在线QQ: 五斗堂面馆
    专题栏目
    专业术语
    ISPN词汇 小儿血液系统疾病
    ISPN词汇 小儿肌肉骨骼系统疾病
    出国资讯
    美国宣布重大移民改革议案取消公民...
    2017美国护士薪资调查报告新鲜出炉
    医护前沿
    《ISPN学习》总第506期
    《ISPN学习》总第505期
     
    当前位置:首页 > ISPN学习
    《ISPN学习》总第514期
    日期:2019-07-26 08:29:39    




    《ISPN学习》2019年07月24日总第514期
     
    相识是缘,相知是福;
    风雨兼程,不忘初心;
    有您相伴,奥医感恩。
     
    From the Programs
    From the Programs [课程选粹]栏目登载奥医网站课程材料精选,旨在帮助读者了解奥医ISPN/NCLEX-RN考试复习课程内容,并加深对考试相关内容的学习、掌握[课程详情见网站或点击阅读原文]您的需要就是我们的努力方向。谢谢)

    RN-ISPN综合复习课程上线
    《RN-ISPN综合复习讲座》4月15日起陆续上线,每周两讲,预计11月底完成。有需要者请联系ISPN周老师咨询、报名,并感谢各位向有需要的亲朋好友推荐本讲座。详情请登录网站(www.omedin.com)“备考资讯”栏目查询、试听。相关介绍在QQ群“国际护士ISPN”(群号:384099249)及微信公众号ISPN周老师(ISPN-CG)同步发布。谢谢!
      
     
    想提高专业英语听力吗?想边练听力边增加护理专业知识吗?Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。
     
     
    ISPN  Review        
     
    Nursing Considerations for Patients Receiving Carbapenems
    碳青霉烯类药使用患者的护理考虑
     
    Assessment: History and Examination
    评估:病史和检查
     
    • Assess for possible contraindications or cautions: known allergy to any carbapenem or beta-lactam (obtain specific information about the nature and occurrence of allergic reactions); history of renal disease; history of seizures and current pregnancy or lactation status.
     
    评估可能的禁忌症或注意事项:已知的碳青霉烯类药或β-内酰胺过敏(获取有关过敏反应性质及发生的具体信息);肾病病史;癫痫病史及当前妊娠或哺乳状况。
     
    • Perform physical assessment to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
     
    进行身体评估,确认评估药物效果及药物疗法相关不良效应发生情况的基线数据。
     
    • Perform culture and sensitivity tests at the site of infection.
     
    进行感染部位细菌培养和敏感性试验。
     
    • Conduct orientation and reflex assessment to evaluate any CNS effects of the drug.
     
    进行定向和反射评估,评价药物的CNS效应。
     
    • Assess vital signs: respiratory rate and adventitious sounds to monitor for signs of infection or hypersensitivity reactions; temperature to assess for signs and symptoms of infection.
     
    评估生命体征:呼吸率和附加音,监测感染或超敏反应体征;体温,评估感染体征和症状。
     
    • Perform renal function tests to determine baseline function of the kidneys and, possibly, the need to adjust dose.
     
    进行肾功能试验,确定肾基线功能,可能的话,评估是否需要高速剂量。
     
    Nursing Diagnoses
    护理诊断
     
    Nursing diagnoses related to drug therapy might include the following:
    • Acute Pain related to GI or CNS effects of the drug
    • Risk for Infection related to loss of normal flora
    • Deficient Knowledge regarding drug therapy
     
    药物疗法相关护理诊断可能包括下列:
    •急性疼痛,与药物的GI或CNS效应相关
    •感染风险,与正常菌群丧失相关
    •药物疗法知识缺乏
     
    Implementation With Rationale
    实施及原理说明
     
    • Check culture and sensitivity reports to ensure that this is the drug of choice for this patient.
     
    检查细菌培养和敏感性试验报告,确保该药为该患者首选。
     
    • Ensure that the patient receives the full course of the carbapenem as prescribed to increase effectiveness and decrease the risk for the development of resistant strains of bacteria.
     
    保证患者按处方服完完整疗程,增强有效性,降低抗药性菌株出现风险。
     
    • Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site. Arrange to continue drug therapy for at least 2 days after all signs and symptoms resolve to decrease the development of resistant strains of bacteria.
     
    监测药物疗程期间感染部位及呈现的体征和症状(如发烧、倦怠)。若这些体征症状未能消退,可能提示需要再行部位细菌培养。安排体征和症状消失后再继续至少2天的药物治疗,以减少抗药菌株出现。
     
    • Monitor the patient regularly for signs of pseudomembranous colitis, severe diarrhea, or superinfections to effectively arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs.
     
    如出现上述毒性现象,应定期检查患者的假膜性结肠炎、严重腹泻或二重感染体征,有效安排停药或减少剂量,
     
    • Provide safety measures to protect the patient if CNS effects, such as confusion, dizziness, or seizures, occur.
     
    若出现CNS效应,如意识不清、头晕、癫痫,要做好安全措施,保护患者。
     
    • Provide small, frequent meals as tolerated to relieve GI discomfort. Also provide adequate fluids to replace fluid lost with diarrhea, if appropriate.
     
    耐受时,少量多餐,减轻GI不适。适当时,液体充分,补充腹泻引起的液体丢失。
     
    • Ensure that patient is hydrated at all times during drug therapy to minimize renal toxicity from drug exposure.
     
    药物治疗期,确保患者随时水化,尽量减轻药物使用引起的肾毒性。
     
    • Instruct the patient about the appropriate dosage regimen and possible adverse effects to enhance patient knowledge about drug therapy and to promote compliance.
     
    指导患者适当用药,注意可能的不良效应,强化患者药物疗法知识,促进患者顺从性。
     
    • Provide the following patient teaching:
    • Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur.
    • Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur.
    • Report difficulty breathing, severe headache, severe diarrhea, fever, and signs of infection.
     
    患者教育包括:
    如果出现CNS效应,应采取安全措施,如慢慢体位变换,避免驾驶及危险任务
    尽量多喝水,尽量维持营养(很重要),即使可能出现恶心、呕吐、腹泻等情况
    呼吸困难、剧烈头痛、腹泻严重、发烧、出现感染体征等,应报告。
     
    Evaluation
    评价
     
    • Monitor patient response to the drug (resolution of bacterial infection).
    • Monitor for adverse effects (orientation and effect, superinfections, GI toxicity, severe diarrhea effects).
    • Evaluate effectiveness of the teaching plan (patient can name drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects).
    • Monitor effectiveness of comfort and safety measures and compliance with the therapeutic regimen.
     
    监测患者对药物的响应情况(细菌性感染消退)
    监测有无不良效应(定向力、效应,二重感染,GI毒性,严重腹泻)
    评价患者宣教的有效性(患者可以说出药物名称、剂量、需要注意的不良效应,有助于避免不良效应的具体措施)
    监测安慰和安全措施的有效性及对治疗方案的顺从性
     
     
    Vocabulary for Today    
     
    carbapenem – n. 碳青霉烯
    beta-lactam – n. β-内酰胺
    reculture – v. 再培养
    pseudomembranous colitis – 假膜性结肠炎
     
    尽快地从茫然中理清复习思路,准确地抓住复习重点,这是每一个考试复习者的一大愿望。“ISPN考试复习要点提示”即是帮您实现这一愿望的利器!该教程已在www.omedin.com陆续上线。
     
     
    Video            
    Antibiotic Therapy 2
     
    Test                 
    1. Before administering intravenous (IV) penicillin, the nurse should do what?
    A. Flush the IV site with normal saline.
    B. Assess the patient for allergies.
    C. Review the patient's intake and output record.
    D. Determine the latest creatinine clearance result.
    2. Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first?
    A. Elevate the lower legs.
    B. Place an ice pack on the site.
    C. Make sure the patient stays calm.
    D. Administer subcutaneous epinephrine.
     
    (本期答案见页底)
     
    奥医教育“在线自测”正式上线,复习练习、效果检验,奥医NCLEX-RN/ISPN题库一站完成。需要就来www.omedin.com
     
     
    本期ISPN Review答案
    1. B. Assess the patient for allergies
    The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.
     
    2. D. Administer subcutaneous epinephrine
    Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.




    上一篇:《ISPN学习》总第513期
    下一篇:《ISPN学习》总第515期