护患情境会话

重症肝炎病人的意识评估

Evaluating the Level of Consciousness for a Patient with Severe Hepatitis

交流

护士：好的，你做得不错，接下来，我们来做几道算术题好吗？

病人：你把我当成小朋友啦（笑着说），那好吧。

护士：3＋7等于多少？

病人：等于10。

护士：13＋18等于多少？

病人：等于20。（老张想了一会儿）

护士：6＋7等于多少？

病人：等于10。

护士：好的老张，你答得不错，现在你先休息。等一下我会来给你抽一个血，做一些化验。

病人：谢谢你，小林。

Interactions

Interactions

(2) 在运营线路之间应设置联通线，联通线宜采用互通道岔连接接轨站。接轨站的配线应保证进站车辆不会因进站进路被占用而停在交叉口范围内，车站与交叉口之间的距离应不小于1倍车辆长度。

Nurse：Good，you did well.Now let us do some math problems，OK？

Patient：You are treating me as a child（He said with a smile），OK please.

Nurse：What is 3plus 7？

Patient：10.

Nurse：What is 13plus 18？

Patient：20.（He thought for a few seconds）

Nurse：What is 6plus 7？

Patient：10.

Nurse：OK，Mr.Zhang，your answers are fine，and take a rest now.I will draw some blood from you shortly so we can run some tests for you.

结果

护士观察到病人有性格改变、计算能力下降，并出现扑翼样震颤，结合病人有便秘、高蛋白饮食，测血氨高于正常范围，初步确认病人处于肝昏迷前驱期。立即汇报医生，经降血氨、灌肠、禁食蛋白质等及时治疗后，病人精神神经系统症状好转，血氨恢复正常，避免了肝昏迷的发生。

Result

The nurse detected the changes of the patient’s character，declining computing power，and having flipping tremor.Combining the patient’s constipation，high protein diet，and his elevated blood ammonia level，she affirmed that the patient was in the prodromal stage of liver coma and reported it to the doctor at once.With prompt treatments such as decreasing the level of blood ammonia，enema，stopping high protein diet，the patient’s neural symptom took a turn for the better and the occurrence of liver coma was avoided.

点评

观察是一种有目的、有计划、比较持久的知觉。敏锐的观察能力是护士必须具备的品质之一，源于注意、记忆、分析、判断等心理活动的综合应用。护理人员在工作中，必须养成运用视、听、触、嗅等感官，随时有目的地、系统地感知护理对象的动作、表情、言语等外显行为所提示的内在变化，正确认识和判断他们的需求，使护理措施有预期的主动性。

Comments

Observation is a purposive，planned and persistent perception.Keen observation is one of the necessary characters that nurses must have.It is stemmed from integrated application of mental activities such as attention，memory，analysis and judgment.Nurses must use all their sensory organs at all times to form a habit of planned and systematic perception to their patients’internal changes that can be tracked from the patients’external behaviors like actions，emotions，speeches，etc.They must correctly understand and evaluate the patients’needs，and make nursing care with proactive interventions.