Cqs Disease Care Time: December 29, 2012 Source: Original site Click: 668 times I want to comment (0) "Font: Big Small"
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Cqs Disease Care
Good care is essential for the recovery of Cqs disease, and the nurse's meticulous care plays a positive role in the whole disease process. Nurses are required to observe the symptoms carefully, report abnormal changes in time, operate gently and accurately, carry out health education, and pay attention to the mental health of patients and their families.
First, common nursing diagnosis and problems
- Hyperthermia is associated with factors such as infection and immune response.
- Impaired skin mucosal integrity associated with small vasculitis
- Potential complications, heart damage.
Second, nursing measures
1. Fever in children with fever as the first symptom, and immune dysfunction. Body temperature is missed heat or relaxation heat, body temperature reaches 38℃~40℃, after admission, the temperature is measured 4 times/d, until the normal temperature changed to 2 times/d. Monitor body temperature, observe heat type and accompanying symptom, report to doctor in time when high fever occurs. Body temperature of 38.5 ℃ can use physical cooling, warm water bath, ice cooler, drink warm water, such as temperature does not drop, continuous rise up to 38.5 ℃ above, should use medication to achieve cooling.
High fever nursing children early onset of high fever, temperature continued 38.5℃~40.0℃ between, continuous 7~10d, individual up to 2 weeks, the use of immunoglobulin and aspirin after 2~4d body temperature decreased. High heat to physical cooling-based, can use ice cooler, warm water bath, while encouraging children to drink more water, intravenous replenishment of liquid.
2. Skin mucosa Care to observe the skin mucosa, children appear rash, and appear finger (toe) end peeling, should keep the skin clean, keep the bed unit clean, flat, dry, bedding underwear soft. Cut short the child's nails to prevent scratching the skin. Half off the skin, with clean scissors cut off, and the parents and children to avoid human tear, should be treated naturally off, so as not to cause infection. The clothes are soft and clean. Scrub your eyes with boric acid cotton balls daily and use eye ointment if necessary. Oral pharyngeal mucosa Diffuse congestion, tongue nipple prominent red bayberry tongue, tonsil is mild or severe enlargement, daily oral care 2-3 times, encourage more mouth, mouth lip dry can be coated lip oil. Attention to oral hygiene, try to avoid eating raw, hard food, to liquid, soft food-based.
Paraffin oil rub lip, with normal saline to clean the mouth, three times a day to avoid stiff excitant food, to warm cool diet is advisable. Children in the fever at the same time Red urticaria, polymorphism erythema, the limbs appear rigid edema, should keep the skin clean, require children's clothes soft, clean, while keeping the sheets dry and smooth.
3. Observe the condition of monitoring children's complexion, mental state, heart rate, rhythm, electrocardiogram, ECG monitoring when necessary, and pay close attention to cardiovascular damage. In the course of the disease, continuous observation of the progress of the rash, superficial lymph node size and texture, the end of the extremities change, children in 1 weeks may appear in the fingers, toe hard swollen, toe joint changes.
4. Diet care children during fever, the body consumes more energy, high-calorie, high-protein, highly vitamin liquid or semi-liquid diet, such as chicken cakes, juice drinks, soy milk, etc., pay attention to the color, aroma, taste, increase the appetite of children, encourage patients to drink more water. Avoid the consumption of raw, hard, hot, spicy excitant food. Acute attack period to a small number of liquid, multi-meal-based, when necessary to supplement nutrients such as fat milk, amino acids, to ensure that adequate nutrition to enter, improve their own disease resistance, promote the early recovery of disease.
5. Psychological care because the disease repeated high fever, children's families prone to impatience, anxiety, emotional instability, should be patient to persuade explain. To understand the needs of patients and their families, timely explain the illness to the patient, the symptoms of the disease explained, in order to obtain cooperation. Children are still small, lack of independent thinking ability, their thoughts and emotions susceptible to external influences, should be timely understanding of the psychological state of the child, with a friendly attitude, good language and effective communication with the child, to help children through the fear stage, increase their confidence in overcoming the disease. can also use the "empathy method", the transfer of children to disease and parental care staff should arrange suitable bed recreational activities for children, more to the children's mental comfort, increase the positive mood.
Third, the care of children with severe disease
Some children can progress to severe disease, limb, perianal, trunk, such as large areas of peeling, nail shedding. After the onset of 1~5d skin polymorphism of erythema damage to scarlet fever-like rash most common, but no blisters and scabs, about 1 weeks can be subsided, in this period should be noted with other infectious rash and drug-induced allergic rash phenomenon of identification, at this time to maintain the skin is particularly important, timely dressing change, to avoid the occurrence of diffuse skin lung infection, Cause sepsis to occur.
Some severe children have a spindle-shaped swelling, tenderness, mouth and lip flushing, dry, chapped, bleeding, scab, even mouth difficult, painful. To strengthen the care of children, daily oral care 4-6 times, and the use of high-permeability saline external lip, coated with vitamin E pill protection. Rinse with light brine to avoid food that is prone to mechanical damage to the oral mucosa, such as fried, spiny or bone-containing foods, nuts with shells, and hard fruits such as sugarcane. For those with chapped lips, the lip can be coated with liquid paraffin before eating to reduce pain. Avoid using overheated food. Focus on nursing operation, alleviate the pain of children.
Children with severe ocular conjunctival congestion or bulbar conjunctival congestion, not accompanied by secretions and swelling, can be cleaned with saline, chloramphenicol eye drops eye drops, to avoid direct intense light stimulation, excessive fatigue. Patients with coronary artery tumor-like dilatation, coronary artery maximum inner diameter >8mm, the incidence of coronary artery stenosis, thrombosis, increased risk of sudden death when heavier, must reduce the heart load, strict bed rest, closely observe vital signs.
1. Disease knowledge education Most parents lack understanding of the disease, when it is known that the disease can cause coronary artery disease and lead to ischemic heart disease, cardiac infarction and sudden death, there are different degrees of tension and anxiety, should be patient to listen to the parents, the initiative to answer the parents ' questions, timely clarification of parents ' doubts, and actively inform the disease's common symptoms, pathogenesis, treatment plan, nursing measures, treatment and prognosis.
2. Drug mission (1) aspirin is an enzyme inhibitor with strong anti-inflammatory and antithrombotic effects. But ASA acid can directly cause gastric mucosal damage, so the patient is to take this medicine after meal, and take the acid-making agent or gastric mucosal protective agent. In most patients, the fecal occult blood test was positive after taking a medium dose of ASA for several days, and the color, quantity and nature of stool should be closely observed. Children who take ASA for a long time are advised to observe the tendency of bleeding.
(2) The study of immunoglobulin has confirmed that the early intravenous infusion of immunoglobulin plus oral aspirin therapy can reduce the incidence of coronary artery tumors in Kawasaki disease. The medication must be emphasized within 10 days after onset. To improve the relevant examination before injection, attention to the occurrence of allergic reaction.
(3) Corticosteroids have a strong anti-inflammatory effect, severe illness can alleviate symptoms, combined with the use of Prednisone and aspirin treatment, effective control of Kawasaki disease early inflammatory response. The application of corticosteroids should be strictly in accordance with medical advice, disinfection and isolation, to avoid cross-infection in children.
3. Discharge guidance
Instruct parents to observe the condition, follow the doctor's orders to take ASA, periodically review platelet, ESR. Patients without coronary artery disease were examined comprehensively 1 months, 3 months, 6 months and 1 years after discharge. For all the patients with residual coronary artery disease, follow up closely, do an echocardiogram every 3-6 months, regular diet, eat fresh vegetables and fruits, not picky eaters, pay attention to rest, avoid strenuous exercise.
Follow the doctor's orders to take aspirin, avoid missed, observe the side effects of drugs, pay attention to rest, avoid strenuous activities, eat more fresh vegetables, fruit, drink more water, keep defecate unobstructed; regular echocardiography, every 6-12 months to review, periodic review of Platelet, ESR, and stressed the importance of regular review.
Cqs Disease Care
