's prevention and health care of nursing of the elderly's plump type myocardium disease

's prevention and health care of nursing of the elderly's plump type myocardium disease
Zhang QingYe Lu LiXia Yang JianHua Wang MeiYu Wang DanDan 2005-12-13 13:29:45 China's modern clinical medicine magazine Number 11 of Vol. 1 of December of 2003

Plump type myocardium disease (HCM) It is a kind of unique special taking place myocardium disease of pathologic physiology and clinical course, having family nature hearts and is unusually inclined to. Some patients can not have subjective symptoms at all but find or die suddenly in the physical examination. Because the plump type varied clinical and hereditary characteristic of myocardium disease, so require and attend to clinically the individual, must solve two problems in attending to the tactics at the same time: First, attend to to the ill, improve the patient's life quality. Detect those, have, die suddenly dangerous patient and attend to actively highly. Until 6 getting plump old person that accept for medical treatment myocardium disease attend to the report as follows since the will it be October - will it be December 2002 2001 this text.
A clinical materials
4 the case men of this group, 2 women, 45-64 years old, the mean age is 58 years old. The medical history is 3- 5 years. Patient's main symptom, in order to have palpitation, be uncomfortable in chest, faint, usually aggravate in the physical exertion. Heart function 2 - grade, the district can hear before the heart and 2/6- 4/6 grades systolic phase noise.
2 is generally attended to
2.1 The psychology attends to the psychological condition of finding out about patient and relative in time, according to patient's different psychological conditions present, dredge, introduce the matters relating to noticing, care for and inquire the condition the corresponding psychology, understand voluntarily the patient needs, makes their trust with the hospitable and affable attitude, make it free one's mind of misgivings and nervous, accept and cooperate with the treatment with the best state of mind. Should also notice at the same time that guide health care in time at time when patient's mood is steady, explain diet, rest and attentive matters after leaving hospital.
2.2 Life attends to and establishes good protecting and suffering from the relation, meet patient's essential demand in life. Less salt that the diet offers, low lipoprotein, light food apt to digest and assimilate, right amount of supplementary cellulose, fresh fruit vegetables, the taking food amount can't satiate, so as not to increase the heart and bear. Appropriate oral laxative, warn the patient must guard against holding one's breath and exerting oneself, so as not to aggravate the burden of the heart at the time of constipation, the cardiac muscle of kindling is ischemic, educate the patient to exhale while defecating or include and obey the Nitroglycerin, wriggle the intersection of direction and the intersection of massage and belly for several times, in order to promote, defecate according to intestines every day.
3 endangers the nursing of the factor high
3.1 It is the omen of dying suddenly that treatment and nursing fainting faint, should cause and pay attention to clinically. Clinical can't ignore to attend to, the nurse should inquire whether a patient faints and breaks out in the history in detail, understand the patient faints in number of times, duration for each time, relation with body posture and there is forerunner's symptom before outbreak happening, such as look pale, be disgusting, vomit, dizzy, the eyes are black, cold sweat,etc. appears. Advise a patient and stay in bed appropriately, avoid moving about, excited vigorously, assist the patient to do a good job of life to attend to. Dowered by the special messenger while going out to check. Prevent from, accelerate because of heart rate and cardiac muscle shrink to aggravate to obstruct, lead to the fact the blood supply of brain drops and faints. Meanwhile, HCM patient take more receptors and block pharmaceutical propranolol and calcium and resist Vera's handkerchief rice of pharmaceutical,etc. short of moneyly, the shouldering muscular strength medicine inhibits the cardiac muscle from shrinking, lighten and flow out a blockade. The nurse should pay attention to observing the harmful effects to the blood pressure and heart rate of above-mentioned medicine, avoid the emergence that faints.
3.2 Prevention and patient, HCM of nursing, that die suddenly happen, die suddenly, go diagnose or make a definite diagnosis of and difficult to foresee recently clearly yet, and die suddenly only as the clinical manifestation that is firsted publish. Should note closely to attend to the patient's subjective symptoms, pay attention to the changes of the heart rate and rhythm of the heart, especially any room emergence with not normal rhythm of the heart. The nurse on duty should grasp use and urgent heart and lungs of the defibrillating device and recover skillfully. The figure of changing to various electrocardiograms, arrhythmia can be judged accurately, in order to make good preparations for rescuing as soon as possible, try to rescue time.
3.3 Assess the clinical symptom that the arrhythmia may be caused in nursing of the arrhythmia, for instance palpitation, weak, uncomfortable in chest, dizzy and fainting etc., pay attention to observing and inquiring the intensity, duration and influence brought to patient's daily life of these symptoms. Measure the heart rate and rhythm of the heart regularly. Guard the electricity of heart in time, observe the emergence with arrhythmia closely. Secondly it is high atrio-ventricular block, three bunches block. Most block can resume, place the pace maker if necessary. The nurse should know electrocardiograph operation method, copy and write the electrocardiogram and indicate date and time in time when the patient broke out suddenly in arrhythmia. Patient substantially as needing lasting heart electricity to monitor, should pay attention to situations such as the number of times, duration, therapeutic effect,etc. of observing breaking out. Get first-aid medicine ready, rescue apparatus if necessary, pay first aid in time. Educate the patient to pay attention to striking a proper balance between work and rest, life law, keep mood steady, avoid taking in the stimulating food, such as coffee, strong tea, strong drink, coke,etc.; The slow patient aroused in interest should avoid holding one's breath to act hard, such as defecate etc. hard, aroused in interest and too slow so as not to aggravate because of nervus vagus of excitement.
3.4 The patient that has declined has not the heart has not taken place yet in the nursing that the heart declines to want to avoid being tired, pay attention to preventing the airway infection, give up smoking, wine. Take place heart decline, should pay attention to abundant rest, offer less salt or have salt, high the intersection of vitamin and light diet, should have more meals a day but less food at each, thiamine 1 and C of rational supply, the low potassium patient increases vegetables, melon and fruit, broth and orange juice,etc. appropriately. Suck the oxygen, observe patient's life changing, dyspneal intensity, rale change in situation and lung of coughing, coughing up phlegm of physical sign tightly. Follow the doctor's advice and take medicine, use medicine and observe changes such as the patient's complexion, heart rate, rhythm of the heart, blood pressure, urine amount, mind,etc. in the course closely, while using diuretic, should record the coming in and going out amount strictly, monitor the electrolytic change, for instance low potassium, low sodium; Use the blood vessel to control the infusion speed and monitor blood pressure, do well and attend to the record while expanding pharmaceuticals, delay the condition to worsen.
HCM makes little progress, but if the condition develops fast or the too high prognosis of blood pressure of latter stage of relaxation of ventricle is relatively bad. Except that the patient arranges activity, insists on treating rationally strictly and continuously, should also pay attention to keeping mood steady, avoid moving vigorously, prudent, movement of holding one's breaths, in order to reduce the emergence dying suddenly. In addition carry on supersound to be aroused in interest to pursue, check, can find the condition to direct relative early.
Author's unit: The 153rd hospital of 450042 PLA men of Zhengzhou, Henan
(Accept draft date: 2003-08-17)

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