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    《ISPN学习》总第506期
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    《ISPN学习》总第687期
    日期:2020-09-28 10:25:00    
     
    《ISPN学习》2020年09月28日总第687期
     
      ISPN  Review  
     
    Local Anesthesia  局部麻醉

    Local anesthesia refers to a loss of sensation in limited areas of the body. Local anesthesia can be achieved by several different methods: Topical administration, infiltration, field block, nerve block, and intravenous regional anesthesia.
    局部麻醉指身体限定区域知觉丧失。可通过多种不同方法获得局部麻醉:局部投药、浸润、区域阻滞、神经传导阻滞、静脉局部麻醉。

    Topical Administration 局部投药

    Topical local anesthesia involves the application of a cream, lotion, ointment, or drop of a local anesthetic to traumatized skin to relieve pain. It can also involve applying these forms to the mucous membranes in the eye, nose, throat, mouth, urethra, anus, or rectum to relieve pain or to anesthetize the area to facilitate a medical procedure. Although systemic absorption is rare with topical application, it can occur if there is damage or breakdown of the tissues in the area.

    表面局部麻醉就是将局部麻醉用乳膏、药水、软膏或滴剂施于创伤皮肤从而减轻疼痛。也可以将上述麻醉剂型用于眼睛、鼻子、咽喉、口腔、尿道、肛门或直肠以减轻疼痛或麻木局部区域以方便医疗操作。虽然局部用药极少出现系统性吸收,但是,如果该区域组织出现破坏或破损,也有可能出现系统性吸收。

    Infiltration 浸润

    Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain.
    浸润局部麻醉是将麻醉药直接注入准备治疗的组织(如,缝合、钻孔、切开)。注射后,麻醉剂接触该区域神经末梢,阻止其将神经冲动传递给大脑。

    Field Block 区域阻滞

    Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions.
    区域阻滞型局部麻醉就是将麻醉剂注入所在区域,该麻醉受操作或手术影响。其麻醉效果强于浸润,因为麻醉药接触的是该区域的所有神经末梢。该型阻滞经常用于拔牙。

    Nerve Block 神经传导阻滞

    Nerve block local anesthesia involves injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. These blocks are performed not in the surgical field, but at some distance from the field. They involve a greater area with potential for more adverse effects.

    神经传导阻滞型局部麻醉则是将麻醉药注入某条神经或穿行于需要疼痛知觉丧失或肌肉麻痹的区域神经的特定位点。这种阻滞不直接施行于手术区内,而是离手术区域一定距离的某个地方。

    Several types of nerve blocks are possible: 神经传导阻滞型麻醉包括:

    • Peripheral nerve block: Blockage of the sensory and motor aspects of a particular nerve for relief of pain or for diagnostic purposes.
    • 周围神经传导阻滞:阻断特定神经的感觉和运动功能,减轻疼痛或用于诊断
    • Central nerve block: Injection of anesthetic into the roots of the nerves in the spinal cord.
    • 中枢神经传导阻滞:将麻醉药注入脊髓神经根
    • Epidural anesthesia: Injection of the drug into the epidural space where the nerves emerge from the spinal cord.
    • 硬膜外麻醉:将药物注入脊髓神经出现的硬膜外腔,
    • Caudal block: Injection of anesthetic into the sacral canal, below the epidural area.
    • 骶管阻滞:将麻醉药注入硬膜区域下方的骶管
    • Spinal anesthesia: Injection of anesthetic into the spinal subarachnoid space.
    • 脊椎麻醉:将麻醉药注入脊髓蛛网膜下腔
    Intravenous Regional Local Anesthesia 静脉局部麻醉

    Intravenous regional local anesthesia involves carefully draining all of the blood from the patient’s arm or leg, securing a tourniquet to prevent the anesthetic from entering the general circulation, and then injecting the anesthetic into the vein of the arm or leg. This technique is used for very specific surgical procedures.

    静脉局部麻醉涉及小心排出患者手臂或腿的血液、扎上止血带以防止麻醉药进入全身循环、然后将麻醉药注入手臂或腿的静脉。这一技术用于极特异性手术操作。


    Vocabulary for Today   
     
    local anesthesia – 局部麻醉
    infiltration – n. 浸润
    field block – 区域阻滞
    nerve block – 神经传导阻滞
    topical anesthesia – 表面麻醉
    anesthetize – v. 麻醉,使麻木
    paralysis – n. 麻痹,瘫痪
    surgical field – 术野,手术区域
    peripheral nerve block – 周围神经传导阻滞
    central nerve block -- 中枢神经传导阻滞
    epidural – a. 硬膜外的
    epidural anesthesia -- 硬膜外麻醉
    caudal – a. 尾部的
    caudal block -- 骶管阻滞
    spinal anesthesia -- 脊椎麻醉
    subarachnoid space -- 蛛网膜下腔

     
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    Video  
     
    Local Anesthetics
     
     
    Test  
     
    1. When administering codeine, the nurse should be aware that:
    A. Codeine produces more sedation than other opiates.
    B. Codeine causes diarrhea, so the client must take an additional drug to prevent this.
    C. Codeine is very constipating.
    D. Codeine is an antitussive in high doses.
    2. The client asks the nurse to explain the action of infiltration anesthesia. The nurse’s response is based on the knowledge that infiltration anesthesia:
    A. Is applied only to mucous membranes to provide local anesthesia.
    B. Blocks a specific group of nerves in tissues close to the operative area.
    C. Blocks sensation to an entire limb, or a large area of the face.
    D. Produces numbing to large, regional areas such as the lower abdomen and legs.

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    答案 Answers
     
    1. C. Codeine is very constipating
    Rationale: Codeine is very constipating, so the client’s diet should include foods that fight constipation, such as water, fruits, and vegetables.
    2. B. Blocks a specific group of nerves in tissues close to the operative area.
    Rationale: Infiltration anesthesia blocks a specific group of nerves close to the operative area by diffusion of a drug into the tissues. It is used to anesthetize small areas. Topical anesthetics are applied to mucous membranes. Nerve blocks provide anesthesia to a large surface area. Spinal anesthesia affects large, regional areas.

     
     

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