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新型冠状病毒肺炎疫情下口腔颌面内科的照顾护士防控

宣布人:品质节制中间 来历:本站 宣布日期:2020/8/13 【字体:

zhuanzaizi:guojikouqiangyixuezazhi

zuozhe:bixiaoqin  xiongmaojing  chenlixian  baiyuanyan  tianli  yanghui

zuozhedanwei:kouqiangjibingyantaoguoduzhongdianchangshishi  guodukouqiangjibinglinchuangyixueyantaozhongjian  sichuandaxuehuaxiyingyaappguanwangxiazaihemianneike,chengdou  610041

[zeyao]  xinxingguanzhuangbingdufeiyandebengfaduikouqianghemianneikedezhenliaohezhaoguhushidailailepangdadetiaoxin。weiyouyongfangzhixinxingguanzhuangbingdufeiyanerzhideyiqingshuzhan,zuidaxianzhixuejianxinxingguanzhuangbingdufeiyanzaiyiliaojigouneichuanbudeweixian,benwenlianxiguoduduixinxingguanzhuangbingdufangkongdezhengtiqingqiuhehemianneikezhuanyetese,nidingkouqianghemianneikezhaoguhushibanlixiangganfangkongbanfa,neirongchujiyujianfenzhen、fenjifanghu、ankangjiaodao、xianggankeshifangkongguantoudianhezhaoguhushicaozongzhongdefangkongzhanlvedeng,yibaozhanghemianneikezhaoguhushirenwuyouxutingzhi,tongshitichulexinxingguanzhuangbingdufeiyanchuanranfangkongshidaidekouqianghemianneikezhaoguhushibanlichangyi,xijiduiyiqingqikouqianghemianneikedezhaoguhushibanlijicihoudeyantaogongjicankao。

[关头词]  新型冠状病毒肺炎;口腔颌面内科;传染防控;照顾护士

xinxingguanzhuangbingdufeiyan(novel coronavirus pneumonia)debengfaduikouqianghemianneikedezhenliaohezhaoguhushidailaipangdadetiaoxin。weishizaiyouyongfangzhixinxingguanzhuangbingdufeiyanerzhideyiqingshuzhan,zuidaxianzhixuejianxinxingguanzhuangbingdufeiyanzaikouqianghemianneikedechuanbuweixian,jinyibubiaozhunhezengqiangkouqianghemianneikehuanzhedeshaichahebanli,baozhangfanbohuanzheheyiwuzhiyuandezhenliaoningjing,bizheanzhaoguoduduixinxingguanzhuangbingdufangkongdezhengtiqingqiu,lianxikouqianghemianneikedezhuanyetese,nidingchuxinxingguanzhuangbingdufeiyanyiqingxiakouqianghemianneikedezhaoguhushibanlijifangkongyingjibanfa,yiqiweigejiyingyaappguanwangxiazaizaiyiqingqidezhaoguhushifangkongrenwugongjicankao。

1   jianzhanglizhi,biaozhunliucheng

1.1  设置三级预检分诊,标准预检分诊流程,明白防护请求

1.1.1  shezhisanjiyujianfenzhen  1)diyijiyujianfenzhen:yingyaappguanwangxiazaijinkouchushelifashaohuanzheyujianfenzhentai,hongwaixianjianceyiqiezhiyuantiwen,tongshikouwenshibushicunzaiyiqulaihuihuokeyixinxingguanzhuangbingduchuanranhuanzhedazhangshidengfengxingbingxueshi。2)dierjiyujianfenzhen:menzhen、jizhenjinkouhushizhanshetiwenjiancedian,duiyiqiejiuzhizhiyuanjiancetiwen,tongshikouwenshibushicunzaiyiqulaihuihuokeyixinxingguanzhuangbingduchuanranhuanzhedazhangshidengfengxingbingxueshi。3)disanjiyujianfenzhen:kouqianghemianneikemenzhen、bingfangyihuzhiyuanjiezhenhuanzheshi,yingzaicikouwenjiuzhizhiyuantiwendengxiangganbingzhengdeshaichahuanjing,kouwenshibushicunzaiyiqulaihuihuokeyixinxingguanzhuangbingduchuanranhuanzhedazhangshidengfengxingbingxueshi,jishitiwen、xinlv、huxi、xueyadengxingmingtizheng。

1.1.2  yujianfenzhenrenwuzhiyuandefanghuqingqiu  yujianfenzhenderenwuzhiyuananzhaoyijifanghuqingqiutingzhifanghu(biaozhunfangbei)。shanggangshichuanzheyicixingrenwumao、neikekouzhaoherenwufu(baidagua),xuyaoshidaiyicixingrujiaoshoutao,bingliyonghumujinghuofanghumianping。zaiyuhuanzhejiaohuanjinchengzhong,zuishaoduizhi1 mdejiange,binganhuadingzuohaoxiangyingjishi。

1.1.3  yujianfenzhenliucheng  yujianfenzhenliuchengtuxiangjiantu1[1]。

 

 

 

tu 1  yujianfenzhenliucheng

fig1  process ofpre-examination and triage

 

1.1.4  yujianfenzhenrenwuzhiyuandezhize  1)tiwenjiance:duiyiqiejinjinkouqiangzhenliaojigou(keshi)dehuanzhehepeihuzhiyuantingzhitiwenjiance。huanzhetiwenkuayue37.3℃,shiweifashao,anzhaoyujianfenzhenliuchengtingzhixiangyingcuozhi;2)zidongkouwenjiuzhizhiyuandefengxingbingxueshi:①laiyuanqian14 dneishibushiyoufashaohuokesoudenghuxidaobingzheng?②laiyuanqian14 dneishibushicengdaoguowuhanshijizhoubiandiyu,huoqiyuyoubinglibaogaodeshequ?③laiyuanqian14 dneishibushiyuxinxingguanzhuangbingduchuanranzhe(hesuanjianceyangxingzhe)youdazhang?④laiyuanqian14 dneishibushidazhangguolaiziwuhanshijizhoubiandiyu,huolaiziyoubinglibaogaoshequdefashaohuoyouhuxidaobingzhengderen?⑤laiyuanqian14 dneidazhangderenqun,shibushiyouduorenchengxianfashao、kesoudengshangfengbingzhengzhe?⑥laiyuanqianshibushiyoubumingshenfendeduorenhuican、jihuihuojinjiangedazhangshi?duiwaibuhuanzhehaiyingjutikouwensuochengzuoguodejiaotongdongxi,ruweidazhongjiaotongdongxi,yingjishichengzuoriqi、hangban、checijizuoweihao。

1.2  jiuzhizhiyuanfenliucuozhiliucheng

jiuzhizhiyuanzaiwufengxingbingxueshi,wufashao(tiwen<37.3℃)、fali、kesoudengbingzhengdehuanjingxia,fenliucuozhiyixia。1)ruoshibushijizhongzhenghuanzhe,ruhelianbuneishang、helianbukongxichuanran、weizhongexingkouqianghelianbuzhongliuhuanzhe,changyizixinghuijiaduanjuechakan,zeqitingzhiyizhi;exingzhongliuhuanzhekeanzhaobingqingjimanshenzhuangtaizhenzhuopenshe(he/huo)huaxueyizhi;2)duishangshuqiuzhugaojizhongzhengdejiuzhizhiyuan,zhidianqijinruzhidingduanjuediyushishizhenliao,tongshidangjibaogaokeshidanrenrenheyingyaappguanwangxiazaichuanranbanwenke。daochangcaozongdeyiwuzhiyuananzhaoerjifanghuqingqiu,chuanzheyicixingrenwumao、daineikekouzhao、daihumujinghuofanghumianping、fanghufuhuorenwufu(baidagua)limianjiatao1jianyicixingduanjueyi、daiyicixingrujiaoshoutao。

jiuzhizhiyuanwufengxingbingxueshi,weiyifashao(tiwen≥37.3 ℃)、fali、kesoudengbingzhengshi,fenliucuozhiyixia。1)duifeijizhongzhenghuofeibixuzhenliaocaozongdehuanzhe,dangjichangyiqiqianquzongheyingyaappguanwangxiazaijiuzhi,zeqitingzhihelianbuyizhi;2)duiheshiqiuzhugaojizhongzhengdejiuzhizhiyuan,zhidianqijinruzhidingduanjuediyushishizhenliao,tongshidangjibaogaokeshidanrenrenheyingyaappguanwangxiazaichuanranbanwenke。daochangcaozongdeyiwuzhiyuananzhaoerjifanghuqingqiu,chuanzheyicixingrenwumao、daineikekouzhao、daihumujinghuofanghumianping、fanghufuhuorenwufu(baidagua)limianjiatao1jianyicixingduanjueyi、daiyicixingrujiaoshoutao[1]。

jiuzhizhiyuanyoufengxingbingxueshi,youfashao(tiwen≥37.3 ℃)、fali、kesoudengbingzhengshi,fenliucuozhiyixia。dunshizhidianhuanzhejinruzhidingduanjuediyu,bingdangjibaogaokeshidanrenrenheyingyaappguanwangxiazaichuanranbanwenke,shishizhuanzhendaoyouduanjuehejiuzhicainengdedingdianyingyaappguanwangxiazai,dengdaizhuanzhenshidaiduihuanzhejienayouyongdeduanjuehejiuzhibanfa。zhuanzhenhou,zaichuanrankezhidianxiaduizhenliaodanweitingzhixiangganxiaoducuozhi。

 

2  增强全部任务职员培训与小我防护认识

2.1  yiqierenwuzhiyuanxujinmiqinmicunjuanbenshendeankangzhuangtai

zhurishangbaoankanghuanjing,ruoyoufashao、kesou、fali、shangfengdengfeichangbingzheng,bixudiyishihouxiangdidiankeshidedanrenrentingzhibaogao,shishianhuadingjienaxuyaobanfa。

2.2  yiwuzhiyuanzaibanshihezhenliaohuanzhejinchengzhong,wubijingquepeidaineikekouzhao

yiwuzhiyuanrenwushidaibuyaodaishouzhuo(lian)、wanbiao、jiezhidengwupin;yankuzunshou“liangqiansanhou”shouweishengzhunsheng(liangqian:dazhanghuanzheqian,tingzhiwujuncaozongqian;sanhou:dazhanghuanzhehou,tiyeluoluhou,dazhanghuanzhesizhouhuanjinghou)[2]。anzhaochabiedegangting,jingquetiaoxuanhepeidaiqiyuxiaowofanghuyongpin。

2.3  anlianbawobingyankulvxinggejifanghudeqingqiuyuneirong

1)yijifanghu(biaozhunfangbei):heyongyuyiqingqihemianneikeyiwuzhiyuanzaijiezhenwufengxingbingxueshijiwuchuanranbingzhengdehuanzhe,baohanzhengxuntai、hushizhan、yujianfenzhendenggangting。fanghuqingqiu:chuanzheyicixingrenwumao、yicixingneikekouzhaoherenwufu(baidagua),xuyaoshiliyongfanghuyanzhaohuomianpingheyicixingyiyongshoutao。

2)erjifanghu(gaodengfanghu):heyongyuyiqingqikouqianghemianneikexingmazuichaguan、shoushucaozong、bayacaozong、qiguanqiekaizhaoguhushi、xitandengnenggouchengxianxueye、tuoye、qirongjiaodengtilichuanbudezhiyuan。fanghuqingqiu:chuanzheyicixingrenwumao、yicixingneikekouzhaohuoyiyongfanghukouzhao,daihumujinghuofanghumianping,fanghufuhuorenwufu(baidagua)limianjiataoyicixingfanghufu,liyongyicixingrujiaoshoutao。

3)sanjifanghu(zengqiangfanghu):heyongyuyiqingqiweiquezhenhuanzhetingzhishoushuhuozhaoguhushicaozong;weigaoduyisihuanzhetingzhimazuichaguan、shoushucaozong、qiguanqiekaizhaoguhushi、xitandengnenggouchengxianxueye、tuoye、qirongjiaodengtilichuanbudezhiyuan。fanghuqingqiu:chuanzhefanghufuhuorenwufu(baidagua)limianjiataoyicixingfanghufu,chuanzheyicixingrenwumao、yiyongfanghukouzhao、fanghumianpingjihumujingheyicixingrujiaoshoutao。

humujinghefanghumianpingliyonghuojinghuahou,xianliyongxiaodushijinhuo75%yichunjiejingxiaodu,shixiaoduchengfenganhua 5~10 min,erhouchongshuajiejing,kuzaohoubeiyong。kouzhao、humujing、fanghumianping、duanjueyidengfanghuyongpinbeixueye、tiye、paixiewudengjinghuahouxuyaoshishigaihuan。xiaowofanghuyongpintuoqushi,yingfangzhishouzhijiedazhangjinghuamian(xiantuofanghuyi、maozihekouzhao,zuichuchushoutao)。tuoqufanghuyongpinjirenwufuhou,biranyaotingzhishouweisheng,yixishouweijia。feijiejingdeshoubuyaodazhangkou、bi、yandengbuwei。

 

3  zengqiangyiliaohuanjingbanli[3]

wanmeiyiliaoquhehouzhenqudeyingxingduanjue,bingyoujiechudetoufeng、tongqiqianti。fenweihuanjingdexiaoduqingqiu:zengqiangtoufeng,zhurizao、zhong、wan3cikaichuangtoufeng,meicizuishao30 min;bingqieliyongfenweixiaodujitingzhixiaodu,anzhaochanwushenmingshushedingxiaodushihou。

zhenliaodiyuanzhao《yiliaojigouhuanjingwaibiaojiejingyuxiaodubanlibiaozhun ws/t 512-2016》deqingqiu,zuohaozhenshihuanjingjiejingyuxiaodu;duihuanzhedazhangdediyuhebuwei,changyijienaxiaodujicashidefangshitingzhixiaodu。)

houzhendiyuyingtingzhihuanjingxiaodu,tiantianzuishao3ci,changyiliyongyouyonglvhanliangwei500 mg•l-1dehanlvxiaodujicashihuozhenduixingxiaodujixiaodu。

duizhifenzhentaimian、hushizhan、tiwenqiangdejiejing。changyimei2 hduifenzhentaihetiwenqiangtingzhijiejingyuxiaodu,baojuliyongxiaodushijinhuohanlvxiaoduji(youyonglvhanliang500 mg•l-1)cashi。liyonghoudemobu,yingliyonghanlvxiaoduye(youyonglvhanliang500 mg•l-1)tingzhijihexizhuoxiaodu。ruoshihuanyingleyisihuanzhe,yingshishiduihushizhanhetiwenqiangdengtingzhijiejingxiaodu。yiqiedexiaodubanfazuohaojishi。

yankuzunshouyiliaofeiliaobanlixiangganhuading,zuohaoyiliaofeiliaofenleibanli。duiyisihequezhenhuanzhedazhangdeyiliaofeiliaohedongxi,yingzhiyushuangcenghuangseyiliaofeiliaobaozhuangdainei,jiena“ejingshi”jiezhafengkou,zaibaozhuangdaiwaibiaozuobiaoshiyitishishusongzhiyuan,binganzhaoyiliaofeiliaocuozhibiaozhuncuozhi。fanfuliyongdejinghuadongxi,yingshengfangzaiqiadangderongqinei,bingzuohaobiaoshi。

huanzhechuyuanhou,an《yiliaojigouxiaodushouyibiaozhun》duiqidazhanghuanjingtingzhizhongmocuozhi。

 

4  zengqiangkouqianghemianneikegeguanjiandechuanranfangkongjizhaoguhushibanli

kouqianghemianneikemenzhenjizhenhuanzhezailingdingshezhidecuozhishihuohuanyaoshitingzhichachaoheyizhi。duichuzhenhuanzhe,huozhitingzhikouqianghemiantongsuchachaodehuanzhe,kezaiyijifanghudehuanjingxiatingzhicuozhi;duixuxinghelianbukongxichuanranqiekaiyinliu,hehelianbuqingchuangfenghedengcaozongdehuanzhe,xuzaierjifanghudehuanjingxiatingzhicuozhi。

ruhuanzhexuyaogaojishoushu,zaizhuanyuntuzhongyingzuohaoyijifanghu;shoushuqianzhangliangtiwendetongshihaiyingdangquerenxiongbuyingxiangxuechachaochengguo。duiyoufengxingbingxueshi,youhuowufashaodengbingzhengdehuanzhe,shoushuyaozaizilidefuyashoushujiantingzhi;ruoshibufuyashoushujian,yingtiaoxuanjubeizilijinghuajizuqiekongjiandiweijueduizilideshoushujian,shoushuzhongfengsuojinghuatixi,shuhoutingzhizhongmoxiaoducuozhi;tongsushoushushiyaojinnenggoutiaoxuankongjiandiweizilideshoushujian。zaishoushujinchengzhong,jinnenggouzuodaowulifenkai,fangzhiheqiyuhuanzhedechuanchachuanran。zaitingzhiqiguanchaguan、qiguanqiekai、xitandengcaozongshi,yihuzhiyuanyaozuodaoerjifanghu,peidaihaohumujing/mianping;liyongdiandaodengdongxishi,jinnenggouliyongchouyanzhuangpeihuoxishouqi,jinnenggouxuejianqirongjiaodefensan。duiyisihuoquezhenhuanzhetingzhigaojijijiushi,yiqieyihuzhiyuanbixuyankulvxingsanjifanghu,yifangzhibingduchuanbu。hushishuzhongyingyushoushudafujinmiqinmigongtong,jucuojingque,gexiangcaozongrourou,qiejimangzhongfancuo,fangzhibuxuyaodeweixian。

xinxingguanzhuangbingdufeiyanyiqingshidai,kouqianghemianneikebingfangshishifengsuoshibanli。bingfangshezhigongyongtongdao,meiyigejinrubingfangdezhiyuandouyaokouwenfengxingbingxueshibingzhangliangtiwen。chuyuandehuanzhejipeihuzhiyuanjunxudaikouzhao、zhangliangtiwen,tiantian3ci;meiyigefangjianzhishouzhi1weihuanzhe,zuiduo1weipeihu。shezhiduanjuebingfang,duifamingkeyidehuanzhetingzhidangchangduanjue。duanjuebingfangxuyaoshezhizaiyigejueduizilidekongjian,zuihaoshifuyabingfang,ruwufuyabingfang,yingshezhijubeijiechutoufenghuanjingdebingfangzuoweiduanjuebingfang。

zengqiangyingyaappguanwangxiazaigeleibangzhuzhiyuan,baohanbaojieyuan、jiesonghuanzhezhiyuan、jinghuazhazishusongzhiyuan、wupinpeisongzhiyuandengdefanghu。yingyaappguanwangxiazaiduizheixiezhiyuanzengqiangpeixun,gongjixuyaodefanghuqiju,bingzhidianhejianshiqijingqueliyong。

zhengshidazhongdiyujidazhongqijudefanghu,baohanmenbashou、geleikaiguan、delvfengjideng。chuyaoqincashixiaoduyiwai,zaijinghuaqupeidaide、zhijiehuozhijiedazhangguoshoushuhuanzhedewaicengrenwumao、kouzhao、shoutao、xietao、fanghufudengjunshiweijinghuawu,wubiliuzaishoushujiandezhidingdiwei,tongyicuozhi,qiebukejinghuadazhongdiyu。

 

5  增强患者收治的照顾护士办理及安康教导任务

5.1  yihudiaohe,zuohaohuanzheshouzhirenwu

youxianshouzhiqiuzhugaojizhongzhenghuanzhe,ruhelianbuneishang、helianbukongxichuanran、weizhongexingkouqiangzhongliuhuanzhe。tongsuzeqishoushuhuanzhe,ruchunelie、tongsuliangxingzhongliu、zhengheneikeshoushuhuanzhechangyizanhuanshouzhi。

zhibanhushizuohaohuanzhedeyudingguahaoyuquanshirenwu,gongdao、linghuodiaojishouzhihuanzhe。hushizaihuanzhechuyuanqianjingyouguochengdelvfengkouwenhuanzhejijiajuanyoumeiyoufashao、kesoudengbingzheng,youmeiyoudazhangyiqushihewaichushideng,zuohaochuyuanqiandeshaicharenwu。

huanzhechuyuandangriyankuanzhaoyingyaappguanwangxiazaisanjiyujianfenjianguizhitingzhixiangyingshaicha,fenjianshaichahouwufeichangfangkechuyuan。chuyuanhouyiwuhushixuyaozaicijutikouwenhuanzhejijiajuanyoumeiyoufashao、kesoudengbingzheng,youmeiyoufengxingbingxueshideng。

zhuguandafuyankuanzhaoqingqiu,shuqianzengqiangduihuanzhefeibuyingxiangxuedechachao,tongshicunjuanxueguanlimubiaodebiangeng,zuohaoshaicharenwu。

5.2  zuohaozhuyuanhuanzhejijiajuandeankangxuanjiaorenwu

bingfangzaiguanlichuyuanxuanjiaodegenbenshangzengtianlexinxingguanzhuangbingdufeiyanfangzhidexiangganxuanjiao。jianzao《xinxingguanzhuangbingdufeiyanwenxinfenggaoshu》bingqingqiuhuanzhejijiajuanjuming,gaifenggaoshudeneirongbaohan:1)chuyuanhouqingzifapeidaikouzhao,shishi1chuang1peihudeguizhi;2)yingshishizidongxiangyiwuzhiyuanbaogaotiwenfeichangheyiqujiaowang、keyixinxingguanzhuangbingduchuanranhuanzhedazhangshidenghuanjing,zidongjieguanyiwuzhiyuandeshaicha、zhenliaochangyihezhipei[4];3)zhuyuanshidaiqinxishou、qinxilian、qinhuanyi,duoyinshui,fangjiankaichuangtoufeng,baozhangchongpeixiexi,duizhipingdan、gaoluanbaiyinshi,jinbumianyili[5];4)dingshijiancetiwen,ruotiwenkuayue37.3℃,xushishifenggaoyihuzhiyuan。

 

6  luoshibingzengqiangkouqianghemianneikehuanzhehanjianjujiazhaoguhushixuanjiao

1)yinshizhaoguhushi:anzhaobenshenhuanjingjinshiliuzhi、banliuzhihuoruanshi,fangzhijinshixinla、guotang、guoyingdeshipin。2)shangkouzhaoguhushi:shuhoushangkoutongsu7~10 dchaixian,ruoshangkouyoufeichang,keshishijieqiaguanchuangdafuhuohushi。3)bingyulianxi:anqingqiutingzhixiangyingdebingyulianxi,ruzhangkoulianxi、tunyangongxiaolianxi、jianjinggongxiaolianxi、xiazhibingyuzhidianlianxideng。4)baozhangyangfen、jiuqinchongpei,duizhiaolian,duoyinshui,zengtiandidangli。5)xuejianwaichu,fangzhidaofengsuo、fenweibuchangtongdedazhongchangsuoherenliumijidiyu,jinnenggoubuchengzuodazhongjiaotongdongxi,bujihui;tebiehuanjingbixuwaichushi,yingdaikouzhao,waichuhoushishixishou、xilian,gaihuanyifu[4,6]。6)ruoyoufashaoheqiyuhuxidaochuanranbingzhengqingshishijiuzhi。

 

7  cankaowenxian(lve)

 

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