2h,The First Affiliated Hospital of Bengbu Medical College in

9、 intensive medicine,,生理鹽水稀釋碘伏溶液稀釋碳酸氫鈉氯己定漱口液......,q12hq8hq6hq4hq2h,刷、沖、洗、沖洗、沖刷......,牙刷、棉球、紗布塊......,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,,,有研究顯示：檢查口腔衛(wèi)生是應用呼吸機病人預防VAP發(fā)生的一

10、種主要方法,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,研究顯示：隨著正規(guī)合格的口腔護理，VAP發(fā)生率在降低,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護士： 口腔衛(wèi)生評估？

11、 護理效果評價？ 口腔護理再培訓 ？ 口腔護理執(zhí)行管理？,如何選擇......？,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護士： 口腔衛(wèi)生評估？ 護理效果評價？ 口腔

12、護理再培訓 ？ 口腔護理執(zhí)行管理？,如何選擇......？,思考,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,背景：很多創(chuàng)傷患者入住ICU，通常需要機械通氣，經口氣管插管使口腔氣道的天然防御機制受損，此類病人VAP發(fā)生幾率比較高。證據顯示：多關注機械通氣患者口腔衛(wèi)生非常有助于預防

13、VAP發(fā)生。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,目的：通過研究來評價ICU護士對于機械通氣患者口腔護理的觀點以及執(zhí)行情況,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,53名,,學歷,,ICU工作時間,,雇

14、傭形式,53名護士基本情況,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,每班次口腔評估次數，每班次每患者口腔護理次數，是否按規(guī)定的時間、規(guī)定的方法進行口腔護理（專用口腔護理表格）,The First Affiliated Hospital of Bengbu Medical College in intensive me

15、dicine,機械通氣患者提出護理頻次,,每班次檢查口腔的次數,每班次每患者口腔護理的次數,,,應用專用口腔護理表格,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,關于列出的十個日常護理規(guī)程，每個護理規(guī)程進行1至10分打分，分值越高者就是優(yōu)先傾向于做的護理規(guī)程,The First Affiliated Hospital of

16、Bengbu Medical College in intensive medicine,10項日常護理規(guī)程得分平均值和標準差,氣管管理,口腔護理,皮膚護理,營養(yǎng)護理,導管維護,個人衛(wèi)生,眼部護理,預防機體超負荷,記錄單書寫,腸道功能護理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,列舉12種口腔護理材料和工具，并且對每種材

17、料和工具1至100分打分，得分高者說明口腔護理時使用的頻次越高,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,12種口腔護理材料和工具使用頻次,紗布塊,氯己定,生理鹽水,口腔沖洗,The First Affiliated Hospital of Bengbu Medical College in intensive medici

18、ne,,列出口腔護理的10種障礙原因，然后對其1至10分打分，分值越高者口腔護理障礙原因越常見,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,護士進行口腔護理障礙原因,人員不足,時間缺乏,擔負書寫任務,害怕感染轉移,缺乏設備,氣管插管存在,不重要,缺乏知識和能力,害怕吸引,不愉快,和我沒關系,The First Affiliat

19、ed Hospital of Bengbu Medical College in intensive medicine,,53名,,學歷,,ICU工作時間,,雇傭形式,53名護士基本情況,,理學士,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,機械通氣患者提出護理頻次,,每班次檢查口腔的次數,每班次每患者口腔護理的次數,,,應

20、用專用口腔護理表格,,,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,10項日常護理規(guī)程得分平均值和標準差,氣管管理,口腔護理,皮膚護理,營養(yǎng)護理,導管維護,個人衛(wèi)生,眼部護理,預防機體超負荷,記錄單書寫,腸道功能護理,,The First Affiliated Hospital of Bengbu Medical Colle

21、ge in intensive medicine,12種口腔護理材料和工具使用頻次,紗布塊,氯己定,生理鹽水,口腔沖洗,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,護士進行口腔護理障礙原因,人員不足,時間缺乏,擔負書寫任務,害怕感染轉移,缺乏設備,氣管插管存在,不重要,缺乏知識和能力,害怕吸引,不愉快,和我沒關系,,The

22、First Affiliated Hospital of Bengbu Medical College in intensive medicine,口腔護理雖說排名第二，但其分值和其他皮膚護理，導管維護，營養(yǎng)護理，個人衛(wèi)生分值差不多，并且遠遠落后于氣道管理,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,結果顯示很有必要為護士開

23、設口腔護理再培訓課程,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,47%的護士認為口腔護理不是非常重要,Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and documentation.

24、 Am J Crit Care. 2003;12(2):113–8. discussion 119.,,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,有必要進行護士口腔護理再培訓以及在預防呼吸道感染中擔當一定的角色,The First Affiliated Hospital of Bengbu Medical College

25、 in intensive medicine,,這篇研究中85%的參與者培訓過應用機械通氣患者口腔護理而另外一篇報道70%的護士沒有培訓過應用機械通氣患者口腔護理,Adib-Hajbaghery M, Ansari A, Azizi-Fini I. Intensive care nurses' opinions and practice for oral care of mechanically ventilated pati

26、ents. Indian J Crit Care Med. 2013;17(1):23–7.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,又有研究報道：在英國，62%的護士說在這個領域內接受過培訓,Jones H, Newton JT, Bower EJ. A survey of the oral care practice

27、s of intensive care nurses. Intensive Crit Care Nurs. 2004;20(2):69–76.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,另外在一篇研究：在歐洲的ICU顯示，77%的ICU護士接受過相關的培訓,Rello J, Koulenti D, Blot S, Sier

28、ra R, Diaz E, De Waele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33(6):1066–70.,The First Affiliated Hospital of Bengbu Medical College in intensive me

29、dicine,,在這篇研究中，盡管大多數護士都接受過此類口腔護理培訓，但是在口腔護理方面并沒有給出高的優(yōu)先分數,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,此研究提到：缺乏時間和人員不足是忽視機械通氣患者口腔護理的最主要因素,The First Affiliated Hospital of Bengbu Medical C

30、ollege in intensive medicine,,另外研究發(fā)現：擔負書寫任務以及時間、人員不足是ICU口腔護理的最大障礙,Adib-Hajbaghery M, Ansari A, Azizi-Fini I. Intensive care nurses' opinions and practice for oral care of mechanically ventilated patients. Indian J Cr

31、it Care Med. 2013;17(1):23–7.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,又有研究發(fā)現：在歐洲59個ICU調查顯示，三分之一的護士認為口腔護理令人不愉快，三分之二的護士認為口腔護理很難去執(zhí)行,Rello J, Koulenti D, Blot S, Sierra R, Diaz E, De Wa

32、ele JJ, et al. Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med. 2007;33(6):1066–70,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,本文調查：口腔沖洗是最常

33、用的方法用于口腔護理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,另外一篇研究不一致：強調牙刷刷洗最有助于清除口腔的菌斑和微生物對于ICU患者,Pedreira ML, Kusahara DM, de Carvalho WB, Nunez SC, Peter-lini MA. Oral care interventions

34、and oropharyngeal coloniza-tion in children receiving mechanical ventilation. Am J Crit Care. 2009;18(4):319–28.,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,有研究顯示：用氯己定口腔沖洗比牙刷刷洗更能減少VAP。,

35、Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexi-dine, toothbrushing, and preventing ventilator-associated pneu-monia in critically ill adults. Am J Crit Care. 2009;18(5):428–37.,The First Affiliated Hospit

36、al of Bengbu Medical College in intensive medicine,,又有研究顯示：機械刷洗遠比棉球擦洗和氯己定沖洗效果好。,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,,開設再培訓課程強調口腔護理重要性，口腔護理真實執(zhí)行情況。對于機械通氣患者口腔護理，執(zhí)行情況管理可以進一步研究。,The F

37、irst Affiliated Hospital of Bengbu Medical College in intensive medicine,,ICU護士： 口腔衛(wèi)生評估？ 護理效果評價？ 口腔護理再培訓 ？ 口腔護理執(zhí)行管理？,如何選擇......？,思考,The First Affiliated Hospital o

38、f Bengbu Medical College in intensive medicine,,ICU護士： 口腔衛(wèi)生評估？ 護理效果評價？ 口腔護理再培訓 ？ 口腔護理執(zhí)行管理？,如何選擇......？,思考,答案,The First Affiliated Hospital of Bengbu Medical Colleg

39、e in intensive medicine,,ICU護士口腔護理再培訓口腔護理重要性VAP所起的作用再認識機械通氣患者口腔護理方法選擇口腔衛(wèi)生評估口腔護理效果評價口腔護理執(zhí)行管理再研究,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,將來的不久... 會有新的認識... 有新的選擇...