子宫平滑肌瘤、计划性剖宫产

子宫平滑肌瘤、性剖宫产 子宫平滑肌瘤临床路径 ,2009版, 一、子宫平滑肌瘤临床路径住院流程 ,一,适用对象。第一诊断为子宫平滑肌瘤 (ICD10:D25) 行经腹子宫全/次全切除术(ICD9CM-3:68.39/68.49) ,二,诊断依据。 根据《临床诊疗指南—妇产科学分册》,中华医学会编著～ 人民卫生出版社, 1. 病史:月经紊乱等, 2. 体征:子宫增大、质硬, 3. 辅助检查:超声检查,必要时需要行盆腔核磁和/或CT检查,。 ,三,治疗的选择和依据。 根据《临床诊疗指南—妇产科学分册》,中华医学会编著～ 人民卫生出版社, 1. 子宫肌瘤诊断明确～有子宫切除的手术指征: ,1, 子宫增大～肌瘤?妊娠10周子宫, ,2, 月经过多、继发贫血, ,3, 有压迫症状, ,4, 可疑恶变。 2. 无手术和麻醉禁忌证, and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical staff project manager as a construction organization, with overall responsibility for the management and operation of projects management, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also committed to the key management personnel are not other works part-time. Project management leadership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists of 3. 术前检查齐全, 4. 征得患者和家属的同意。 ,四,临床路径标准住院日为?11 天。 ,五,进入路径标准。 1. 第一诊断必须符合ICD10:D25子宫平滑肌瘤 疾病编码, 2. 当患者同时具有其他疾病诊断时～但在住院期间不需特殊处理 也不影响第一诊断的临床路径流程实施时～可以进入路径。 ,六,术前准备3 天～必须的检查项目。 1. 血常规、血型, 2. 尿常规, 3. 生化检查,包括电解质、肝肾功能、血糖,, 4. 凝血功能, 5. 感染性疾病筛查(如乙肝、丙肝、艾滋病、梅毒), 6. 心电图, 7. 胸部X光片, 8. 超声检查, 9. 宫颈刮片,有条件可选择TCT或CCT,, 10. 阴道清洁度检查, 11. 其他根据病情需要而定,如血清CA、hCG等,。 125 ,七,预防性抗菌药物选择与使用时机。 1. 按《抗菌药物临床应用指导原则》,卫医发〔2004〕285号,应 用预防性抗菌药物, cons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project11Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical s 2. 预防性用药时间为术前30分钟, 3. 手术超时3小时加用一次抗菌药物, 4. 术后72小时内停止使用预防性抗菌药物。 ,八,手术日为入院第 2-4天。 1. 麻醉方式:请麻醉科医师会诊～腰麻或硬膜外麻醉或联合麻醉～ 必要时全麻, 2. 术中用药:止血药物和其他必需用药, 3. 输血:必要时, 4. 病理:石蜡切片,必要时行冰冻检查,。 ,九,术后住院恢复?7天。 1. 必须复查的项目:血常规、尿常规, 2. 术后用药, 3. 预防性用药:术后72小时内停止使用静脉性抗菌药物。 ,十,出院标准,围绕一般情况、切口情况、第一诊断转归,。 1. 患者一般情况良好～恢复正常饮食～腹部无阳性体征, 2. 相关实验室检查结果基本正常～体温正常, 3. 切口愈合良好。 ,十一,有无变异及原因。 1(因实验室检查结果异常需要复查～导致术前住院时间延长。 2(其他意外情况需进一步明确诊断～导致术前住院时间延长。 3(术后出现发热及出血等并发症需要治疗和住院观察～导致住院 时间延长。 12ership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management lead-rtake the construction tasks. Also committed to the key management personnel are not other works partanagement and operation of projects management, complete and professional and technical personnel and skilled workers to undethe mxperience in the management, technical staff project manager as a construction organization, with overall responsibility for civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive e safe,the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure thatation ion control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organizking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevatf jactisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course o2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, sa and difficulties of 1, the construction process to ensure railway operation safety is key. 二、子宫平滑肌瘤临床路径表单 适用对象:第一诊断为子宫平滑肌瘤 (ICD10:D25) 行经腹子宫全/次全切除术(ICD9CM-3:68.39/68.49) 患者姓名: 性别: 年龄: 门诊号: 住院号: 住院日期: 年 月 日 出院日期: 年 月 日 标准住院日 ?11天 时间 住院第1-3天 住院第1-3天 住院第1-3天 ? 询问病史、体格检查 ?实施各项实验室检查和影像学?三级医师检诊 ? 下达医嘱、开出各项检查单 检查 ?进行术前讨论 ? 完成首次病程 ?上级医师查房及病程记录 ?向家属交待病情和有关手术 ? 完成入院记录 ?继续术前准备 事项 主 ? 完成初步诊断 ?签署“手术知情同意书” 要 ? 开始术前准备，连续3天 ?签署“输血知情同意书” 诊 ?完成术前准备 疗 ?下达手术医嘱，并提交手术工 通知单 作 ?麻醉医师查看患者，签署“麻 醉知情同意书” ?完成术前小结 长期医嘱: 长期医嘱: 术前医嘱: ?妇科常规护理 ?妇科常规护理 ?明日在腰麻或硬膜外麻醉或 ??级护理 ??级护理 联合麻醉下行经腹子宫全/ ?普食 ?普食 次全切除术 ?阴道冲洗 ?阴道上药 ?术晨禁食水 临时医嘱: ?药物(阴道上药) ?术区备皮 重 ?妇科检查 ?静脉取血 点 ?阴道清洁度检查 ?交叉备血 医 ?静脉采血 ?血常规+血型 ?抗菌药物皮试 嘱 ?尿常规 ?便常规 ?生理盐水10ml，皮试用 ?凝血功能 ?生化检查 ?肠道准备 ?感染性疾病筛查 ?留置尿管(术晨) ?心电图 ?阴道擦洗(术晨) ?胸部X光片 ?碘伏100ml，阴道擦洗用 ?超声检查(盆腔，必要时上腹 部:肝胆胰脾肾) ?按入院流程做入院介绍 ?静脉抽血 ?介绍术前准备内容、目的和 ?入院评估 ?指导患者到相关科室进行检查麻醉方式 ?进行入院健康宣教 并讲明各种检查的目的 ?指导患者正确排痰方法及床主 ?讲解阴道准备的目的及方法 上排便法 要 ?术前阴道冲洗、上药 ?术前备皮、沐浴、更衣 护 ?术前健康宣教 理 ?晚餐少量进食后禁食水 工 ?肠道准备 作 ?提醒患者术晨禁食水 ?保持夜间病房安静，患者口 服镇静药入睡 病情 ?无 ?有，原因: ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 1. 记录 2. 2. 2. 白班 小夜班 大夜班 白班 小夜班 大夜班 白班 小夜班 大夜班 护士 签名 医师 签名 13Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical scons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project 时间 住院第2-4日(手术当日) 住院第3-5日(术后第1日) 住院第4-6日(术后第2日) ?完成手术治疗 ?医师查房及病程记录 ?医师查房及病程记录 ?24小时内完成手术记录 ?必要时复查血、尿常规及电解质 ?抗菌药物治疗、预防感染 主要诊?完成术后病程记录 ?抗菌药物治疗、预防感染 ?必要时切口换药 疗工作 ?术后查房 ?必要时切口换药 ?向患者家属交待术后注意事项 长期医嘱: 长期医嘱: 长期医嘱: ?按子宫全切除术后护理 ??级护理 ??级护理 ??级护理 ?流食 ?半流食 ?禁食水 ?留置尿管接无菌引流袋 ?会阴擦洗 临时医嘱: ?碘伏会阴擦洗 ?抗菌药物治疗 重 ?留置尿管 ?抗菌药物治疗 ?必要时补液 点 ?如留置引流管，接袋计量 ?补液 临时医嘱: 医 ?记录24小时出入量 临时医嘱: ?拔除尿管(留置48小时者) 嘱 ?生命体征监测，必要时心电监护 ?血、尿常规检查(术后1-3天?切口中换药 ?抗菌药物治疗 内完成) ?补液 ?必要时查电解质 ?止血药物(必要时) ?静脉取血 ?止血药物(必要时) ?拔除尿管(留置24小时者) ?嘱患者术晨禁食水 ?保持尿管通畅，观察尿色、尿?拔除尿管并协助患者排小便 ?协助患者做好术前准备 量并记录 ?叩背及术后呼吸锻炼 ?术毕回病房，交接患者，了解?会阴擦洗保持外阴清洁 ?术后饮食指导 主 麻醉及术中情况 ?取半卧位并告知患者半卧位的?了解患者术后心理状态并给予要 ?按医嘱进行治疗 好处 正确的指导 护 ?随时观察患者情况 ?指导并协助患者按时床上翻身?给患者讲解各项治疗及护理措理 ?术后6小时翻身 及下肢的屈膝运动，鼓励下地施 工 ?手术后心理与生活护理 活动 ?晨晚间护理、夜间巡视 作 ?晨晚间护理、夜间巡视 ?术后健康教育 ?术后饮食指导 ?协助患者生活护理 ?晨晚间护理、夜间巡视 病情 ?无 ?有，原因: ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 1. 记录 2. 2. 2. 护士 白班 小夜班 大夜班 白班 小夜班 大夜班 白班 小夜班 大夜班 签名 医师 签名 ership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management lead-rtake the construction tasks. Also committed to the key management personnel are not other works partanagement and operation of projects management, complete and professional and technical personnel and skilled workers to undethe mxperience in the management, technical staff project manager as a construction organization, with overall responsibility for civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive e safe,the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure thatation ion control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organizking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevatf jactisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course o2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, sa and difficulties of 1, the construction process to ensure railway operation safety is key.14 时间 住院第5-7日(术后第3日) 住院第9-11日(术后7日) ?医师查房 ? 检查切口愈合情况与拆线 主 ?停预防性静脉抗菌药物，必要时口服? 确定患者出院日期 要 抗菌药物 ? 向患者交代出院注意事项及复查诊 ?必要时切口换药 日期 疗 ? 通知出院处 工 ? 开具出院诊断书 作 ? 完成出院记录 长期医嘱: 临时医嘱: 重 ??-?级护理 ? 通知出院 点 ?普食 医 ?必要时会阴擦洗 嘱 ?必要时抗菌药物治疗 ?术后饮食指导 ?协助患者办理出院手续 ?术后心理指导 ?给患者讲解各项治疗及护理措施 ?晨晚间护理、夜间巡视 主 要 护 理 工 作 病情 ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 记录 2. 2. 白班 小夜班 大夜班 白班 小夜班 大夜班 护士 签名 医师 签名 15Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical scons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project 计划性剖宫产临床路径 ,2009版, 一、计划性剖宫产临床路径标准住院流程 ,一,适用对象。第一诊断为首选治疗方案符合: 子宫下段剖宫产术ICD-9-CM-3:74.1手术编码者 ,二,诊断依据。 根据《临床诊疗指南-妇产科学分册》,中华医学会编著～ 人民卫生出版社, ,三,选择治疗方案的依据。 根据《临床诊疗指南-妇产科学分册》,中华医学会编著～ 人民卫生出版社, 1. 骨盆及软产道异常, 2. 胎儿因素, 3. 羊水过少, 4. 头盆不称, 5. 高龄初产妇, 6. 慢性胎儿窘迫, 7. 有影响阴道分娩的各种合并症, 8. 孕妇及家属要求。 ,四,标准住院日为9 天。 16ership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management lead-rtake the construction tasks. Also committed to the key management personnel are not other works partanagement and operation of projects management, complete and professional and technical personnel and skilled workers to undethe mxperience in the management, technical staff project manager as a construction organization, with overall responsibility for civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive e safe,the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure thatation ion control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organizking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevatf jactisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course o2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, sa and difficulties of 1, the construction process to ensure railway operation safety is key. ,五,进入路径标准。 1. 第一诊断为首选治疗方案符合:ICD-9-CM-3:74.1子宫下段剖 宫产术手术编码者, 2. 孕妇患有其他疾病时～但在住院期间不需特殊处理～也不影响 第一诊断的临床路径流程～可以进入路径。 ,六,术前准备,术前评估,0-2天～所必须的检查项目。 1. 血、尿常规, 2. 凝血功能, 3. 感染性疾病筛查,孕期未作的乙肝、丙肝、艾滋病、梅毒等,, 4. 其他根据病情需要而定。 ,七,选择用药。 1(按《抗菌药物临床应用指导原则》,卫医发〔2004〕285号,执行, 2(抗菌药物选择第一代头孢类, 3(预防性用药时间为断脐后使用。 ,八,手术日为入院第 2天。 1. 麻醉方式:硬膜外或腰硬联合, 2. 手术方式:子宫下段剖宫产术, 3. 术中用药:缩宫素10-20μ～抗菌药物, 4. 输血:必要时输血, 5. 新生儿处理:断脐、保暖、清理呼吸道等常规处理。 ,九,术后住院恢复?7 天。 1. 必须复查的检查项目:血常规～尿常规, 17Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical scons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project 2. 术后用药:抗菌药物～缩宫药物, 3. 预防性抗菌药物:第一代头孢类～术后72小时内停止使用。 ,十,出院标准。 1. 一般状况良好～体温正常, 2. 血、尿常规基本正常, 3. 切口愈合良好, 4. 少量阴道出血。 ,十一,有无变异及原因分析。 1. 孕妇原因延期手术, 2. 子宫复旧不良～并发阴道流血过多, 3. 并发产褥感染, 4. 切口延期愈合。 the mxperience in the management, technical staff project manager as a construction organization, with overall responsibility for civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive e safe,the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure thatation ion control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organizking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevatf jactisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course o2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, sa and difficulties of 1, the construction process to ensure railway operation safety is key.18ership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management lead-rtake the construction tasks. Also committed to the key management personnel are not other works partanagement and operation of projects management, complete and professional and technical personnel and skilled workers to unde 二、计划性剖宫产临床路径表单 适用对象:第一诊断为首选治疗方案符合:子宫下段剖宫产术者(手术编码ICD-9-CM-3:74.1) 患者姓名: 性别: 年龄: 门诊号: 住院号: 住院日期: 年 月 日 出院日期: 年 月 日 标准住院日: ?9 天 时间 住院第1天 住院第2天(手术日) ? 询问孕期情况、既往病史与体格检查 ? 手术(剖宫产术) ? 完成产科入院记录 ? 完成手术记录 ? 常规辅助检查 ? 上级医师查房 主 ? 上级医师查房与分娩方式评估 ? 完成手术日病程记录和上级医师查房 要 ? 确定诊断和手术时间 ? 向孕妇及家属交代术后注意事项 诊 ? 完成上级医师查房记录、术前小结 ? 确定有无手术并发症 疗 ? 签署“手术知情同意书” ? 确定有无麻醉并发症(麻醉科医师随访) 工 ? 签署“输血知情同意书” 作 ? 完成麻醉科“麻醉知情同意书” ? 完成“术前准备” ? 向孕妇及家属交代术前注意事项 长期医嘱: 长期医嘱: ? 产科常规护理 ? 剖宫产术后常规护理 ? ?级护理 ? ?级护理 ? 普食 ? 禁食水12小时后流食 ? 听胎心1次/4-6小时 ? 测血压:1次/15分钟，2小时血压平稳后， ? 胎心监护1-2次/日 改为每日两次。观察宫底及阴道出血情况 临时医嘱: ? 尿管引流接无菌袋 ? 血常规、尿常规 ? 会阴擦洗2/日 重 ? 凝血功能 ? 乳房护理 点 ? 孕期未查的乙肝、丙肝、艾滋病、梅? 静脉输液1次/日 医 毒等感染性疾病筛查 ? 抗菌药物 嘱 ? 胎儿超声及脐带血流检查 ? 缩宫素 ? 拟明日上午时在硬膜外或腰硬联合? 剖宫产新生儿护理常规: 麻醉下行子宫下段剖宫产术 ? 新生儿抚触 1/日 ? 明晨禁食水 ? 新生儿油浴 1/日 ? 明晨留置尿管 ? 脐部护理 ? 常规备皮 临时医嘱: ? 抗菌药物皮试 ? 低流量吸氧(术后) ? 必要时配血、备血 ? 维生素K 5mg im 1 ? 注射卡介苗及乙肝疫苗 ? 入院介绍(介绍病房环境、设施和设备) ? 为新生儿注射卡介苗及乙肝疫苗 ? 入院护理评估 ? 随时观察产妇情况 主 ? 静脉取血 ? 帮助产妇早开奶、早吸吮 要 ? 指导孕妇到相关科室行超声等检查 ? 术后心理护理及生活护理 护 ? 术前患者准备(术前沐浴、更衣、备皮) ? 健康教育包括饮食等指导产妇术后活动 理 ? 术前物品准备 ? 夜间巡视 工 ? 术前心理护理 作 ? 提醒孕妇明晨禁食水 病情 ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 记录 2. 2. 白班 小夜班 大夜班 白班 小夜班 大夜班 护士 签名 医师 签名 taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical scons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project19Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag 时间 住院第3天(术后第1日) 住院第4日(术后第2日) 主 ? 医师查房，进行手术及手术切口评估，? 医师查房，进行手术及手术切口评估，确要 确定有无手术并发症及手术切口感染 定有无手术并发症及手术切口感染 诊 ? 儿科医师查房 ? 完成日常病程记录和上级医师查房记录 疗 ? 完成日常病程记录 ? 腹部切口换药(必要时) 工 ? 完成上级医师查房记录 作 ? 腹部切口换药(必要时) 重 长期医嘱: 长期医嘱: 点 ? 剖宫产术后常规护理 ? 剖宫产术后常规护理 医 ? ?级护理 ? ?级护理 嘱 ? 排气后半流食 ? 半流食或普食 ? 测血压1次/日 ? 乳房护理 ? 观察宫底及阴道出血情况 ? 抗菌药物 ? 乳房护理 ? 剖宫产新生儿护理常规 ? 静脉输液1次/日 ? 新生儿抚触 1/日 ? 抗菌药物 ? 新生儿洗浴1/日 ? 缩宫药物 ? 脐部护理 ? 剖宫产新生儿护理常规 ? 新生儿抚触 1/日 ? 新生儿洗浴1/日 ? 脐部护理 临时医嘱: 拔除留置导尿管 主 ? 随时观察产妇情况 ? 随时观察产妇情况 要 ? 指导产妇喂母乳 ? 指导产妇喂母乳 护 ? 术后心理护理及生活护理 ? 术后心理护理及生活护理 理 ? 指导产妇术后活动 ? 指导产妇术后活动 工 ? 夜间巡视 ? 夜间巡视 作 病情 ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 记录 2. 2. 白班 小夜班 大夜班 白班 小夜班 大夜班 护士 签名 医师 签名 20ership by the project manager, Assistant Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management lead-rtake the construction tasks. Also committed to the key management personnel are not other works partanagement and operation of projects management, complete and professional and technical personnel and skilled workers to undethe mxperience in the management, technical staff project manager as a construction organization, with overall responsibility for civilized, this engineering project construction will be used. I unit in jacking construction of frame bridge has extensive e safe,the owners of the quality, duration, target, Tianjin, as well as requirements for construction and environmental protection, and responsibilities of the Department in order to ensure railway safety and the safety, quality of construction, ensure thatation ion control is difficult. 3. construction organization plan 3.1. construction organization scheme 3.1.1. construction organizking bridge, preventing the subgrade collapse is another focus of this project. 4, when jacking bridge, rectifying and elevatf jactisfactory effect to ensure safety operations are good, is a priority in the construction of this project. 3, in the course o2, high water table in the project areas, the soil softer and Grouting to bridge is required, how to control the Grouting, sa and difficulties of 1, the construction process to ensure railway operation safety is key. 时间 住院第5日(术后第3日) 住院第6-9日(术后第4-7日) 主 ? 上级医师查房，进行手术及手? 上级医师查房，进行手术及手术切要 术切口评估，确定有无手术并口评估，确定有无手术并发症及手诊 发症及手术切口感染 术切口感染 疗 ? 完成日常病程记录和上级医? 完成日常病程记录和上级医师查工 师查房记录 房记录 作 ? 腹部切口换药(必要时) ? 腹部切口换药(必要时) 长期医嘱: 长期医嘱: ? 剖宫产术后常规护理 ? 剖宫产术后常规护理 ? ?级护理 ? ?级护理 重 ? 半流食或普食 ? 普食 点 ? 乳房护理 ? 乳房护理 医 ? 抗菌药物 ? 剖宫产新生儿护理常规 嘱 ? 剖宫产新生儿护理常规 ? 新生儿抚触 1/日 ? 新生儿抚触 1/日 ? 新生儿洗浴1/日 ? 新生儿洗浴1/日 ? 脐部护理 ? 脐部护理 ? 随时观察产妇情况 ? 随时观察产妇情况 主 ? 指导产妇喂母乳 ? 指导产妇喂母乳 要 ? 术后心理护理及生活护理 ? 术后心理护理及生活护理 护 ? 指导产妇术后活动 ? 指导产妇术后活动 理 ? 新生儿母乳喂养后72小时取? 夜间巡视 工 足跟血筛查或听力筛查(有条 作 件实施) ? 夜间巡视 病情 ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 记录 2. 2. 白班 小夜班 大夜班 白班 小夜班 大夜班 护士 签名 医师 签名 -ted to the key management personnel are not other works partement, complete and professional and technical personnel and skilled workers to undertake the construction tasks. Also commitmanag taff project manager as a construction organization, with overall responsibility for the management and operation of projectstruction will be used. I unit in jacking construction of frame bridge has extensive experience in the management, technical scons et, Tianjin, as well as requirements for construction and environmental protection, safe, civilized, this engineering projectorder to ensure railway safety and the safety, quality of construction, ensure that the owners of the quality, duration, targ nt inorganization plan 3.1. construction organization scheme 3.1.1. construction organization and responsibilities of the Departme apse is another focus of this project. 4, when jacking bridge, rectifying and elevation control is difficult. 3. constructione colltions are good, is a priority in the construction of this project. 3, in the course of jacking bridge, preventing the subgrad, the soil softer and Grouting to bridge is required, how to control the Grouting, satisfactory effect to ensure safety operaareas and difficulties of 1, the construction process to ensure railway operation safety is key. 2, high water table in the project21Project Manager, Chief Engineer, Chief Security Officer, and consists oftime. Project management leadership by the project manager, Assistant