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Yolanda♬ 【我们都是夜护侠】护理英语系列之⑧护理交班⑵
Just for Fun
片段讲解秀
from:《蒙娜丽莎的微笑》
✍✍✍DIL case✍✍✍
● Bed 10,Wang Hua,coronary heart disease,angina pectoris,acute extensive
anterior moyocardial infarction.The patient suddenly complained of chest pain at 22:30
● Oxygen was given immediately and the flow rate was 3L/min.ECG monitoring was started and showed sinus rhythm.
10床,王华,冠心病,心绞痛,急性广泛前壁心肌梗死,昨天22:30病人主诉心前区疼痛,立即给予吸氧3L/分,心电监护,心电示波示窦性心律。
● The heart rate was 63 beats/min.Bp was 115/64mmHg.Meanwhile Dr.Zhang Xue was informed.
● After taking 3 tablets of introglycerin sublingually at 5 minute intervals as indicated,the pain was persistent.The ECG showed the 0.2-0.6mv of elevated V1-V5 St segment.Dr.Zhao Yong saw the patient.
心率63次/分,血压115/64mmHg,通知张学医生看病人,遵医嘱给予硝酸甘油3mg舌下含服,症状无缓解,行床旁心电图检查示V1-V5ST段抬高0.2-0.6mv,二线赵勇副主任医师到场看病人。
● Heparin 100mg in normal saline 500ml and Dopamine 80mg in normal saline 500ml were give by IV infusion.The drop rate were 500u/h and 1.5ug/kg/min respectively.The patient was DIL.
遵医嘱给予静脉输入生理盐水500ml+肝素钠注射液100mg,滴速为500u/h,生理盐水250ml多巴胺注射液80mg,滴速1.5ug/kg/min,报病危。
● Iv infusion were kept patent.The patient slept intermittently in the evening.The ECG showed sinus rhythm.The heart rate was at range of 63-74beats/min and Bp was 91-115/53-64mmHg.The patient was turned every 2 hours and now is on supine(prone,lateral,Fowler's,semi-Fowler's)position.
夜班输液通畅,患者间断睡眠,心电示波呈窦性心律,心率波动在63-74次/分,血压波动在91-115/53-64mmHg.每两小时翻身一次,现病人平卧位(俯卧位、侧位、半卧位、较低半卧位)。
● The skin was integrity.The total input was 400ml and the output was 300ml.
患者皮肤无破损,全天入量400ml,尿量300ml。