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疾病护理常规

2017-10-13 50页 doc 181KB 22阅读

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疾病护理常规疾病护理常规 慢性阻塞性肺疾病病人的护理 1. 一般护理 室内保持合适的温湿度,冬季注意保暖,避免直接吸入冷空气。 病人采取舒适的体位,晚期病人宜采取身体前倾位,使辅助呼吸机参与呼吸。 视病情安排适量的活动量,活动以不感到疲劳、不加重症状为宜。 2. 饮食 高热量、高蛋白、高维生素的饮食,在病人最饥饿和休息最好的时候 进餐,餐前休息至少30分钟,餐前和进餐时避免过多饮水,餐前和咳嗽后漱 口,餐后避免平卧。避免进食产气或引起便秘的食物。 3. 病情观察 观察咳嗽、咳痰、痰液的色、量及性状,咳痰是否通畅;呼吸困 难的程度,监...
疾病护理常规
疾病护理常规 慢性阻塞性肺疾病病人的护理 1. 一般护理 室内保持合适的温湿度,冬季注意保暖,避免直接吸入冷空气。 病人采取舒适的体位,晚期病人宜采取身体前倾位,使辅助呼吸机参与呼吸。 视病情安排适量的活动量,活动以不感到疲劳、不加重症状为宜。 2. 饮食 高热量、高蛋白、高维生素的饮食,在病人最饥饿和休息最好的时候 进餐,餐前休息至少30分钟,餐前和进餐时避免过多饮水,餐前和咳嗽后漱 口,餐后避免平卧。避免进食产气或引起便秘的食物。 3. 病情观察 观察咳嗽、咳痰、痰液的色、量及性状,咳痰是否通畅;呼吸困 难的程度,监测动脉血气分析和水、电解质、酸碱平衡情况。 4. 促进排痰 指导病人多饮水或超声雾化吸入湿化气道,协助病人胸部叩击和 体位引流,指导病人有效咳痰,如晨起时或就寝前咳嗽时,病人取坐位,头 略前倾,双肩放松、曲膝、前臂垫枕,如有可能应使双足着地,有利于胸腔 的扩展,增加咳痰的有效性。咳痰后恢复坐位,进行放松性深呼吸。COPD 病人容易疲劳,充分休息对有效咳嗽十分必要。 5. 氧疗护理 呼吸困难伴低氧血症者,遵医嘱给予长期持续低流量吸氧。密切 注意病人吸氧后的变化,如观察病人的意识状态、呼吸的情况和动脉血气结 果。 6. 用药护理 遵医嘱应用抗生素、支气管舒张药和祛痰药物,注意观察疗效及 不良反应。?止咳药:可待因有麻醉性中枢镇咳作用,用于剧烈干咳者,有 恶心、 呕吐、便秘等不良反应,可能会成瘾。?祛痰药:盐酸氨溴索是润 滑性祛痰药,不良反应轻,用于痰液较多或年老体弱、无力咳痰者。尽量避 免使用可待因,因其抑制中枢和加重呼吸道阻塞和炎症。 7. 呼吸功能锻炼 指导病人进行缩唇呼气或腹式呼吸,加强呼吸肌肌力和耐力, 改善呼吸功能。缩唇呼吸和腹式呼吸每日训练3,4次,每次重复8,10次。 (1)缩唇呼吸:病人闭嘴经鼻吸气,然后通过缩唇(吹口哨样)缓慢呼气, 同时收缩腹部。吸气和呼气时间比为1:2或1:3。缩唇大小程度与呼气流 量,以能使距口唇15,20cm处,与口唇等高点水平的蜡烛火焰随气流倾斜 又不至于熄灭为宜。 (2)膈式或腹式呼吸:病人可取立位、平卧位或半卧位,两手分别放于前胸 部和上腹部。用鼻缓慢吸气时,膈肌最大幅度下降,腹肌松弛,腹部凸出, 手感到腹部向上抬起。呼气时用口呼出,腹肌收缩,膈肌松弛,膈肌随腹腔 内压增加而上台,推动肺部气体排出,手感到腹部下降。 支气管哮喘病人的护理 1. 一般护理 保持室内空气流通、新鲜、温湿度适宜,不摆放花草及使用羽毛 枕头,避免尘埃飞扬。发作时,协助病人取半卧位或坐位,于床旁小桌伏案 休息。保持皮肤的清洁、干燥和舒适,保持口腔清洁。 2. 饮食护理 清淡、易消化、足够热量,高维生素的流质或半流质饮食为主, 避免硬、冷、油煎食物,避免食用与哮喘有关的食物如鱼、虾、蟹、牛奶, 注意食物添加剂如酒石黄和亚硝酸盐,戒烟酒,保持大便通畅,多饮水。 3. 氧疗护理 给予鼻导管或面罩吸氧,吸氧流量为1,3L?min,吸氧时注意呼 吸道湿化、保暖和通畅,必要时行机械通气。 4. 病情观察 观察哮喘发作的前驱症状如鼻咽痒、喷嚏、流涕、眼痒等。哮喘 发作时,观察病人意识状态、呼吸频率、节律、深度等,监测呼吸音和哮鸣 音变化,监测动脉血气分析和肺功能情况,了解治疗效果。哮喘严重发作时 加强对病人的监护。 5. 用药护理 观察用受体激动剂:不宜长期、规律、单一、大量使用,不良反 应有心悸、骨骼肌震颤、低血钾等。 6. 药疗效和不良反应 (1) β2受体激动剂:不宜长期、规律、单一、大量使用,不良反应有心悸、 骨骼肌震颤、低血钾等。 (2) 茶碱类:静注时浓度不宜过高、速度不宜过快、注射时间在10分钟以 上,药物不良反应有恶心、呕吐、心律失常、血压下降和兴奋呼吸中枢, 与西米替丁、喹诺酮类、大环内酯类合用可减慢茶碱代谢。 (3) 糖皮质激素:吸入药物的不良反应为口腔念珠菌感染、声音嘶哑或呼吸 道不适等,应指导病人喷药后立即用清水反复漱口;口服激素宜在饭后 服用,以减少对胃肠道的刺激;静滴激素时,密切观察是否有消化道出 血。激素的用量应按医嘱逐渐减量,病人不可自行停药或减量 呼吸衰竭病人的护理 1、休息与活动 一般呼吸衰竭的病人去半卧位或坐位,趴伏在床桌上,并尽量减少自理活动和不必要的操作。 2、氧疗 根据基础疾病、呼吸衰竭的类型和缺氧的严重程度选择适当的给氧方法和吸入氧分数。 (1)浓度:?型呼吸衰竭给予有较高浓度(,35%)吸氧,使PaO提高到60,280mmHg或SaO>90%。?型呼吸衰竭在PaO<60mmHg时才开始氧疗,给予低22 浓度(<35%)持续吸氧,使PaO控制在60mmHg或SaO在90%或略高,以防22 因缺氧完全纠正,使外周化学感受器失去低氧血症的刺激而导致呼吸抑制,反而会导致呼吸频率和幅度降低,加重缺氧和CO潴留。 2 (2)方法:轻度呼吸衰竭和?型呼吸衰竭的病人可用鼻导管和鼻塞给氧。严重低氧血症和呼吸状态不稳定的?型呼吸衰竭病人可用普通面罩或无重复呼吸面罩给氧。COPD引起的呼吸衰竭最适用文丘里面罩给氧。 (3)观察效果:呼吸困难缓解、发绀减轻、心率减慢,表示氧疗有效。意识障碍加深或呼吸过度表浅、缓慢,可能为CO潴留加重。应根据动脉血气分析结2 果和病人的临床表现,及时调整吸氧流量,保证氧疗效果,防止氧中毒和CO2麻醉。 (4)注意事项:保持吸入氧气湿化,吸氧管道、面罩妥善固定、通畅、清洁,定期更换消毒,防止交叉感染。 3、保持呼吸道通畅,促进痰液引流 指导并协助病人有效咳嗽和咳痰。每1,2小时翻身和扣背一次。病情严重和意识不清的病人,应取仰卧位、头后仰、托起下颏,用多孔导管经鼻或经口进行机械吸痰。饮水、口服或雾化吸入祛痰药。注意观察痰的色、质、量、味及检验结果,并及时做好记录。 4、 病情监测 收住ICU进行密切监护,严密监测呼吸状况、缺氧和CO潴留2情况、循环状况、意识状态及神经精神症状、体液平衡状态、实验室检查结果。 5、 用药护理 按医嘱及时准确给药,观察疗效及不良反应。应用呼吸兴奋剂,应保持呼吸道通畅,适当提高吸入氧浓度,静滴时不宜速度过快,注意观察神志、呼吸频率和节律、动脉血气的变化,若出现恶心、呕吐、烦躁、面色潮红、皮肤瘙痒等现象,应减慢速度并及时通知医生。出现严重不良反应及时停药;?型呼吸衰竭病人禁用对呼吸有抑制作用的药物如吗啡等,慎用其他镇静剂如地西泮等,以防止导致呼吸抑制的严重后果。 6、心理护理 呼吸衰竭的病人预感病情严重,会产生紧张焦虑情绪,了解病人的心理状况,让病人说出或写出引起焦虑的因素,指导病人放松、分散注意力和引导性想象等,缓解病人的紧张和焦虑。 慢性心力衰竭病人的护理 1.休息与活动 保持病室安静、整洁、适当通风。根据病人呼吸困难程度采取适当的体位,严重呼吸困难时,应协助端坐位,必要时双腿下垂,注意病人体位的舒适与安全,必要时加用床档防止坠床。心衰急性加重期应卧床休息。恢复期循序渐进增加活动量,病人活动中有呼吸困难、胸痛、心悸、头晕、疲劳、大汗、低血压等情况时应停止活动。 2.皮肤护理 协助病人更换体位,嘱病人穿质地柔软、宽松的衣服;保持床铺柔软,整洁、严重水肿者可使用气垫床,保持皮肤清洁。 3.饮食 给予低盐、低热量、高蛋白、高维生素的清淡易消化饮食,避免产气的食物及浓茶、咖啡或辛辣刺激性食物,戒烟酒、多吃蔬菜、水果、少量多餐,不宜过饱。限制水分和钠盐的摄入,每天食盐入量在5g以下为宜。 4.氧疗 可给予鼻导管持续吸氧2,4L?min。 5.病情监测 (1)密切观察呼吸困难有无改善,发绀是否减轻,监测血氧饱和度,动脉血气分析结果等。若病情加重或血氧饱和度降低,应医生。 (2)注意观察水肿的消长情况,每日测量体重,准确记录24h出入量,控制输液量及速度,若病人尿量,30ml?h,应报告医生。有腹水者应测量腹围。控制液体摄入量,一般每天入水量限制1500ml以内。 6.用药护理 注意观察不良反应 (1)血管紧张素转换酶抑制剂的不良反应有体位性低血压、皮炎、蛋白尿、咳嗽、间质性肺炎,高钾血症等。 (2)β受体阻滞剂的主要不良反应有液体潴留和心衰恶化、疲乏、心动过缓和心脏传导阻滞、低血压等,应检测心率和血压,当心率低于50次?分,停药。 (3)利尿剂 噻嗪类利尿剂最主要的不良反应是低钾血症,应监测血钾及有无乏力、腹胀、肠鸣音减弱等低钾血症的表现,同时多补充含钾丰富的食物,必要时遵医嘱补充钾盐。口服补钾时间应在饭后或将水剂与国汁同饮,以减轻胃肠道不适。噻嗪类的其他不良反应还有胃部不适、呕吐、腹泻高血糖等。螺内酯的不良反应有嗜睡、运动失调、男性乳房发育、面部多毛等,肾功能不全及高钾血症者禁用。非紧急情况下,利尿剂的应用时间选择早晨或日间为宜,避免夜间排尿过频而影响病人休息。 7.洋地黄中毒的处理 (1)预防洋地黄中毒:?洋地黄用量个体差异很大,老年人、心肌缺血缺氧、严重心力衰竭、低钾低镁血症、肾功能减退等情况对洋地黄较敏感,使用时应严密观察病人用药反应。?严格按时按医嘱给药,教会病人服地高辛时应自测脉搏,当脉搏<60次?分或节律不规则应暂停服药并通知医生;用毛花甙丙或毒毛花甙K时务必稀释后缓慢静脉注射,并同时监测心率、心律及心电图变化。?注意不予维拉帕米、胺碘酮等药物合用,必要时监测血清地高辛浓度。 (2)观察洋地黄毒性反应:胃肠道反应如食欲不振、恶心、呕吐。神经系统表现如头痛、乏力、头晕、黄视、绿视。心脏毒性反应如频发室性期前收缩呈二联律或三联律、心动过缓、房室传导阻滞等。 (3)洋地黄中毒的处理:停用洋地黄、补充钾盐,可口服或静脉补充氯化钾, 停用排钾利尿剂;纠正心律失常,快速性心律失常可用利多卡因或苯妥英纳,心率缓慢者可用阿托品静注或临时心脏起搏器。 7. 心理护理 呼吸困难病人常因日常生活及睡眠受到影响而心情烦躁、痛苦、 焦虑。应予其家属一起安慰鼓励病人,稳定情绪,以降低交感神经兴奋性, 有利于减轻呼吸困难。 心肌梗死病人的护理 1.休息与活动 急性期卧床休息12小时,保持环境安静,减少探视,协助病人进食、洗漱及大小便。如无并发症,24小时床上肢体活动,第三天室内走动,第4,5天逐渐增加活动量,以不感到疲劳为限。有并发症者适当延长卧床时间。 2.饮食指导 进食低盐、低脂、低胆固醇、易消化的食物,少量多餐,不宜过饱。禁烟、酒;避免浓茶、咖啡及过冷、过热、辛辣刺激性食物。 3.保持大便通畅 急性心肌梗塞病人由于卧床休息、进食少、使用吗啡等药物易引起便秘,而排便用力易诱发心力衰竭、肺梗死甚至心脏骤停。 4.病情观察 进行心电、血压监测3,5天,严密监测病人的症状、脉搏、心律、血压及血流动力学改变,及时发现心律失常、休克、心力衰竭等并发症的早期症状。备好各种急救药品和设备。 5.疼痛护理 应及早采取有效的止痛措施。应用杜冷丁等止痛药,给予吸氧,应用硝酸酯类药物。 6.溶栓治疗的护理 溶栓前询问病人有无活动性出血、消化性溃疡、脑血管病、近期手术、外伤史等溶栓禁忌症,检查血小板、出凝血时间和血型,配血;准确配置并输注溶栓药物;用药后询问胸痛有无缓解,监测心肌酶、心电图及出凝血时间,以判断溶栓效果;观察皮肤、粘膜及内脏有无出血。 7.心理护理 急性心肌梗死病人常有焦虑、抑郁、恐惧心理。当病人胸痛发作时,护士应尽量陪伴在病人身边,给予有效的心理支持,介绍治疗方法,解释不良情绪对疾病的负面影响,指导其保持情绪稳定,积极配合治疗。 原发性高血压病人的护理 1.休息与活动 保持病室安静,减少探视。头痛时指导病人卧床休息,抬高床头,避免劳累、情绪激动、精神紧张、吸烟、酗酒、环境嘈杂等。 2.防止低血压反应 指导病人改变体位时动作宜缓慢,避免长时间站立,选择平静休息时服药,避免用过热的水洗澡或蒸汽浴而引起周围血管扩张,防止发生低血压反应。 3.避免受伤 避免迅速改变体位,避免活动场所光线暗、病室内有障碍物、地面滑、厕所无扶手等危险因素,必要时加用床档。病人症状严重时应有人陪伴,防止发生意外。 4.用药护理 正确用药并观察效果。利用利尿剂时应防止低血钾症;用β,受体阻滞剂应注意其抑制心肌收缩力、心动过缓、房室传导时间延长、支气管痉挛、低血糖、血脂升高的不良反应;钙通道阻滞剂硝苯地平的不良反应有头痛、面部潮红、下肢浮肿、心动过速,地尔硫卓可致负性肌力作用和心动过缓;血管紧张素转换酶抑制剂的不良反应主要是刺激性干咳和血管性水肿。 5.心理护理 负性情绪反应可使血压升高,指导病人自我调节,减轻精神压力,避免情绪激动、紧张,保持健康的心理状态。 6.高血压急症的护理 (1)避免诱因:避免情绪激动、过劳和寒冷刺激。必须按医嘱服用降压药,不可擅自增减药量,更不可突然停服,以免血压突然急剧升高。 (2)病情观察:定期监测血压,严密观察病情变化,发现血压急剧升高、剧烈头痛、呕吐、大汗、视力模糊、面色及神志改变、肢体运动障碍等症状,立即通知医生。 (3)一旦发生高血压急症,应立即卧床休息,抬高床头,避免一切不良刺激和不必要的活动,协助生活护理,安定情绪,必要时按医嘱用镇静剂。吸氧,保持呼吸道通畅,持续心电血压监护。 急性胰腺炎病人的护理 1. 休息与体位 重症者绝对卧床休息以减少耗能,取弯腰、屈膝侧卧位以减轻 疼痛或半坐卧位以利于呼吸,因剧痛辗转不安者应防止坠床。 2. 禁食与胃肠减压 重症者多数需禁食1,3天,明显腹胀者行胃肠减压,通过 减少胃酸分泌,进而减少胰腺分泌,缓解腹痛和腹胀。禁食期间注意营养支 持。 3. 止痛 腹痛剧烈者可给哌替啶等,但反复使用易致成瘾。禁用吗啡以防Oddi 扩约肌痉挛而加重病情。注意观察用药前、后病人腹痛有无减轻,性质和特 点有无改变。 4. 病情观察 注意观察生命体征、神志和尿量的变化。观察呕吐物的量和性质。 胃肠减压者,观察和记录引流量及性质。观察病人皮肤粘膜的情况,准确记 录24小时出入量。监测淀粉酶、血糖和电解质的变化。注意失水程度和低血 容量性休克的表现。 上消化道大量出血病人的护理 1.休息与活动 少量出血者应卧床休息,大出血者绝对卧床休息,取平卧位并抬高下肢,呕吐时头偏向一侧,保持呼吸道通畅,必要时吸氧。 2.饮食 急性大出血伴恶心呕吐者应禁食,少量出血无呕吐者进温凉清淡饮食,出血停止后,可逐渐改为半流质、软食,少量多餐,逐步过渡到正常饮食。 3.病情观察 (1) 观察生命体征、精神和意识状态、皮肤、甲床和肢体温度,观察尿量、准 确记录出入量,观察呕吐物和粪便的性质、颜色及量,了解血象、电解质 和血气分析的变化。 (2) 出血量的估计:?大便隐血试验阳性:每天出血量大于5,10ml。?黑便: 出血量在50,70ml以上。?呕血:胃内积血量达250,300ml。?头晕、 心悸、乏力等症状:超过400,500ml。?急性周围循环衰竭甚至失血性 休克:超过1000ml。 (3) 继续出血或再出血的判断:?反复呕血或黑便次数增加,粪质稀薄,血色 转为鲜红或暗红,肠鸣音亢进;?周围循环衰竭的表现经足量补液、输血 后未改善或好转后又恶化,血压波动,中心静脉压不稳定;?红细胞计数、 血红蛋白与红细胞压积继续下降,网织细胞计数持续升高;?足量补液与 尿量正常的情况下,血尿素氮持续或再次升高。 (4) 出血停止的判断:病人脉搏、血压、稳定在正常水平,大便转黄色,提示 出血停止。 4.用药护理 立即建立静脉通道,准确实施输血、输液、止血治疗,输液开始宜快,避免因输液输血过快引起急性肺水肿,肝病病人忌用吗啡等药物,宜输入新鲜血,库存血含氨量高,易诱发脑病。 5.心理护理 观察病人有无紧张、恐惧、悲观等心理反应,关心安慰病人,大出血时陪伴病人,缓解病人情绪。 6.三(四)腔二囊管压迫止血的应用和护理 (1) 置管前:检查管道和气囊通畅无漏气,并做好标记。 (2)置管:插管至65cm时抽出胃液,先向胃囊注气约250,300ml,囊内压约50mmHg(6.7kPa)并封闭管口,缓缓向外牵引管道使胃囊压迫胃底部曲张静脉。如单用胃囊压迫已止血,则食管囊不必充气。如未能止血,继续向食管囊注气80,100ml至囊内压约40mmHg(5.3kPa)并封闭管口,使气囊压迫食管下段的曲张静脉。管外端以绷带连接0.5kg沙袋经牵引架持续牵引。 (3)置管后:气囊充气加压12,24小时应放松牵引,食管囊应放气15,30分钟,同时放松牵引,并将三(四)腔二囊管向胃内送入少许,以解除贲门压力,避免局部黏膜糜烂坏死。如出血未止,再注气加压,以免食管粘膜受压时间过长发生糜烂、坏死。气囊充气不足或破裂时需要及时处理,以免管路上移阻塞喉部引起窒息。 (4)拔管:出血停止后,放松牵引,放出囊内气体,保留管道继续观察24小时,未再出血可考虑拔管,对昏迷病人亦可继续留置管道用于注入留置食物和药液。拔管前口服液体石蜡20,30ml,润滑粘膜及管、囊的外壁,抽尽囊内气体,以缓慢、轻巧的动作拔管。气囊压迫一般以3,4天为限,继续出血者可适当延长。 肾病综合征病人的护理 1.一般护理 严重水肿者卧床休息,抬高下肢,但应保持适度的床上及床旁活动。症状缓解后,可逐步增加活动量。 2.饮食护理 肾功能正常者给予优质蛋白质、高热量、低脂肪饮食,当肾功能不全时应给予优质低蛋白饮食,补充维生素及铁、钙等元素,水肿时应限水。 3.病情观察 注意观察病人水肿程度、生命体征及有无感染征象。 4.用药护理 注意观察利尿剂、激素等药物的不良反应。使用激素时不可擅自减量或停药。 5.皮肤的护理 卧床病人经常变换体位,协助病人翻身,可加用气垫或软垫;衣着柔软、宽松,避免皮肤损伤和感染,尽量避免肌肉注射。 6.预防感染 保持病区环境清洁、舒适,定期做好病室的通风与消毒,减少病区的探访人次,做好防寒保暖,注意个人卫生。 慢性肾衰竭病人的护理 1.休息与活动 注意休息,避免过度劳累,休息与活动量视病情而定。 2.饮食护理 根据肾功能情况调整蛋白质的摄入量,控制水钠的摄入,供给热量充足、富含维生素C、维生素B、叶酸及低磷饮食。采取措施改善病人食欲,加强口腔护理。 3.病情观察 定期监测病人的生命体征、体重变化、血尿素氮、血肌酐、血清清蛋白及血红蛋白水平等。 4.用药护理 注意观察促红细胞生成素、降压药、强心药等药物的不良反应。遵医嘱合理使用肾毒性小的抗炎药物。 5.加强皮肤护理 评估皮肤情况,避免皮肤过于干燥,,勤剪指甲以免抓破皮肤,勤用温水擦洗,注意应用温和的肥皂、沐浴液擦身。水肿者应按水肿的护理要求进行皮肤护理。必要时遵医嘱给予抗组胺类药和炉甘石洗剂等。 6.预防感染 病室定期通风和消毒;严格无菌操作,避免不必要的检查,加强生活护理,卧床病人定期翻身并指导有效咳嗽,指导病人做好防寒保暖,进行乙肝疫苗接种,减少输注血液制品。 贫血病人的护理 (一)休息与活动 指导病人合理休息与活动,轻度贫血可适当活动,中毒或中度贫血应卧床休息。 (二)饮食护理 给予高蛋白、高热量、高维生素、易消化饮食。改变不良的饮食习惯,改善食欲。缺铁性贫血者增加含铁丰富食物如动物肉类、肝脏与血、蛋黄、海带、木耳和铁强化食物等,但不应与减少食物铁吸收或饮料同服(如浓茶、咖啡、牛奶等)。巨幼细胞性贫血者进食富含叶酸和维生素B12的食品,婴幼儿 和妊娠妇女要补充叶酸。 (三)病情观察 观察病人的面色、皮肤和粘膜,以及自觉症状,监测血象等。 (四)用药护理 注意观察疗效和药物不良反应。 1.铁剂 (1)口服铁剂的护理:?口服铁剂最主要的不良反应是恶心、呕吐及胃部不适等胃肠道反应,应饭后或餐中服用,从小剂量开始;?避免与牛奶、茶、咖啡、抗酸药和H受体拮抗剂等同服;?水剂的铁制剂使用吸管,避免牙齿及舌染黑;2 ?向病人解释服药后大便颜色改变,以消除病人顾虑。 (2)防止铁中毒:严格按医嘱服药,注射铁剂时注意铁总量,防止长期服用铁剂或从食物中摄铁过多。 (3)铁剂治疗有效者与用药后1周左右网址红细胞数开始上升,10天左右渐达高峰;2周左右血红蛋白开始升高,约1,2个月恢复至正常。为进一步补充体内储存铁,在血红蛋白恢复正常后,仍需继续服用铁制剂3,6个月,或待血清铁蛋白>50ug?L停药。 2.肌注维生素B偶有过敏反应,甚至休克,要善于观察并及时处理。老年人、12 有心血管疾患和进食量少者,需遵医嘱预防性补钾。 3.丙酸睾酮为油剂,不易吸收,需采取深部缓慢、分层性肌内注射,并应注意注射部位的更换。长期应用雄激素类药物多对肝脏有损害,用药期间应定期检查肝功能。免疫抑制剂治疗过程中可出现超敏反应、出血加重和血清病、继发感染等不良反应,用药期间应注意病情观察。 (五)预防感染 1.预防呼吸道感染 保持病室内空气清新,物品清洁,定期消毒室内。限制探视。 9严格执行无菌。对粒细胞绝对值?0.5×10,L者,有条件者实行保护性隔离。 2.预防口腔感染 加强口腔护理,进餐前后、睡前、晨起应漱口。 3.预防皮肤的感染 保持皮肤清洁,避免抓伤皮肤。肌内、静脉注射或各种损伤性穿刺时,局部要严格消毒。女病人尤其要注意会阴部的清洁。 4.预防肛周的感染 睡前、便后坐浴。保持大便通畅,避免肛裂。 糖尿病病人的护理 (一)饮食护理 1.制定总热量 根据病人性别、年龄和身高算出理想体重,根据理想体重计算每日所需总热量。成人休息状态下每日每公斤理想体重给予热量105,125.5kJ(25,30kcal),轻体力劳动125.5,146kJ(30,35kcal),中度体力劳动146,167kJ(35,40kcal),重体力劳动167kJ(40kcal)以上。儿童、孕妇、乳母、营养不良和消瘦、伴有消耗性疾病者应酌情增加,肥胖者酌减。 2.食物的组成和分配 碳水化合物约占总热量的50%,60%,提倡用粗制米、面和一定量的杂粮;蛋白质一般不超过总热量的15%,成人每日每公斤理想体重0.8,1.2g,儿童、孕妇、乳母、营养不良或伴有消耗性疾病者宜增至1.5,2.0g,伴有肾病者应适当限制蛋白质,其中1?3应来源于动物蛋白;脂肪约占总热量的30%。确定每日饮食的热量和种类后,应定量定时按每日三或四餐分配。 ? 严格定时进食;?控制总热量:当病人出现易饥感时,可3.饮食注意事项 增加蔬菜、豆制品等副食。超重者忌食油炸、油煎食物,炒菜宜用植物油。?限制各种甜食、酒类;少食动物内脏、蟹黄、虾、鱼子等高胆固醇食物;食盐<6gd。?多食豆类、蔬菜、粗谷物、含糖分低的水果等高纤维素;?每周定时定磅秤测量体重一次,如果体重改变>2kg、应报告医生查找原因。 (二)体育锻炼 1.运动的方式 有氧运动最佳,如步行、慢跑、骑自行车、做广播操、太极拳、球类活动等,其中步行安全、易坚持、可作为首选。 2.运动量的选择 合适的运动强度为活动时病人的心率达到同龄正常人最大心率的60%,计算方法为心率=170-年龄。活动时间为20,30分钟,每天一次。 3.运动的注意事项 ?尽量避免恶劣天气,宜在饭后1小时进行;随身携带糖果,当出现饥饿感、心慌、出冷汗、头晕及四肢无力或颤抖时及时食用。?有心肌梗死病史、并发糖尿病肾病及严重微血管病变时应避免剧烈运动,在运动中若出现胸闷、胸痛、视力模糊等应立即停止并及时处理。?运动时随身携带糖尿病卡, 以备急需。?运动后应做好运动日记,以便观察疗效和不良反应。 (三)口服降糖药物护理 指导病人遵医嘱正确服药,观察血糖、尿糖、尿量和体重变化,评价药物疗效,及时纠正不良反应。磺脲类药物应在餐前半小时服用,其主要不良反应是低血糖反应,以及不同程度的胃肠道反应、皮肤瘙痒、胆汁淤滞性黄疸、再生障碍性贫血、溶血性贫血等;双胍类药物应在餐前或餐中服用,其不良反应有口中金属味。恶心、呕吐、腹痛、厌食等;α-葡萄糖苷酶抑制剂应在进食第一口饭时服用,其不良反应为腹胀、腹泻、肠鸣音亢进等。 (四)胰岛素治疗的护理 1.注射时间、部位和方法 普通胰岛素与饭前半小时注射,低精蛋白锌胰岛素在早餐前1小时注射。长、短效胰岛素混合使用时,应先抽短效胰岛素,再抽长效胰岛素,然后混均。胰岛素采用皮下注射法,宜选择上臂三角肌、臀大肌、大腿前侧、腹部等部位,注射部位应交替使用。注射时应严格无菌操作,防止发生感染。 2.胰岛素不良反应的观察及处理 ?低血糖反应是最主要的不良反应,如出现头昏、心悸、多汗、饥饿甚至昏迷等,应及时监测血糖,根据病情进食糖果、含糖饮料或静注50%葡萄糖液20,30ml。?胰岛素过敏,表现为注射部位溃疡,继而出现荨麻疹样皮疹,可伴恶心、呕吐、腹泻等胃肠道症状。立即更换胰岛素制剂种类,严重过敏者需停止或暂时中断胰岛素治疗。?注射部位皮下脂肪萎缩或增生,停止使用该部位后可缓慢自然恢复。 3.使用胰岛素治疗过程中应定期监测血糖、尿糖变化。 (五)预防感染 1.保持皮肤清洁 勤洗澡、勤换衣,选择质地柔软、宽松的内衣;如有皮肤感染,不可任意用药。 2.保持口腔清洁 预防呼吸道感染,重症病人应做好口腔护理。 3.保持会阴清洁 女性病人每次排尿后应用温水清洗外阴部并擦干,减少瘙痒和湿疹发生。对于尿潴留病人,尽量人工诱导排尿,避免导尿,减少感染机会。 (六)足部护理 1.足部观察与检查 每天检查双足一次,观察足部皮肤颜色、温度及足背动脉搏动情况,检查趾甲、趾间、足底部皮肤,了解足部感觉。 2.保持足部清洁 勤换鞋袜,每天清洁足部。皮肤干燥可涂用羊毛脂,但不可常用。修剪趾甲避免太短,应与脚趾平齐。 3.预防外伤 应选择轻巧柔软、前端宽大的鞋子,弹性好、透气及散热性好的棉毛袜子;不要赤脚走路。外出时不可穿拖鞋;冬天使用电热毯或烤灯时谨防烫伤;鸡眼、胼胝、脚癣应及时治疗。 4.促进肢体血液循环 注意保暖,避免长期暴露于寒冷或潮湿环境;经常按摩足部;进行适度的散步、起坐等运动,避免同姿势站立过久和盘腿坐、两腿交叉坐;积极戒烟。 脑梗死病人的护理 1(休息与环境 急性期应卧床休息,病情稳定后,可鼓励病人早期进行肢体活动, 保持环境安静,避免情绪激动。 2.溶栓治疗的护理 严格把握药物剂量,密切观察意识和血压变化。注意监测有无活动性出血,如牙龈和鼻腔黏膜出血、黑便、皮肤青紫和瘀斑。定期监测血小板、出凝血时间、凝血酶原时间等。 3.病情观察 密切观察病人意识、瞳孔、生命体征变化。有无脑疝发生的先兆,评估肢体瘫痪程度,注意观察有无应急性溃疡以及电解质和酸碱度平衡紊乱,备好各种药品和应急设备。 4.饮食护理 给予病人低盐低脂、高营养易消化饮食,不能经口进食者给予鼻饲饮食。少量多餐,避免粗糙、干硬、辛辣等刺激性食物。禁烟酒。 5.保持大便通畅 病人长期卧床,肠蠕动减慢,易引起便秘,必要时给予缓泻剂,如番茄汁、福松等。 6.预防并发症 预防窒息和吸入性肺炎、压疮、泌尿系感染等并发症。 7.康复期护理 ? 保持肢体功能位:防止足下垂、关节强直、肌肉萎缩。?对于失语的病人给予语言功能锻炼,促进语言功能恢复。 8.心理护理 密切观察病人的心理动态变化,尽量满足病人的正常需要,解除其不良情绪,增强病人自我照顾的能力,树立病人战胜疾病的信心。 脑出血病人的护理 1.急性期绝对卧床2,4周,避免搬动,减少颠簸,床头抬高15,30?,以减轻脑水肿。减少探视,避免情绪激动。 2.保持呼吸道通畅 昏迷病人头偏向一侧,随时吸出口腔内分泌物和呕吐物,必要时行气管插管或气管切开,并给予持续低流量吸氧,如有舌后坠可给予口咽导管。 3.病情观察 急性期入重症监护室,给予心电血压血氧监护,严密观察生命体征、意识状态、瞳孔的改变,备好各种急救药品和设备。如高热,可给予物理降温。 、预防并发症 4 (1)预防脑疝发生:给予脱水药物,剂量及时准确。并注意局部血管的观察,防止输液外渗,用药过程中应监测肾功和水电解质平衡。 (2)预防压疮:保持肢体功能位,协助肢体功能锻炼,定时翻身,保持床单位清洁。 (3)预防应激性溃疡 少量多餐,必要时给予保护胃粘膜药物。 (4)预防感染 防止尿路感染和坠积性肺炎的发生。 5.饮食指导 进低盐、低脂、高蛋白、高维生素易消化饮食。如昏迷病人发病72小时给予禁食,3日后给予鼻饲流食。 6.保持大便通畅 必要时给予缓泻剂,避免排便用力引起再出血。 7.心理护理 给予病人讲解疾病相关知识,消除恐惧、紧张情绪,积极配合治疗。 手术前病人的护理 1(护理评估 (1)一般资料:性别、年龄、家族史、既往史、遗传史及生育史等。 (2)现病史及伴随的其他系统疾病。 (3)药物应用情况及过敏史。 (4)病人的营养状态、手术耐受性。 (5)病人对手术的了解程度及心理状况。 2.协助病人做好术前检查,主要包括血常规(包括血型)、尿常规、便常规、出凝血功能、血液生化(包括肝功能、肾功能、电解质及血糖检查等)、肺功能、心电图检查及影像学检查等。 3.术前准备 (1)呼吸道准备:根据病人的手术部位,进行深呼吸和有效排痰的锻炼,如胸部手术者训练腹式呼吸;腹部手术者训练胸式呼吸。深呼吸有效排痰法:先轻咳数次,在深呼吸后用力咳嗽。有吸烟嗜好者,术前两周戒烟。 (2)胃肠道准备:肠道手术者,入院后开始少渣饮食。择期手术者于术前12小时起禁食,4四小时起禁水。除急诊手术者严禁灌肠外,择期手术者应根据手术部位、范围及麻醉方式给予不同的肠道准备。 (3)皮肤准备:充分清洁手术术野皮肤和剔除毛发。皮肤准备时间越接近手术开始时间越好,一般不超过24小时。术前一日,协助病人剪指(趾)甲、沐浴、洗发及更换清洁衣裤。 (4)术前晚保证病人充分休息。睡眠欠佳者,应遵医嘱应用镇静药。 (5)其他准备:药物过敏试验;做好血型鉴定和交叉配血试验;指导病人床上大小便等。 4.术日晨准备 (1)认真检查、确定各项准备工作的落实情况。 (2)若发现病人有不明原因的体温升高,或女性病人月经来潮等情况,及时通知医生。 (3)入手术室前,协助病人排尽尿液。 (4)胃肠道及上腹部手术者应放置止胃管。 (5)嘱病人拭去指甲油、口红等化妆品;取下活动的义齿、发夹、眼镜、手表、首饰和其他贵重物品。 (6)遵医嘱给予术前药物。 (7)备好手术需要的病历、x线片及药品等,随同病人带入手术室。 (8)与手术室接诊人员仔细核对病人、手术部位及名称等,做好交接。 5.手术后用物准备 根据不同部位手术要求,铺好麻醉床,准备术后用物,如吸氧装置、吸引器、胃肠减压器、引流袋及监护仪等。 手术后病人的护理 1.护理评估 (1)手术类型和麻醉方式,术中出血、输血和补液等情况。 2)生病体征、切口状况、引流管,引流物等情况。 ( 2.一般护理 (1)与麻醉师和手术室护士做好床边交接工作。 (2)根据麻醉方式、手术类型,正确安置病人的卧位。全身麻醉尚未清醒着取平卧位,头偏向一侧;椎管内麻醉者,去平卧位6,8小时;局部麻醉者,可视手术和病人需求安置体位。(3)正确连接各引流装置,保证静脉输液通畅,注意保暖。 3.根据手术大小和病情情况,定时监测生命体征。 4.切口护理 观察切口有无出血、渗血、渗液、敷料脱落及局部红、肿、热、痛或波动感等典型体征。若辅料有渗血、渗液、或污染,应及时更换。 5.疼痛护理 (1)正确评估疼痛的性质、部位、时间和程度,一般术后24小时内疼痛最为剧烈,2,3天后逐渐缓解。若疼痛呈持续性或减轻后再次加剧,应警惕切口感染的可能。 (2)有效减轻或缓解病人疼痛。如妥善固定引流,防止牵拉痛;翻身 、深呼吸或咳嗽时,按压切口部位,减轻震动性疼痛;指导病人听音乐等分散注意力;遵医嘱及时应用止痛药等。 6.发热护理 手术后病人的体温升高一般不超过38?.高热者给予物理降温,必要时应用解热镇痛药,并保证足够的液体摄入,协助病人及时更换潮湿衣裤等。 7.饮食护理 视手术和病人的具体情况来确定术后恢复饮食时间。 (1)非消化道手术:局部麻醉后,根据病人需求禁食;蛛网膜下腔和硬膜外腔麻醉术后6小时,病人清醒,无明显恶心、呕吐等不适时可开始进食。 (2)消化道手术:手术后48,72小时禁食,待肠蠕动恢复、肛门排气、胃管拔出后,开始进流质饮食,逐渐过渡到半流质饮食和普食。 8.活动 术后非制动病人应早期下床活动;活动应根据病情轻重和病人的耐受程度循序渐进,一般术后1,2天,开始床上活动,术后3,4天离床活动。 9.引流管道护理 根据不同的需要,术中可在切口、体腔和空腔内脏器官内放置各种类型的引流物。 (1)留置多根引流管者,应区分引流管的引流部位和作用,做好标记并妥善固定。位置不可过高或过低,避免引流管移位、脱出,防止逆行感染。如胸腔引流管的位置不能高于插管入口处的平面;脑室引流管有脑脊液引流时,常抬高引流管位置,切勿过高或过低,以免出现引流不畅或引流过度而至低颅压、抽出和继发出血等。 (2)定时挤压引流管,检查管道有无堵塞或扭曲,保持引流通畅。换药时,协助医生将暴露在体外的管道妥善固定,以防滑入体腔或脱出。若引流不畅,应及时通知医生,查明原因,协助医生给予相应处理。 (3)每天观察并记录引流液的量和性质变化。及时倾倒引流袋的液体,以免因引流袋过重掉落导致引流管脱出。对意识不清醒的病人,必要时采取约束措施,防止意外拔管。 (4)保持引流系统密闭无菌,长期置管的病人,定期更换引流袋或负压吸引器时,严格遵守无菌操作原则(胃管除外)。 (5)对于负压引流管,应观察并调整压力,保证引流治疗效果,如乳腺引流负 压吸引管。 (6)观察引流管处伤口情况,观察周围皮肤有无发红、疼痛、肿胀及渗血深夜等情况,及时发现,及时处理。保持局部清洁,渗液多时,应及时更换敷料。 (7)熟悉不同引流管的拔管指征,做好健康教育。一般切口胶片引流在术后1,2日拔除,烟卷引流在术后7天拔除。 (8)指导病人取合适体位,病人翻身、活动时,应避免牵拉过度而致引流管脱出。 甲状腺腺瘤病人的护理 (一)术前护理 1.完善检查 出术前常规检查和化验检查外,还应包括颈部透视或摄片、心脏检查、喉镜检查、基础代谢率的测定、神经肌肉应激性的检查。 2.药物降低基础代谢率是术前准备的重要环节,待甲亢症状基本控制(病人情绪稳定,睡眠好转,体重增加,脉率稳定在每分钟90以下,脉压恢复正常,基础代谢率+20%以下)即可手术。通常开始即用碘剂,常用复方碘化钾溶液每日3次口服,第一日每次3滴,第二日每次4滴,以后逐日每次增加1滴至每次16滴止,维持此剂量至手术。也可加用硫脲类药物。若常规应用碘剂或合并应用硫脲类药物不能耐受或无反应的病人,可单用普萘洛尔或碘剂合用做术前准备。术前不用阿托品。 3.病人术前需补充足够液体,禁止引用对中枢神经有兴奋作用的浓茶、咖啡等刺激性饮料。 4.术前教会病人头低肩高体位。每日练习用软枕垫高肩部数次。 5.手术当日床旁被引流装置、无菌手套、拆线包及气管切开包等急救物品。 (二)术后护理 1.监测生命体征和病情变化,包括:?监测生命体征,一旦病人脉率过快,体温升高,应警惕甲状腺危象的发生。?严密观察切口渗血情况并记录出血量。?观察并记录引流液量、颜色和性状。?观察病人是否出现音调降低或声音嘶哑。 ?观察病人进食流质饮食后有无呛咳或误咽。?观察病人有无面部、唇部或手足部的针刺样麻木感或强直感。若出现手足抽搐,应限制病人食用肉类、乳品和蛋类等食品。 2.病人全麻清醒,血压平稳后取半卧位。在床上变换体位、起身活动、咳嗽时可用手固定颈部保持头颈部于舒适位置。 3.饮食与营养 术后病人清醒可饮用少量温水或凉水,观察有无呛咳、误咽等现象,若无不适,给予微温流质饮食,逐步过渡到普食。 4.病人术后继续服用复方碘化钾溶液,每日三次,每次10滴,共一周左右;或 由每日3次,每次16滴开始,逐日每次减少1滴,至病情平稳。年轻病人术后常服甲状腺素,每日30,60mg,连服6,12个月。 (三)并发症的观察与护理 1.呼吸困难和窒息 是术后最危急的并发症,常发生于术后48小时内。病人出现进行性呼吸困难、烦躁、发绀,甚至窒息;可有颈部肿胀,切口渗出鲜血等。应立即行床旁抢救,及时剪开缝线,敞开切口,迅速除去血肿,若呼吸困难仍无改善,应立即行气管切开。 2.喉返神经损伤 单侧损伤多引起声音嘶哑;双侧喉返神经损伤导致双侧声带麻痹,引起失音、呼吸困难,甚至窒息。声音嘶哑一般为暂时性,经理疗等处理后,一般在3,6个月内可逐渐恢复。 3.喉上神经损伤 外支损伤,引起声带松弛、音调降低。内支损伤,病人进食特别是饮水时,容易发生误咽、呛咳,一般经理疗后可逐渐恢复。 4.甲状旁腺损伤 多在术后1,2天出现症状。多数病人只有面部、唇部或手足部的针刺样麻木感或强直感,经过2,3周后,症状逐渐消失。严重者可出现面肌和手足伴有疼痛的持续性痉挛,甚至可发生喉和隔肌痉挛,引起窒息死亡。饮食方面应限制肉类、乳品和蛋类等。 5.甲状腺危象 是甲亢的严重并发症。主要表现为:术后12,36小时内高热(〉39?)、脉快而弱(〉120次?分)、大汗、烦躁不安、谵语,甚至昏迷,常伴有呕吐、腹泻等。如处理不及时或不当常很快死亡。处理方法包括吸氧、服用碘剂、应用氢化可的松、肾上腺素能阻滞剂、镇静剂及大量葡萄糖溶液等药物,甚至应 用洋地黄制剂。 乳房癌病人的护理 (一)术前护理 1.妊娠期及哺乳期病人,立即终止妊娠或停止哺乳。 2.晚期病人,保持病灶局部清洁,应用抗生素,控制感染。对于乳头溢液或局部破溃者,及时给予换药,保持局部清洁。 3.术前一日,根据手术切除范围进行皮肤准备。如拟行植皮,应做好供皮区的准备。 4.心理护理 乳房做为女性的性器官,手术切除后不仅影响病人形体的改变,病 人心理将承受严重打击,帮助病人做好充分的心理准备,接受现实,树立战胜疾病的信心。 (二)术后护理 1.麻醉清醒、血压平稳后取半卧位。 2.严密观察生命体征的变化及切口敷料渗血、渗液情况,并准确记录。乳房癌扩大根治术有损伤胸膜的可能,病人若出现胸闷、呼吸困难等症状,及时通知医生,以便早发现和协助处理肺部并发症,如气胸等。 3.有效止痛,鼓励病人深呼吸,有效咳嗽,防止肺部并发症。 4.保持皮瓣供血良好,护理上应 (1)手术部位用弹力绷带加压包扎,防止皮下积液积气。松紧度以容纳一手指、维持正常血运、不影响病人呼吸为宜。 (2)观察皮瓣颜色及创面愈合情况,正常皮瓣的温度较健侧略低,颜色红润,与胸壁紧贴;若皮瓣颜色暗红,则提示血循环欠佳,有坏死的可能。 (3)观察患侧上肢远端血循环情况,若手指发麻,皮肤发绀、皮温下降、动脉搏动不能扪及,提示腋窝部血管受压,应及时调整绷带的松紧度。 (4)弹力绷带加压包扎一般维持7,10日,包扎期间告知病人不可自行松解绷带,瘙痒时不能将手指伸入敷料下抓搔。若绷带松脱,应重新加压包扎。 5.维持有效引流管 术后皮瓣下常规放置负压引流管,护理上应 (1)确保引流连接紧密,保持有效负压。负压过高,引流管瘪陷,引流不畅;负压过低,达不到有效引流目的,易致皮下积液、积血。 (2)妥善固定引流管,长度适宜,卧位时固定于床旁,起床活动时固定于上身衣服。 (3)保持通畅,防止引流管受压和扭曲,如出现局部积液、皮瓣不能紧贴胸壁并有波动感,及时报告医生,协助处理。 (4)观察引流液的量、性质、颜色,注意有无出血。一般术后1,2天,每日血性引流液50,200ml,以后颜色及量逐渐变淡、减少。 (5)一般术后4,5天,引流液的颜色逐渐转为淡黄色,量少于10,15ml,创面与皮肤紧贴,手指按压切口周围的皮肤无空虚感,即可考虑拔管。若拔管后仍 有皮下积液,可在严格消毒后抽液并局部加压包扎。 6(预防患侧上肢肿胀,护理上应 (1)避免患侧上肢测量血压、抽血、做静脉及皮下注射等处置。 (2)抬高患侧上肢,适当运动。平卧位时患侧下方垫枕抬高10,15?,肘关节轻度屈曲;半卧位时屈肘90?放于胸腹部;下床活动时用吊带托或用健侧手将患肢抬高于胸前,需他人扶持时只能扶持健侧,防止腋窝皮瓣滑动而影响愈合,避免患肢下垂过久。 (3)按摩患侧上肢,进行患侧握拳、屈伸肘部运动。 (4)保护患侧上肢,避免意外伤害;患肢负重不宜过大;不宜带首饰或手表。 7.患侧肢体功能锻炼 无特殊情况应早期进行功能锻炼。 (1)术后24小时内,活动手指及腕部,可作伸指、握拳、屈腕等锻炼。 (2)术后1,3天,进行患侧上肢肌肉的等长收缩;可用健侧上肢或在他人协助下进行患侧上肢的屈肘、伸臂等锻炼,逐渐过渡到肩关节的小范围前屈、后伸运动 。 3)术后4,7天,鼓励病人用患侧手进食、梳理头发、洗脸等,并作以患侧手( 触摸对侧肩部及同侧耳朵的锻炼。 (4)术后一周开始作肩关节活动,以肩部为中心,前后摆臂。术后10天左右循 序渐进的作抬高患侧上肢、手指爬墙、梳头等锻炼。 (5)患侧功能锻炼时,锻炼和活动量根据病人的实际情况而定,一般以每日3,4次,每次20,30分钟为宜;应循序渐进,逐渐增加锻炼内容;术后7,10日内不外展肩关节,不以患侧肢体支撑身体。 胃癌病人的护理 (一)术前护理 病人术前应少量多餐,进食高蛋白、高热量、富含维生素、易消化的食物,必要时静脉补充血浆或全血。术前一日进流质饮食。 (二)术后护理 1.一般护理措施 (1)监测生命体征。 (2)病人全麻清醒,血压平稳后取低半卧位。如病情允许,鼓励病人早期活动。 (3)保持胃管与引流管通畅,妥善固定,防止脱出;观察并记录引流管引流物的颜色、性质和量。 (4)根据病人疼痛情况,适当应用止痛药物。 (5)禁食水期间,经静脉补充液体,维持水、电解质平衡并提供必要营养素;准确纪录24小时出入水量,以便保证合理补液;若病人营养状况差或贫血,应补充血浆或全血。 (6)遵医嘱及时应用抗生素,预防感染。 2.饮食护理 进食的原则是少量多餐、循序渐进,定时定量。方法:肠蠕动恢复,肛门排气后可拔除胃管,拔管当日可以饮少量水或米汤;第2日进半量流质饮食,每次50,80ml;如病人无腹痛、腹胀等不适,第3日进全量流质饮食, 150ml,以蛋汤、菜汤、藕粉为宜;第4日可进半流质饮食,以稀饭每次100, 为好,第10,14日可进软食。少进食牛奶、豆类等产气食物,忌生、冷、硬及刺激性食物。每日5,6餐,逐渐减少进食次数并增加每次进餐量,逐渐过渡到正常饮食。全胃切除术后,肠管代胃容量较小,开始全流质饮食时宜少量、清淡 每次饮食后需观察病人有无腹部不适。 (三)并发症的观察与护理 1.术后胃出血 术后短期内从胃管不断吸出大量鲜红色血液,持续不止,应警惕术后出血,立即报告医生。护理方面:?严密观察病人的生命体征及神志情况。?病人禁食,维持适当的胃肠减压的压力。?遵医嘱应用止血药物和输新鲜血等,或用冰生理盐水洗胃。?若经非手术疗法不能有效止血或出血量500mlh时,应行手术止血。 2.胃排空障碍(或称残胃蠕动无力) 常发生于术后7,10天,病人在改为进半流质饮食或不易消化的食物后出现上腹持续性饱胀、钝痛、伴呕吐,呕吐物含有食物和胆汁。多数病人经过禁食、胃肠减压,肠外营养,纠正低蛋白,维持水、 电解质和酸碱平衡、应用促胃动力药物等治疗而好转。 3.胃肠吻合口破裂或瘘 常发生于术后3,7天,表现为体温升高、上腹部疼痛和腹膜刺激症,胃管引流量突然减少而腹腔引流管的引流量突然增加。若病人症状较轻、无弥漫性腹膜炎,可行保守治疗,包括禁食、胃肠减压,充分引流、肠外营养,抗感染等综合治疗,必要实行手术治疗。 4(十二指肠残端破裂 多发生于术后3,7天。表现为突发上腹部剧痛、发热、腹膜刺激症,白细胞计数增加,腹腔穿刺可有胆汁样液体。一旦诊断,应立即手术治疗。 5(倾倒综合征 早期倾倒综合征多发生于进食后30分钟内,表现为心悸、心动过速、出汗、无力、面色苍白等症状,常伴有恶心、呕吐、腹部绞痛、腹泻等消化道症状。多数病人经调整饮食后,症状能减轻或消失。处理方法为少量多餐,避免过甜、过咸、过浓流质食物,进餐后平卧10,20分钟。晚期倾倒综合征多发生于餐后2,4小时,表现为头晕、心慌、无力、出冷汗、脉细弱甚至晕厥,也可导致虚脱。病人进食,尤其是糖类即可缓解。饮食中减少碳水化合物含量,增加蛋白质比例,少量多餐可防止发生。 包括吻合口梗阻和输入袢梗阻、输出袢梗阻。 6.术后梗阻 肠梗阻病人的护理 (一)非手术治疗的护理 1(卧床休息,无休克、生命体征平稳者给予半卧位。 2(病人禁食水、胃肠减压期间,观察胃液的性质和量。当肠梗阻缓解,肠功能恢复,可逐步进流质饮食,忌食产气的甜食和牛奶等。 3(准确纪录24小时的出入液量,结合血清电解质和血气分析结果,合理安排输液种类和调节输液量,维持水、电解质、酸碱平衡。 4.严密观察病情变化 包括病人神志、精神状态、生命体征、呕吐、排气、排便、腹痛、腹胀、腹膜刺激症,肠蠕动情况,观察期间慎用或禁用止痛药,以免掩盖病情。出现下列情况应考虑绞窄性梗阻,及时报告医生。 (1)病情发展迅速,早期出现休克,抗休克治疗后改善不显著。 (2)腹痛发作急剧,起始呈持续性剧烈疼痛,或在阵发性加重之间仍有持续性 疼痛。肠鸣音可不亢进。呕吐出现早、剧烈而频繁。 (3)有明显腹膜刺激症,体温上升、脉率增快、白细胞计数增高。 (4)腹胀不均匀,腹部局部隆起或触及有压痛的肿块(胀大的肠袢)。 (5)呕吐物、胃肠减压液、肛门排除物为血性,或腹腔穿刺抽出血性液体。 (6)经积极的非手术治疗而症状体征无明显改善。 (7)腹部x线检查见孤立、突出胀大的肠袢、不因时间而改变位置,或有假肿瘤庄阴影;或肠间隙增宽,提示有腹腔积液。 5.有效缓解疼痛 (1)禁食水、胃肠减压 92)腹部按摩:对于不完全、痉挛性或单纯蛔虫所致的肠梗阻,可适当顺时针轻柔按摩腹部。 (3)遵医嘱应用解痉剂治疗。 做好术前准备 6. (二)术后护理 1.麻醉清醒、生命体征平稳后取半卧位。 2.禁食水,保持胃肠减压通畅,观察和记录胃肠减压液的颜色、性状及量。 3.严密监测生命体征,准确纪录24小时出入量。观察病人有无腹胀及腹痛,肛门排气、排便、粪便性质等情况。对于有腹腔引流管的病人,妥善固定引流管,保持通畅,观察并记录引流液的颜色、性质及量。 4.禁食水期间,遵医嘱进行抗生素治疗和静脉补液,合理安排输液顺序。 5.病人肠蠕动恢复,肛门排气后方可拔除胃管进食。先少量饮水,无不适可进食半量清流,全量流质,逐渐过渡到软食。进食原则为少量多餐,禁食油腻,逐渐过渡。 6.鼓励病人早期下床活动,促进肠蠕动恢复,防止粘连性肠梗阻发生。 7.并发症的观察与护理 绞窄性肠梗阻术后,如出现腹部胀痛、持续发热、白细胞计数增高、腹壁切口处红肿,或腹腔引流管周围流出较多带有粪臭味的液体时,应警惕腹腔内感染、切口感染及肠瘘的可能,应及时报告医生。,并协助处理。 大肠癌病人的护理 (一)术前护理 1(心理护理 由于癌症、术前检查及手术治疗等生理方面的改变和经济负担, 是病人产生一些不良心理反应,如焦虑、恐惧等。根据病人具体情况做好安慰解释工作,采用多种形式给予必要的健康教育。同时,寻求可能的社会支持以帮助病人增强治疗疾病的信心,提高适应能力。 2.营养支持 病人术前应补充高蛋白、高热量、丰富维生素、易消化的少渣饮食。对于贫血、低蛋白血症的病人,应给予少量多次输血。对于脱水明显的病人,应注意纠正水、电解质及酸碱平衡的紊乱,以提高病人对手术的耐受力。 3.肠道准备 目的是清空肠道内的粪便,减少肠道内细菌数量,防止术中污染、术后腹胀和切口感染,有利于吻合口愈合。 (1)传统肠道准备法:?控制饮食:术前3日进少渣半流质饮食,术前2日起进流质饮食;?清洁肠道:术前3日番茄叶6g泡茶饮用或术前2日口服泻剂硫酸镁15,20g或蓖麻油30ml,每日上午服用。术前2日每晚用1%,2,肥皂水灌肠一次,术前1日晚清洁灌肠;?药物使用:口服抗生素,抑制肠道细菌,如卡那霉素1g,每日2次,甲硝唑0.4g,每日4次;?因控制饮食及服用肠道杀菌剂,使维生素K的合成及吸收减少,故病人术前应补充维生素K. (2)全肠道灌洗法 病人手术前12,14小时开始服用37?左右等渗平衡电解质液(由氯化钠、氯化钾、碳酸氢钠配置),造成容量性腹泻,已达到清洁肠道的目的。一般3,4小时完成灌肠全过程,灌洗液量不少于6000ml。可根据情况,在灌洗液中加入抗菌药物。对于年老体弱,心肾等器官功能障碍和肠梗阻者,不宜使用。 (3)口服甘露醇肠道准备法 病人术前1日午餐后0.5,2小时内口服5,,10,的甘露醇1500ml左右。此方法可不改变病人饮食或术前2日进少渣半流质饮食。对于年老体弱、心、肾功能不全者,禁用。 (4)对于有肠梗阻症状的病人,应延长术前准备的时间。对于直肠癌肠腔有狭窄者,应在直肠指诊引导下(或直肠镜直视下),选择合适的肛管,轻轻通过狭窄口至狭窄病变以上肠腔进行灌肠,以防癌细胞扩散。故目前有主张直肠癌术前不灌肠而只服泻剂。 4(阴道冲洗 如癌肿以侵及女病人的阴道后壁,病人术前3日每晚应行阴道冲洗。 (二)术后护理 1.严密观察病情 (1)监测生命体征 术后监测血压、脉搏、呼吸每半小时一次,4,6次以后改 为每小时一次,病情平稳后延长间隔时间。 (2)观察局部出血情况 观察腹部及会阴部切口敷料,若渗血较多,应估计量,做好记录,并通知医生给予处理。 2.体位 病情平稳者,病人取半卧位,以利呼吸和腹腔引流。 3.饮食 病人术后禁食水、胃肠减压,由静脉补充水和电解质。2,3日后肛门排气或造口开放后即可拔出胃肠减压,进流质饮食;如无不良反应,进半流质饮食,1周后改进少渣饮食,2周左右可进普食。食物应以高热量、高蛋白、丰富维生素、低渣饮食为主。 4.引流管的护理 保持腹腔及骶前引流管通畅,妥善固定,避免扭曲、受压、堵塞及脱落;观查记录引流液的颜色、质、量;及时更换引流管周围渗湿和污染的敷料。骶前引流管一般保持5,7天,引流液量减少、色变淡,方考虑拔出引流管。 5.直肠癌行Miles手术病人术后留置尿管约2周,保持其通畅,妥善固定,防止扭曲、受压;观查记录尿液的颜色、质、量;会阴护理每日二次。拔尿管前,应试行夹管,每4,6小时或病人有尿意时开放,以训练病人膀胱的舒缩功能,防止排尿功能障碍。。 6(结肠造口的护理 又称人工肛门,是近端结肠固定于腹壁外而形成第的粪便排出通道。 (1)造口开放前的护理:造口外敷凡士林或生理盐水纱布,及时更换外层渗湿 敷料,防止感染。注意观察有无肠段回缩、出血、坏死等现象(由肠管张力过大、缝合不严、血运障碍等原因所致)。 (2)造口开放后的护理 :?造口一般于术后2,3天,肠蠕动恢复后开放。观察造口肠管血循环情况,有无肠粘膜颜色变暗、发紫、发黑等异常,防止造口肠管坏死、感染。?造口开放,病人应取造口侧卧位,防止造口流出物污染腹部切口敷料。另外,用塑料薄膜隔开造口与腹壁切口,起到保护腹壁切口,防止感染的作用。?造口开放初期,保持造口周围皮肤清洁、干燥,及时用中性皂液或0.5,氯已定溶液清洁造口周围皮肤,再涂上氧化锌软膏,起到保护皮肤作用;观察造口周围皮肤有无红、肿、破溃等现象。每次造口排便,以凡士林纱布覆盖外翻的肠粘膜,外盖厚敷料,起到保护作用。 (3)正确使用造口袋(人工肛门袋):造口与皮肤愈合后改用造口袋。?选择袋口合适的造口袋。袋口对准造口贴紧,袋囊朝下,用有弹性的腰带固定造口袋。 ?及时更换造口袋:造口袋内充满三分之一排泄物,应更换造口袋。同时,清洁造口周围皮肤,观察皮肤变化。?除使用一次性造口袋外,病人可备3,4个造口袋用于更换。用过的造口袋可用中性洗涤剂和清水洗净,或用1:1000氯已定溶液浸泡30分钟,擦干、晾干备用。 (4)饮食指导:?注意饮食卫生,避免食物中毒等原因引起腹泻。?避免进食胀气性或有刺激性气味的食物。?避免食用引起便秘的食物。 (5)并发症的观察与预防:?造口狭窄:造口处拆线愈合后,每日扩肛一次,防止造口狭窄。每次操作时,指套涂石蜡油,沿肠腔方向逐渐深入,动作轻柔,避免暴力,以免损伤造口或肠管。?肠梗阻:观察病人有无恶心、呕吐、腹痛、腹胀、停止排气、排便等症状。?便秘:病人术后一周后,应下床活动,锻炼定时排便习惯。若进食后3,4天未排便或因粪块堵塞发生便秘,可将粗导尿管插入造口,一般深度不超过10cm灌肠,常用液体石蜡或肥皂水,但注意压力不能过大,以防肠道穿孔。 (6)帮助病人接受造口现实,提高自我护理能力:?观察病人的情绪反应,鼓励病人及家属诉说对造口的感觉和接受程度,避免出现厌恶情绪。?向病人及家属解释经过一段恢复,病人能逐渐适应造口并恢复正常生活、参加适量的运动和社交活动。?护理过程中保护病人的隐私和自尊。?鼓励家属参与病人的造口护理。?帮助病人提高自我护理能力:从接受造口开始,与其讨论有关造口自我护理的相关问,指导病人自我护理的步骤。?鼓励病人亲自动手,并逐渐完成造 口的自我护理。 (二)并发症的预防与护理 1.切口感染 ?监测体温变化及局部切口有无红、肿、热、痛等炎性反应。若有异常症状,及时通知医生处理。?术后根据医嘱及时应用抗生素。?保持切口周围清洁、干燥,尤其会阴部切口,应及时更换渗湿、污染的敷料。对于造口病人,注意保护腹壁切口。?会阴部切口可于术后4,7天用1:5000高锰酸钾温水坐浴,每日两次。 2.吻合口瘘 术前肠道准备不充分、手术造成局部血供差、低蛋白血症等原因可导致吻合口瘘。观查有无吻合口瘘的表现。术后7,10天不能灌肠,以免影响吻合口的愈合。一旦发生瘘,应行盆腔持续滴注、吸引,同时病人禁食,胃肠减压,给予肠外营养支持。若瘘口大、伴有腹膜炎或盆腔脓肿,则必须行横结肠造口以 转流粪便,并作腹腔灌洗,彻底清除残留粪质以加速愈合。 胆囊结石病人的护理 (一)疼痛护理 1.严密观察疼痛的程度、性质、发作时间、诱因及缓解的相关因素 (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations.
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