Common unsafe factors in hospitals and their prevention

Formed nursing: early humanistic care-doctors, witches, whether in the Middle Ages-nuns served in hospitals, aristocratic occupations in the Renaissance-became independent, and religious reform-in the dark ages, the basic tasks of nursing were: alleviating pain, preventing diseases, restoring health, promoting healthy physical environment, hospitals, spaces, temperature, humidity, ventilation, light, sound and decoration. General ward temperature 18? The temperature in the elderly and neonatal wards should be kept at 22? 24。 The humidity in the ward is 50% to 60%. The purpose of the 30-minute window is to replace the indoor air circulation. The ideal noise intensity of daytime hospitals should be kept at 35-45 decibels. Nurses should do four things in their work, that is, speak lightly, walk lightly and operate the light switch lightly. Patients who use green or blue decorations in the operating room feel quiet and confident! Relationship with the hospital: the relationship between nurses and patients, the relationship between doctors and patients, and the relationship between patients and other staff. In the process of hospitalization, furniture and equipment provide the patient's bed unit, and the patient's excretion activities are rest and treatment of sleep and food, which is the most basic living unit. The spare bed for operation is temporarily empty according to the law, and the patient stays in bed under anesthesia. The bed and bedside table are about 20 cm, 15 cm on the bedside chair. Admission procedure: nurse the patient to the hospital and disinfect, and escort the patient to the ward. Generally speaking, hospital care for patients: welcome new patients in the hospital bed preparation unit, measure the patient's temperature, pulse, respiration, blood pressure and weight, measure and record the height, inform your doctor to remind the patient's needs, assist in physical examination or treatment time when necessary, fill in the tickets, and care (fill in the hospitalization, eyebrows and various forms page by page with blue pen, and the date and time of admission are vertical. Which one can recommend filling in the hospital registration card for treatment, nursing measures and hospital care in written form under the guidance of the doctor? Emergency patients participate in the intensive care unit, prepare bed units, prepare first aid items and drug rescue, and provide lasting escort and graded care; It is divided into priority diseases and patients' ability, self-care level nursing, special nursing, nursing, secondary nursing and tertiary nursing. Special care objects such as critically ill patients should be observed at any time and rescued. (such as severe trauma, complicated and difficult operation, organ transplantation, extensive burns, serious illness, etc.). ) nursing; Arrange 24-hour nursing, closely observe the patient's condition changes and important signs, formulate nursing plans, diagnosis and treatment plans and nursing measures, strictly implement them, fill in special nursing records in time and accurately, prepare emergency drugs and basic nursing of drugs, prevent complications and ensure the safety of patients. Suitable for object-level nursing, critically ill patients need absolute rest. (such as major surgery, shock, coma, paralysis, high fever, bleeding, liver and renal failure and premature infants) nursing contents; One round, each time 15? Observe the changes of illness and vital signs for 30 minutes and make a nursing plan? Procedures, strict implementation of outpatient and nursing measures, timely and accurately complete special care and good basic nursing follow-up records to prevent complications and meet patients' physiological and psychological needs. Applicable objects of secondary nursing; Severe patients who can't take care of themselves (such as stable major surgery, the elderly, the infirm, the chronically ill, and the young children). ), nursing content, per 1? Make rounds every 2 hours, observe the daily care of patients with heart diseases, meet their physiological and psychological needs, and provide necessary technical support. Applicable objects of tertiary care; Lighter patients can basically take care of themselves. Health status (such as chronic diseases, disease recovery, preoperative preparation): visit twice a day to observe the sick patients, and provide medical services according to daily care, guidance and supervision, patient compliance and other regulations to meet the physiological and psychological needs of patients. Zhang is comfortable, safe and comfortable, and the individual is in a state of relaxation, satisfaction, comfort, no anxiety, no pain, health and tranquility. Discomfort; Personal physical and mental health is imperfect or defective, and self-discomfort and pain that can't meet all needs of body and mind are the most serious manifestations. The principle of putting prevention first is to care for patients with discomfort, promote their comfort, strengthen supervision, find discomfort, take effective measures to eliminate or alleviate discomfort, trust each other and give psychological support. Lateral position, supine position classification, supine position active and passive lateral position, and forced supine position. Change positions at least every two hours. Second-hand supine position (concave supine position for anesthesia patients, pillow supine position for shock patients, supine position for abdominal examination and catheterization patients; ), lateral position (enema, anal examination and gastroscopy, intramuscular injection to prevent pressure ulcers), semi-recumbent position (patients with dyspnea in face and neck surgery, patients with cardiopulmonary diseases, patients with thoracoabdominal and pelvic surgery, patients with weak constitution), easy-to-sit position (patients with heart failure, pericardial effusion and bronchial asthma), (lower back, check or cooperate with cholangiopancreatography, spinal surgery, (pulmonary secretion drainage, duodenum) Students' low knee chest position (anus, rectum, sigmoidoscopy to correct fetal malposition or promote postpartum uterus to recover forward tilt), lithotomy position (perineal anus examination, fertility concept) pain, subjective feeling related to existing or potential tissue damage is a defensive response to pain stimulus that is harmful to the body) and personal pain often accompanied by physiological, behavioral and emotional reactions. Nursing evaluation Pain assessment, pain location, pain time, pain quality, pain degree and pain manifestation The World Health Organization divides pain into four categories, namely 0 painless 1 (mild) and pain, but it is not serious, but unbearable and will not be affected by sleep. 2 (moderate), obvious pain, unable to stand, sleep disorder, sedative: 3 (severe), severe pain, unable to stand, seriously disturbing sleep, need to use painkillers. Nursing measures reduce or eliminate pain, relieve or alleviate pain. Psychological nursing is a safe and comfortable environment, and peace is an environment without danger or harm. Common unsafe factors in hospitals; Mechanical injury, thermal injury, chemical injury, biological injury, psychological injury and iatrogenic injury. Protection; The AIDS section of the bed stand is tied with crutches (minus 40 cm high) and sugar cane. Chapter II Prevention and Control of Hospital Infection Hospital infection in broad sense and narrow sense generally refers to hospital infection in narrow sense, including infection during hospitalization and infection in backyard after discharge. Classification; Exogenous infection and endogenous infection. Basic conditions for formation; Source of infection, route of transmission and susceptible host. Clean, remove dirt, dust and organic matter on the surface, aiming at eliminating and reducing the physical methods of the body without killing microorganisms. Disinfection; Remove or kill all microbial spores by physical or chemical methods. Disinfection kills all microorganisms, physical or chemical methods. Choose aseptic, natural high temperature and high humidity disinfection method, preferably high pressure steam sterilization; For those who are afraid of heat, humidity and valuables, formaldehyde or ethylene oxide gas should be selected as disinfectant to disinfect and corrode metals. Natural surface, smooth surface and ultraviolet disinfection should be considered in surface disinfection. You can choose to wipe the surface with disinfectant, or spray disinfectant for long-term use and short-term use. Aseptic technology, a series of operating techniques and management methods to maintain aseptic pollution and prevent microorganisms from invading or spreading to others during medical and health care operations. Infertility: unpolluted goods have been sterilized by physical or chemical methods. Sterile area: the polluted area of shopping resort, which has been chemically disinfected. Non-sterile area: a contaminated area that has not been disinfected or disinfected. Aseptic technology: clean and spacious environment, regular disinfection, stop the hemp sweeping project half an hour before business, reduce walking, and avoid unnecessary crowd and textile dust discharge. Employees' clothing meets aseptic requirements: before aseptic, employees are a good hat. Wash your hands and wear a mask. The mask should be changed once, and moist bacteria can easily penetrate for 4-8 hours. 3. The materials shall be managed in an orderly manner, and the sterile and non-sterile materials shall be placed separately with obvious signs. After disinfection, they shall not be exposed to the air, and shall be stored in sterile bags or containers. The sterile packaging shall be marked with the effective order name and sterilization date, and shall be placed in sterile packaging for 7 days. Once the aseptic gripper is removed, suspicious or contaminated items should be replaced and disinfected again. 4. Clean up the sterile area and non-sterile area, and the operator should keep a certain distance from the sterile area and the sterile area for taking and placing articles. Don't sterilize your arm through the sterile field, so as not to face the sterile field, laugh, cough, sneeze, and touch articles that have not been sterilized at high temperature, sterile or passed through the sterile field. Sterile workers, a group of patients, to prevent cross-infection. Sterile grip pliers: oval (careless) trident (careful) big and small pliers soaked in disinfectant (minor problem) 2? The joint axis of 3 cm hand disinfection forceps is fixed in the back third. Sterile goods? Generally, it is effective within seven days, but it is only 24 hours, and the aseptic carton is opened in 4 hours. Isolation: take measures to prevent the spread of infection, control the source of microorganisms, cut off the route of transmission, and protect susceptible people. Classification: infectious disease isolation and protective isolation. Isolation types: strict isolation (cholera and plague), respiratory isolation (tuberculous meningitis), intestinal isolation (typhoid, dysentery and hepatitis A), contact isolation (tetanus and gas gangrene), blood and body fluid isolation (hepatitis B, AIDS and syphilis), insect isolation and protective isolation (encephalitis, epidemic hemorrhagic fever, typhoid scar, malaria, etc.). ), and vice versa. The collar and robe on the inner surface of the clean area to which it belongs. Carefully comb the hair care knot and apply 30% alcohol penetration! Close the bathtub for more than 7 months. Pressure ulcer: also known as pressure ulcer, under long-term pressure, local tissue blood circulation is blocked, and persistent ischemia, hypoxia and malnutrition cause tissue ulcer and malnutrition. Mechanical factors, pressure sore pressure, shear force, friction force.

Limit malnutrition or edema patients stimulated by local humidity and excreta. The classification and clinical manifestations of bedsore are: congestion and ruddy stage, inflammatory infiltration stage and ulcer stage. Product features: 1 degree pressure sore shows dark red skin. Redness, swelling, heat, pain, numbness, etc. The characteristics of these two kinds of trauma, the skin is blue-purple subcutaneous induration, edema thinning, skin exudation and inflammatory reaction, such as blisters the size of wet trauma, burst to form irrigation. Third-degree pressure sore: superficial tissue infection, suppuration, pus-out, ulcer formation, bad ulcer infection spreading to the periphery and deep, often not reaching the bone surface, black bad tissue, increased purulent secretion, smelly! Effective rest conditions: adequate sleep, comfortable body and relaxed spirit! Musculoskeletal status of complete paralysis: 0

Muscle girth contracted slightly, but there was no limb movement. Limbs can move, but they can't be lifted. Three limbs can be lifted off the bed surface, but they can't resist the resistance;

Level 4 resistance, but powerless; Classification of normal physical activity of muscle strength; 0 degrees completely independent and free activities. Equipment or device to be used. 3 degrees, 2 degrees, need care, help and education, need help, but also need equipment and machinery. 4 degrees completely independent. Isometric contraction muscle training exercises and tense vital signs, such as body temperature, pulse, respiration, blood pressure and general conditions. Temperature: oxidative decomposition of sugar, fat and protein. Thermoregulation: the self-regulation and thermoregulation behavior of body temperature. Changes of physiological temperature: day and night, age, activity, drug fever department (such as environment, diet, mood, etc. ): low fever 37.3 to 38.0 38. 1 to 39.0, high temperature, fever 39. 1 to 41; During the rising period of ultra-high fever, the temperature of the thermal process is higher than 465,438 0 degrees, the time and type of fever: continuous fever (lasting 39-40 degrees), pneumonia, typhoid fever, flabby fever (exceeding 39 degrees and fluctuating greatly), septicemia, rheumatic fever, intermittent fever (the body temperature suddenly rises above 39 degrees), common forms of malaria: despite the sultry weather, high fever care: cooling down.