中医肛肠科护理常规

中医肛肠科护理常规 目 录 中医肛肠科护理常规……………………………………………………………… 一般护理常规……………………………………………………………………… 痔…………………………………………………………………………………… 肛痈………………………………………………………………………………… 肛漏………………………………………………………………………………… 肛裂………………………………………………………………………………… 脱肛………………………………………………………………………………… 直肠息肉…………………………………………………………………………… the needs of future rehabilitation centre. facilitates future expansion of the hospital-wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a security point of view, the internal network of centres for the rehabilitation of the project system and Internet construction independently. to protect data within medical rehabilitation center from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and not the hospital external link external network and an external network and data Association, two independent sets of network equipment. Medical network to four-room for 2 large Gigabit switches at the core, double-machine 中医肛肠科护理常规 一、一般护理常规 1、病室环境 (1)病室环境清洁、舒适、安静，保持室内空气新鲜。 (2)根据病证性质，室内温湿度适宜。 2、根据病种、病情安排病室，护送患者到指定床位休息。 3(入院介绍 (1)介绍主管医师、护士，并通知医师。 (2)介绍病区环境及设施的使用方法。 (3)介绍作息时间、相关。 4、生命体征监测，做好护理记录。 (1)测量入院时体温、脉搏、呼吸、血压、体重。 (2)新入院患者每日测体温、脉搏、呼吸3次，连续3日。 (3)若体温37.5ºC以上,每日测体温、脉搏、呼吸4次。 (4)若体温39ºC以上，每4小时测体温、脉搏、呼吸1 次，或遵医嘱执行。 (5)体温正常3日后，每日测体温、脉搏、呼吸1次，或 遵医嘱执行。 (6)危重患者生命体征监测遵医嘱执行。 5、每日记录大便次数1次。 6、每周测体重1次，或遵医嘱执行。 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili1 7、协助医师完成各项检查。 8、遵医嘱执行分级护理。 9、定时巡视病房。 (1)及时了解患者在生活起居、饮食、睡眠和情志等方面的问题，实施相应的护理，做好护理记录。 (2)手术患者按手术护理常规进行，做好术前准备、术后护理。 (3)观察伤口有无出血，出血与大便的关系。发现异常，医师并配合处理。 10、根据患者病情，对患者或家属进行相关健康指导，使之对疾病、治疗、护理等知识有一定了解，积极配合治疗。 11、加强情志护理，疏导不良心理，使其配合治疗。 12、遵医嘱准确给药。正确实施外治熏洗法，注意观察用药后的反应。 13、遵医嘱给予饮食护理，忌食辛辣刺激食物，多吃蔬菜水果，保持大便通畅。 14、预防院内交叉感染 (1)严格执行消毒隔离制度。 (2)做好病床单位的终末消毒处理。 15、做好出院指导，并征求意见。 二、肛肠科手术护理常规 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation2 1、术前护理 (1)遵医嘱完善术前各项检查。 (2)针对患者存在的心理问题做好情志护理。 (3)讲解有关疾病的知识、术前的注意事项、床上使用便器等所需的指导。 (4)术前清洁皮肤，遵医嘱行手术区备皮，并注意脐部的清洁，做好护理记录。 2、术前晚护理 (1)遵医嘱禁食、禁水。 (2)遵医嘱给予清洁灌肠。 (3)遵医嘱给予安神镇静药物，保证睡眠休息。 3、术日晨排空膀胱，遵医嘱给予麻醉用药。 4、根据手术要求准备术后用床。 三、术后护理 1、术后根据病情遵医嘱送入ICU、普通病房等。 2、硬膜外麻醉、骶麻患者去枕平卧6小时，禁食、禁水。 3、病情观察，做好护理记录 (1)观察生命体征。 (2)观察肛周有无水肿，肛门有无脱出物，创面有无渗血，发现异常报告医师，及时处理。 4、手术当日不宜排便。局部处理从术后第2天初次排便开 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili3 始，创面分泌物或粪便要及时除去。可遵医嘱用中药液坐浴和局部洗涤，预防术后感染。 5、术后尽早给予普食，进食富含纤维素的食物和足够的水分，忌辛辣刺激，保持排便通畅。 6、便秘者遵医嘱给缓泻的中药。 7、尿潴留者给予热敷下腹部或诱导排尿，或遵医嘱针刺。 8、创口疼痛甚者遵医嘱用局部止痛药，或中药煎液肛门湿热敷或坐浴，或给予耳针止痛。 9、指导患者做适当的提肛运动，以促进创口愈合，利于功能康复。 痔 因饮食不洁，燥热内生，下迫大肠及久坐、负重远行等所致。以便血、肛门有肿物、坠胀、异物感或疼痛为主要临床现。根据发病部位的不同，分为内痔、外痔和混合痔。 一、护理评估 1(患者的职业、饮食、排泄习惯及诱发因素。 2(排便有无疼痛、便血，便后有无肿块脱出等。 3(直肠检查结果。 4(心理社会状况。 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation4 5(辩证:风伤肠络证、湿热下注证、气滞血瘀证、脾虚气陷证。 二、护理要点 1(一般护理 (1)按中医肛肠科一般护理常规。 (2)痔发作期要侧卧休息。 (3)保持肛门及会阴部清洁，便后坐浴。 2(病情观察，做好护理记录 (1)排便时如痔核脱出，应及时还纳。 (2)外痔伴有感染或发生嵌顿、或突发血栓外痔者应卧床休息并报告医师。 3(给药护理 大便后遵医嘱用中药熏洗。 4(饮食护理 (1)鼓励多饮水，多进蔬菜、水果以及纤维素的饮食，忌烟、酒、辛辣等刺激之品。 (2)气滞血瘀者给予补中益气温阳之品;脾虚气陷者忌酸冷食物，宜进温补食物。 5(情志护理 疏导患者情志，使之配合治疗。 6(临证(症)施护 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili5 (1)术后出现尿潴留，但经诱导无法解除者，遵医嘱针刺或导尿。 (2)术后7~9天为痔核坏死脱落开段，嘱患者减少活动，密切观察便血情况。 (3)内痔结扎术，嘱患者不可牵拉留在肛外的线端，以免疼痛或出血。 三、健康指导 1(保持肛门清洁，坚持每晚热水或中药液坐浴。 2(养成定时排便习惯，避免排便时间过长。习惯性便秘患者，多食粗纤维食物，保持大便通畅。 3(避免肛门局部刺激，便纸宜柔软，不穿紧身裤或粗糙内裤。 4(忌久坐、久立或久蹲，最好选用软坐垫。 5(勿负重远行，防止过度劳倦，进行适当锻炼。可指导患者进行提肛运动，对于改善肛门局部血液循环，锻炼肛门括约肌功能有积极的作用。 6(发现排便困难者应及时到医院复诊。 肛 痈 因过食肥甘、辛辣、醇酒，或肺、脾、肾亏虚，湿热之邪乘 -room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitationmachine6 虚下注所致。以肛门周围红肿、疼痛、有波动感，伴恶寒发热为主要临床表现。肛门直肠周围脓肿可参照本病护理。 一、护理评估 1(患者的饮食、排便习惯及诱发因素。 2(肛周症状及伴随症。 3(直肠检查结果。 4(心理社会状况。 5(辩证:火毒蕴结证、热毒炽盛证、阴虚毒恋证。 二、护理要点 1(一般护理 (1)按中医肛肠科一般护理常规进行。 (2)避免坐位，高热及病情较重者，应卧床休息，取侧卧位。 2(病情观察，做好护理记录 (1)观察局部皮肤红肿范围、温度、疼痛程度、有无波动感，观察体温变化及全身情况。 (2)对切开排脓术后，应观察伤口情况及引流的色、质、量，有无出血或渗血，发现异常，报告医师并配合处理。 3(给药护理 (1)大便后遵医嘱中药熏洗。 (2)火毒蕴结、热毒炽盛者，中药应饭后偏凉服。 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili7 (3)阴虚毒恋者遵医嘱用中药泡水代茶饮。 4(饮食护理 (1)饮食宜清淡、富有营养，忌食辛辣刺激之品。 (2)急性期给予少渣半流质。 5(情志护理 做好情志疏导，解除害羞及因惧痛而害怕排便、担心预后等心理问题，使其积极配合治疗。 6(临证(症)施护 (1)体温超过39ºC，按高热护理常规进行。 (2)局部疼痛难忍者，遵医嘱使用止痛剂。 三、健康指导 1(忌油腻辛辣之品，戒烟酒。 2(养成定时排便的习惯，防止便秘，便后清洗肛门或坐浴。 3(发现肛门局部异常，及时就诊治疗。 肛漏 因肛门、直肠周围脓肿破溃，久不收口，或因虚劳久嗽、脾肺两虚、湿热下注大肠所致，以局部反复流出脓水或粪汁，伴疼痛、瘙痒为主要临床表现。病位直肠、肛周，涉及肺、脾。肛瘘可参照本病护理。 一、护理评估 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation8 1、既往病史，病程长短。 2、 肛周症状。 3、 肛门指检、镜检等检查结果。 4、 心理社会状态。 5、 辨证:湿热下注证、正虚邪恋证、阴液亏虚证。 二、护理要点 1、 一般护理 (1)按中医肛肠科一般护理常规。 (2)疼痛剧烈时，卧床休息。 2、 病情观察，做好护理记录。 (1)注意肛周瘘口流出脓液的色、质、量、气味及肛门疼痛、瘙痒程度等。 (2)观察有无大便失禁现象，做好皮肤的护理，防止发生皮肤湿疹、糜烂等并发症。 3、给药护理 大便后遵医嘱用中药熏洗。 4、饮食护理 (1)饮食忌辛辣刺激性食物。 (2)湿热下注者宜食西瓜、绿豆、赤小豆等清热利湿之品。 5、 情志护理 关心体贴患者，解除不良情绪。 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili9 6、 临证(症)施护 (1)可用耳针缓解疼痛。 (2)指导施行挂线疗法患者不要拖拉留在肛管外的橡皮筋，以免引起疼痛及断裂。若发现异常，应报告医师，并配合处理。 (3)指导瘘管切除并缝合治疗的患者术后2,3天控制大便，以免刺激伤口。 三、健康指导 1、 生活有规律，按时作息，避免劳累。 2、 保持肛门清洁，每晚及便后用温开水坐浴。 3、 饮食宜清淡，富含营养，忌辛辣、发物，戒烟酒。 4、积极治疗肛周疾病，防止发生继发肛瘘。 肛 裂 因阴津不足或脏腑热结、肠燥便秘、粪便粗硬、排便努责等所致。以肛门周期性疼痛、出血、便秘为主要临床表现。病位在肛门，与大肠关系密切。 一、护理评估 1(饮食、排便习惯及病程长短。 2(肛门症状。 3(心理社会状况。 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation10 4(辩证:血热肠燥证、阴虚津亏证、气滞血瘀证。 二、护理要点 1(一般护理 (1)按中医肛肠科一般护理常规进行。 (2)保持大便通畅，防止便秘。 2(病情观察，做好护理记录 观察肛门疼痛的性质、程度与持续时间，大便是否带血、滴血及出血量。 3(给药护理 (1)早期肛裂者，排便后遵医嘱用中药坐浴，或用生肌玉红膏涂于裂伤处。 (2)陈旧性肛裂，遵医嘱给予中药坐浴，以促进创面愈合。 4(饮食护理 (1)血热肠燥者多食蔬菜、水果。 (2)气滞血瘀者给予理气活血之品。 (3)阴虚津亏者多进滋阴增液之品。 5、情志护理 (1)因裂口剧痛难忍，易产生不良情绪，可教会患者按摩腹部，以减轻排便疼痛。 (2)气滞血瘀者，易出现胸闷、烦燥，须加强情志疏导。 6、临证(症)施护 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili11 (1)疼痛剧烈时，遵医嘱可针刺镇痛，亦可予中药外敷肛裂局部。 (2)便秘时，切忌努责，可遵医嘱给服润下剂或缓泻剂。 三、健康指导 1、注意个人卫生，养成每天定时排便的习惯，每日早晨可空腹服淡盐水一杯。 2、指导患者预防便秘的方法，坚持腹肌锻炼，排便时避免蹲坑时间过长。 3、发生肛裂及时治疗，防止继发贫血和其他肛门疾病。 脱肛 因体虚劳倦、产育用力、久泻久痢或经常便秘而致大便努责等所致。以大便后、劳累、下蹲时，直肠黏膜脱出，伴直肠下坠感、疼痛及黏膜充血、水肿等为主要临床表现。病位在肛门和肠。直肠脱垂可参照本病护理。 一、护理评估 1、 肛门脱出物情况，有无伴随症状。 2、肛门指检及其他检查结果。 3、心理社会状况。 4、 辨证:脾虚气陷证、湿热下注证。 二、护理要点 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation12 1、 一般护理 (1)按中医肛肠科一般护理常规进行。 (2)保持大便通畅，防止便秘。 (3)避免劳累，大便时不宜采用蹲位，每日练习提肛运动，增强肛门括约肌功能。 2、 病情观察，做好护理记录 (1)观察脱出物的形态、长度，表面是否充血、水肿、糜烂、出血及伴腹痛。如有情况，应及时报告医师，并配合处理。 (2)指导患者脱肛后及时复位，用中药或温水坐浴，取侧卧位用黄连软膏纱布托住脱出物，轻轻还纳，并用“#”字敷料和“丁”字带压迫固定。 (3)脱垂物发生嵌顿水肿，报告医师并配合处理。 3、 给药护理 便后遵医嘱用清热解毒、活血消肿中药熏洗。 4、 饮食护理 (1)多食蔬菜水果，多饮水，忌食过于寒凉及辛辣、煎炸助火之品。 (2)脾虚气陷者饮食宜偏温热，忌食生冷硬物。 (3)湿热下注者可给予西瓜、绿豆、赤小豆等清凉利湿食物。 5、 情志护理 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili13 保持情绪稳定，安心养病。 6、临证(症)施护 (1)如肛门脱出物嵌顿者，可遵医嘱及时还纳。 (2)对脾虚气陷者，可遵医嘱针刺提肛穴，亦可艾灸或隔姜灸。 (3)对行直肠脱垂注射治疗者，术后平卧;控制3日内不大便，第3日开始遵医嘱每晚给予润下剂，保持大便通畅。 三、健康指导 1、 掌握适宜的排便体位、时间、排便环境，多饮水，多摄取粗纤维食物，保持大便通畅。 2、 便后如有脱垂，及时还纳，有嵌顿不易还纳时，立即就医。 3、 病愈三个月内禁重体力劳动、负重劳动、剧烈运动及长时间站立、下蹲或半弯腰体位，避免咳嗽、泄泻、便秘，有感染者及时治疗。 4、每日做提肛运动练习。 直肠息肉 多因先天禀赋不耐所致。以便血或便后滴血、伴黏液和肛门坠胀为主要临床表现。病位在直肠和乙状结肠下段。儿童型息肉、炎性息肉、家族性息肉等均可参照本病护理。 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation14 一、护理评估 1、 家族史，既往病史，病程长短和心理社会状况。 2、 排便性质、形状、出血状况。 3、 大便常规和培养、肠镜等检查结果。 4、辨证:风伤肠络证、气滞血瘀证、脾气亏虚证。 二、护理要点 1、一般护理 (1)按中医肛肠科一般护理常规进行。 (2)便后及时清洗会阴部，保持清洁。 (3)需手术者，做好手术前后护理。 2、病情观察，做好护理记录 (1)观察便血的色、质、量，有无黏液，是否伴腹痛、腹泻，或腹部不适，有无排便习惯的改变及肛门脱出肿物等。 (2)若见粪块上附着黏液或渗血时，及时报告医师。 3、 给药护理 便后遵医嘱用清热解毒、活血消肿中药清洗。 4、 饮食护理 (1)指导患者多食蔬菜、水果，保持大便通畅，忌辛辣刺激食物。 (2)气滞血瘀及风伤肠络者，宜多食清热、凉血之品。 5、 情志护理 machine-room for 2 large Gigabit switches at the core, double-equipment. Medical network to four not the hospital external link external network and an external network and data Association, two independent sets of networkk and from influence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal networlitation of the project system and Internet construction independently. to protect data within medical rehabilitation center security point of view, the internal network of centres for the rehabi wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-tation centre. facilitates future expansion of the hospitalthe needs of future rehabili15 调畅情志，保持心情舒畅，忌烦躁恼怒，鼓励其树立战胜疾病的信心。 6、 临证(症)施护 (1)息肉脱出后应及时回纳;脾气亏虚者，可遵医嘱针刺。 (2)息肉脱出不易回纳、疼痛甚者，属气滞血瘀证，可遵医嘱针刺。 三、健康指导 1、 保持大便通畅，注意观察粪便有无黏液及血丝。 2、戒烟酒，忌辛辣刺激性食物。 machine-room for 2 large Gigabit switches at the core, double-ment. Medical network to foure hospital external link external network and an external network and data Association, two independent sets of network equipnot thnfluence of external network, ensure safe and reliable medical information. Intranet for the hospital's internal network and on of the project system and Internet construction independently. to protect data within medical rehabilitation center from isecurity point of view, the internal network of centres for the rehabilitati wide voice communications, reducing costs due to expansion. Taking into account the special nature of public hospital, from a-centre. facilitates future expansion of the hospital the needs of future rehabilitation16