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天使加油站·专科护士必备丛书:移植护理必备

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《天使加油站·专科护士必备丛书:移植护理必备》为移植护理专科必备用书,由从事移植工作的护理专业人员编撰而成。全书内容涵盖了肝移植、儿童肝移植、肾移植、儿童肾移植、胰肾移植、心脏移植、造血干细胞移植等各类移植的相关内容。
Catalogue

第一站 基础问答
一、肝移植部分
1.什么是肝移植?肝移植可分几类?
2.什么是原位肝移植术?
3.什么是辅助性肝移植术?
4.什么是活体部分肝移植?
5.亲体肝移植有哪些优点?
6.亲体肝移植供体的要求有哪些?
7.供肝后肝还能再生吗?
8.亲体肝移植术后受体可能出现的并发症有哪些?
9.肝移植适应证有哪些?
10.肝移植的相对禁忌证有哪些?
11.肝移植的绝对禁忌证有哪些?
12.在什么情况下肝肿瘤患者可以进行肝移植?
13.肝的生理功能包括哪些?
14.终末期肝疾病常见并发症有哪些?
15.上消化道出血的护理措施有哪些?
16.应严密观察的病情包括哪些内容?
17.三腔两囊管护理注意事项包括哪些内容?
18.腹水是如何形成的?
19.肝性脑病分哪几期及各期特征是什么?
20.什么是供肝保存性损伤?
21.什么是肝的热缺血及热缺血时间?
22.什么是肝的冷缺血及冷缺血时间?
23.什么是肝的温缺血及温缺血时间?
24.肝移植患者的术前准备包括哪些内容?
25.肝移植术前进行的自理能力训练包括哪些内容?
26.肝移植排异反应类型有哪些?
27.急性排异反应最具体征性的组织学改变是什么?
28.急性排异反应的高发期是何时?
29.诊断急性排异反应的金标准是什么?
30.慢性排异反应的发生时间是何时?
31.如何发现排异反应?
32.肝移植术后最常见的病毒感染是什么?
33.肝移植术后早期有哪些比较严重的并发症?
34.肝移植手术放置T管的目的是什么?
35.肝移植术后的主要胆道系统并发症是什么?
36.移植肝功能不全的主要临床表现是什么?
37.肝移植术后早期出现黄疸的原因是什么?
38.为什么肝移植术后血糖升高?
39.为什么移植术后的大部分患者需要注射胰岛素?
40.高血糖的危害有哪些?
41.低血糖的危害有哪些?
42.肝移植术后患者为什么有时会出现少尿?
43.肝移植术后早期患者应保持何种体位?
44.肝移植术后监测包括哪几方面内容?
45.肝移植术后腹部引流管的护理包括哪些内容?
46.肝移植术后常用的免疫抑制剂有哪些?
47.什么叫“全血药物谷浓度”?有什么用途?
48.肝移植术后患者如何正确服用他克莫司(FK506)?
49.服用他克莫司(FK506)的副作用有哪些?
50.环孢素导致的不良反应有哪些?
51.长期大剂量应用激素引起的主要不良反应有哪些?
52.肝移植术后肝功能多长时间恢复?
53.肝移植术后的饮食原则有哪些?
54.肝移植术后如何预防感染?
……

第二站操作规程
第三站实战案例
第四站临床速查
Book Abstract

12.急性排斥反应的发生时间是何时,以及临床表现有哪些?
答:发生时间为肾移植后第6天至术后3~6个月内。
临床表现:患者突然出现发热、头晕、鼻塞、腹泻等类似感冒的症状。血压突然升高,并伴有难以解释的情绪改变。移植肾区肿大、压痛、胀痛。尿量减少,血肌酐、尿素氮上升。尿细胞学检查白细胞增高,淋巴细胞分类大于0.15。彩色多普勒检查显示肾体积增大,皮质结构不清、分界模糊,肾乳头增大,肾血流减少,血管阻力指数增高。
13.慢性排斥反应的发生时间是何时,以及临床表现有哪些?
答:发生时间为手术6个月以后。
临床表现:患者开始出现慢性进行性肾功能减退或丧失,并出现蛋白尿、血尿、血压增高、贫血,血肌酐逐渐升高,尿量减少、移植肾萎缩、肾血流量减少等,一般呈不可逆转性改变。
14.排斥反应的护理包括哪些内容?
答:(1)密切观察生命体征的变化,定时测量体温、脉搏、呼吸、血压,注意观察腹痛的性质,是否有伤口疼痛或移植肾区胀痛,未确诊前禁用止痛剂。
(2)保持各引流管固定、通畅,严密观察导尿管引流液的性质及量,记录每小时尿量。若导尿管内的尿液排出减少,且排除尿管受压、弯曲、扭折、接头松脱及尿管内有小凝血块等因素,应考虑为排斥反应。立即通知医生,根据病情行抗排斥反应的冲击治疗。
(3)在行冲击治疗的过程中观察患者全身有无慢性感染病灶,肾移植术后发生感染的主要原因如下:①肾移植受者术前长期透析,常常存在贫血、凝血功能障碍、蛋白质消耗,导致免疫力减退。②肾移植手术打击致抵抗力暂时下降。③术前有感染病灶未得到及时治疗。④术后大剂量应用免疫抑制剂,明显降低免疫力。
15.肾移植术后多尿期的护理包括哪些内容?
答:(1)准确记录出入量及每小时尿量、颜色、性质,判断是否为多尿期。每12小时小结一次出入量,每24小时总结一次,以便及时调整治疗,确保出入量平衡。患者下床活动后,每日晨测量一次体重。
(2)保持输液管道通畅及保持出入量平衡,防止水、电解质紊乱。依照量出为人的原则,根据医嘱准确及时地完成大剂量的输液,同时监测中心静脉压以了解心脏负荷情况。
(3)观察患者眼睑、四肢及全身皮肤的脱水情况。
(4)严密观察生命体征,定时监测体温、呼吸、血压、脉搏并记录。注意观察血压与尿量关系的变化。在血循环容量正常、血压正常而尿量少于100ml/h时,可使用利尿剂。尿量少、血压偏低时,可给多巴胺静脉点滴维持到基础血压,改善肾血液灌流,增加尿量,以期提高肾移植早期人/肾存活率。
16.肾移植术后常见外科并发症有哪些?
答:按发生时间可分为早期与晚期并发症两类。早期并发症出现于手术后数小时或数天内,发生率高,性质严重,如术后出血、移植肾破裂、肾动静脉栓塞、创口感染等。晚期并发症发生于手术后数天、数月或数年,以血尿、感染、肾动脉狭窄、肾动静脉瘘等为常见。
……
Introduction

器官移植作为一种有效的治疗手段已被广泛应用,移植护理作为不可或缺的部分直接关系到患者的生存质量和生存率。许多国家制定了移植专业护士资格认证标准及考核规范。在我国,随着临床移植事业的迅速发展,迫切需要既有专业知识、专科技能又有丰富临床经验的专业护理人员。
《移植护理必备》一书为移植护理专科必备用书,由从事移植工作的护理专业人员编撰而成。全书内容涵盖了肝移植、儿童肝移植、肾移植、儿童肾移植、胰肾移植、心脏移植、造血干细胞移植等各类移植的相关内容。
编撰中结合各专科临床特点,将内容设为基础问答、操作规程、实战案例、临床速查四大部分,详细介绍了移植护理的基础理论与实践技能,更侧重临床护理观察与分析处理,特点是以经典的问答形式表述复杂的护理问题,把智慧之精华奉献给读者。本书对移植护理工作具有指导作用,可促进护理质量的提高,确保患者获得科学的护理。我们坚信本书将有助于提高移植护理的水平。
感谢作者们的无私奉献,他们将自己的专科知识和临床经验与大家分享。还要感谢一丝不苟的书稿审阅者,对所有的编者和审阅者付出的辛苦表示真诚的感谢。

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