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同学们好

上节课

我们一起学习了什么是上消化道

什么是上消化道出血

什么是上消化道的大量出血

主要的病因以及常见的临床表现

那么对于这种比较凶险的疾病

我们该如何尽早诊断尽早治疗呢

下面就让我们一起来看一下

为了明确诊断

除了结合病史和症状以外还需要进行哪些检查

首先是实验室检查

测定红细胞 白细胞

血小板计数

血红蛋白浓度 血细胞比容

肝功能 肾功能

大便隐血等等

这些有助于估计失血量

以及动态观察有没有活动性出血

判断治疗独到的效果以及协助病因诊断

比如白细胞增高 提示急性出血

白细胞 凝血酶原时间正常或下降

肝功能异常 考虑肝硬化

胆红素增高 考虑胆道出血 肝硬化 壶腹肿瘤

其次要做的就是胃镜的检查

它是上消化道出血定位 定性诊断的

首选检查方法

记住了 首选的检查方法

出血后24至48小时内

进行急诊内镜

可以直接观察病灶的情况

判断出血的部位 病因

及内镜下止血治疗

接下来是 X线钡餐检查

对于明确病因有他的价值

但就什么时候进行仍有争论

目前多主张在出血停止和病情基本稳定

数天后进行为宜

主要适用于

有胃镜检查禁忌证或不愿进行胃镜检查者

对经胃镜检查出血原因未明

疑病变在十二指肠降段以下小肠段

有特殊诊断价值

另外呢 其他检查 比如像是吞棉线试验

消化液检查

选择性动脉造影

内镜检查无阳性发现时用

主张在出血活动期进行

另外还有胶囊内镜

主要用于原因不明的小肠出血

对于上消化道出血的诊断

需要从几个方面进行评估和判断

首先要确立是不是上消化道出血

其次是判断出了多少血呢

再次是探究是什么原因引起的出血

最后是对于出血是否停止进行判断

这是很重要的四大内容

对于上消化道出血诊断的确立

需要根据

呕血 黑粪和失血性周围循环衰竭的临床表现

以及实验室检查作出诊断

大多是能够查明

患者的出血部位和原因的

以下几点值得注意

确定是上消化道出血以后就需要对出血量进行估计

可以从下面几方面进行判断

1 大便隐血试验阳性说明

每天的出血量大于5mL

出现黑粪说明

出血量大于50 70mL

出现呕血说明

胃内积血250 300mL

当一次出血小于400mL时

可无全身症状

但如果短期内出血

大于1000mL

则可有周围循环衰竭表现

2 具体出血量的估计

主要还是根据血容量减少所致的周围循环衰竭表现来进行判断

那么就需要对血压 脉搏作动态观察

结合患者接受补液与输血量

对血压 脉搏

恢复与稳定的效果加以判断

如果患者由卧位改半卧位

既出现脉搏增快 头昏等

表示出血量大

3 呕血与黑粪的频度与数量

血红蛋白 红细胞 红细胞压积测定只能作为参考

在上消化道出血的众多病因当中

一般要结合病史和体征

一起做初步判断

常见的病因及特点有

首先就是我们前面也学习过的消化性溃疡

它主要的特性是 慢性 周期性 节律性上腹痛

并且常常会有出血前疼痛加剧

出血后减轻或缓解

第二个原因就是急性胃黏膜损伤

病人有服用阿司匹林 吲哚美辛 糖皮质激素

等损伤胃黏膜的药物史

或者酗酒史

有创休克或者严重感染等应激状态

第三个原因

如果是40岁以上的男性

并且近期有上腹痛 厌食 消瘦 体重减轻的话就应考虑胃癌

第四个原因 如果是有肝病史

及肝病 门脉高压表现

就应考虑食管胃底静脉曲张破裂出血

门脉高压性胃病

这四大原因 消化性溃疡 急性糜烂出血性胃炎

胃癌

肝硬化导致的食管胃底静脉曲张破裂出血

是上消化道出血最常见的四大病因

那么该如何判断出血是否停止呢

观察下列迹象 提示有活动性出血或者再次出血

上消化道大出血是临床急症

应该采取积极措施进行抢救

先进行急救措施 迅速补充血容量

纠正水电解质失衡 预防和治疗失血性休克

给予止血治疗 治疗并发症

同时积极进行病因诊断和治疗

一般急救措施包括 卧床休息

保持呼吸道通畅 注意吸氧

正好处于活动性出血的时候应该暂时禁食

密切监测血压 心率 脉搏

尿量 神志意识 呕血与黑便情况等等

迅速补充血容量 纠正休克

这应该放在一切治疗措施之首

这是最重要的抢救措施

立即配血 快速输液

必要时紧急输血

紧急输血指征是

当体位改变

出现晕厥 血压下降

心率增快

收缩压低于90 mmHg

或较基础压下降25%

血红蛋白少于70g/L

或血细胞比容低于25%

输血量以使血红蛋白达到70g/L为宜

输血量可以根据估计的失血量来确定

止血的措施有两大类

第一就是食管胃底静脉曲张破裂出血

第二是非曲张静脉上消化道出血

食管胃底静脉曲张破裂出血呢

往往是因为出血量比较大 出血速度也比较快

再出血率和死亡率比较高

治疗措施上也有其特殊的地方

首先可以采用药物止血的方式

比如血管加压素及其类似物

生长抑素及其类似物

像是临床上用得比较多的有8肽生长抑素类似物奥曲肽 14肽天然生长抑素

另外可以采用三腔二囊管压迫止血

这个管的两个气囊分别是胃囊和食管囊

三腔管内的三个腔分别通往两个气囊和患者的胃腔

用以抽吸食管内积蓄的分泌物或者血液

它的止血作用还是值得肯定的

但患者比较痛苦

发症比较多 早期再出血率比较高

所以不推荐作为首选的止血措施

主要是用于药物治疗无效时的暂时止血

事实上就是物理的一个压迫方式

以争取时间

进行其他有效治疗 比如内镜止血等措施

内镜下止血是在药物治疗和气囊压迫

基本控制出血 病情基本稳定以后

进行急诊内镜检查和止血治疗

常用的方法有通过硬化剂注射 食管曲张静脉套扎术 EVL 进行止血

是治疗上消化道出血重要的手段

也可以作为预防性治疗

另外 当食管胃底静脉曲张破裂大出血

内科治疗无效的时候

应该考虑外科手术或经颈静脉肝内门 体静脉分流术 TIPS

而如果是非曲张静脉上消化道出血的话这类出血是

除了食管胃底静脉曲张破裂出血以外的其他病因导致的上消化道出血

以消化性溃疡为最常见的病因

止血措施也可以分为

药物治疗 内镜治疗 手术治疗 介入治疗

其中药物治疗呢

主要应用的是抑制胃酸分泌药

主要是因为胃酸和胃蛋白酶干扰

内 外源性凝血系统

抑制血小板因子Ⅲ的活性及血小板聚集

并可破坏血凝块

有效的抑酸治疗

使胃内 pH值大于6

是促进血小板聚集和血浆凝血功能的有力措施

代表性的药物有H2受体拮抗剂

比如西咪替丁 雷尼替丁 法莫替丁等

以及质子泵抑制剂呢就是像奥美拉唑 泮托拉唑等等

急性出血期都是静脉给药

另外内镜直视下止血适用于

有活动性出血或者暴露血管的溃疡

临床上面应用的方法很多

可以是内镜下药物喷洒止血 微波止血

高频电凝止血

激光止血 注射药物止血等等

少数不能够进行内镜止血或者手术治疗的

严重大出血的患者呢

可以选择肠系膜动脉造影寻找出血病灶

给予血管栓塞治疗

最后可以采用手术治疗

但不同病因导致的出血 所采取的手术方式不同

综上 多数上消化道出血的患者

经过治疗以后可以止血或者自然停止出血

大约有15% 20%的患者持续出血或者反复出血

由于出血的并发症使死亡的危险性增高

所以对于这些患者应该早发现早治疗

特别是要掌握抢救处理

迅速补充血容量

预防和治疗失血性休克

改善预后

今天的课到这里就结束了

谢谢大家

Medical Nursing课程列表:

Unit 1 Care of Patients with Respiratory System Diseases (Part One)

-Introduction to Medical Nursing

--Introduction to Medical Nursing

--Introduction to Medical Nursing

-Chapter 1 Overview of Respiratory System Diseases

--Overview of Respiratory System Diseases

--Overview of Respiratory System Diseases

--Overview of Respiratory System Diseases

-Chapter 2 Care of Patients with Pneumonia

--Overview of pneumonia

--Overview of pneumonia

--Streptococcal Pneumonia

--Streptococcal Pneumonia

--Other types of pneumonia

--Other types of pneumonia

--The quality and color of sputum

--Care of Patients with Pneumonia

-Chapter 3 Care of Patients with Lung Abscess

--Introduction of lung abscess

--Introduction of lung abscess

--Treatment and nursing of lung abscess

--Treatment and care of nursing abscess

--Care of Patients with Lung Abscess

-Chapter 4 Care of Patients with Pulmonary Tuberculosis

--Etiology and pathogenesis of pulmonary tuberculosis

--Etiology and pathogenesis of pulmonary tuberculosis

--Clinical manifestation of pulmonary tuberculosis (I)

--Clinical manifestation of pulmonary tuberculosis (I)

--Clinical manifestation of pulmonary tuberculosis (II)

--Clinical manifestation of pulmonary tuberculosis (II)

--Treatment and nursing of pulmonary tuberculosis

--Treatment and nursing of pulmonary tuberculosis

--Care of Patients with Pulmonary Tuberculosis

Unit 2 Care of Patients with Respiratory System Diseases (Part Two)

-Chapter 5 Care of Patients with Chronic Obstructive Pulmonary Disease

--Care of patients with chronic bronchitis

--Care of patients with chronic bronchitis

--Care of patients with chronic bronchitis

--Introduction of chronic obstructive pulmonary disease

--Introduction of chronic obstructive pulmonary disease

--Care of chronic obstructive pulmonary disease

--Care of chronic obstructive pulmonary disease

--Oxygen

--Care of Patients with Chronic Obstructive Pulmonary Disease

-Chapter 6 Care of Patients with Bronchial Asthma

--Etiology and pathogenesis of bronchial asthma

--Etiology and pathogenesis of bronchial asthma

--Clinical manifestation of bronchial asthma

--Clinical manifestation of bronchial asthma

--Treatment and nursing of bronchial asthma

--Treatment and nursing of bronchial asthma

--Care of Patients with Bronchial Asthma

-Chapter 7 Care of Patients with Chronic Pulmonary Heart Disease

--Etiology and pathogenesis of chronic pulmonary heart disease

--Etiology and pathogenesis of chronic pulmonary heart disease

--Treatment and nursing of chronic pulmonary heart disease

--Treatment and nursing of chronic pulmonary heart disease

--Care of Patients with Chronic Pulmonary Heart Disease

Unit 3 Care of Patients with Respiratory System Diseases (Part Three)

-Chapter 8 Care of Patients with Primary Bronchogenic Carcinoma

--Etiology and pathogenesis of primary bronchogenic carcinoma

--Etiology and pathogenesis of primary bronchogenic carcinoma

--Clinical manifestation and auxiliary examination

--Clinical manifestation and auxiliary examination

--Treatment and nursing of primary bronchogenic carcinoma

--Treatment and nursing of primary bronchogenic carcinoma

--Care of Patients with Primary Bronchogenic Carcinoma

-Chapter 9 Care of Patients with Pleural Effusion

--Etiology, pathogenesis and clinical manifestations

--Etiology, pathogenesis and clinical manifestations

--Treatment and nursing of pleural effusion

--Treatment and nursing of pleural effusion

--Determination of the nature of pleural effusion

--Care of Patients with Pleural Effusion

-Chapter 10 Care of Patients with Respiratory Failure and Acute Respiratory Distress Syndrome

--Etiology and pathogenesis of respiratory failure

--Etiology and pathogenesis of respiratory failure

--Treatment and nursing of respiratory failure patients

--Treatment and nursing of respiratory failure patients

--Care of Patients with Respiratory Failure

--Introduction of acute respiratory distress syndrome

--Introduction of acute respiratory distress syndrome

--Treatment and nursing of acute respiratory distress syndrome

--Treatment and nursing of acute respiratory distress syndrome

--Care of Patients with Respiratory Failure

--Care of Patients with Acute Respiratory Distress Syndrome

-Unit Test: Respiratory System

-Unit Assignment: Respiratory System

Unit 4 Care of Patients with Cardiovascular System Diseases (Part One)

-Chapter 1 Care of Patients with Cardiovascular System Diseases

--Overview of Cardiovascular System

--Overview of Cardiovascular System

--Overview of Cardiovascular System

-Chapter 2 Care of Patients with Heart Failure

--Overview of heart failure

--Overview of heart failure

--Chronic heart failure (1)

--Chronic heart failure (1)

--Chronic heart failure (2)

--Chronic heart failure (2)

--Acute heart failure

--Acute heart failure

--Heart Failure

-Chapter 3 Care of Patients with Arrhythmia

--Overview of arrhythmia

--Overview of arrhythmia

--Sick sinus syndrome

--Sick sinus syndrome

--Supraventricular tachycardia

--Supraventricular tachycardia

--Atrial fibrillation

--Atrial fibrillation

--Ventricular tachycardia

--Ventricular tachycardia

--Atrioventricular block

--Atrioventricular block

--Nursing care of patients with arrhythmia

--Nursing care of patients with arrhythmia

--Cardiac arrhythmia

Unit 5 Care of Patients with Cardiovascular System Diseases (Part Two)

-Chapter 4 Care of Patients with Coronary Artery Disease

--Overview of coronary heart disease

--Overview of coronary heart disease

--Stable angina pectoris

--Stable angina pectoris

--Unstable angina pectoris

--Unstable angina pectoris

--Acute myocardial infarction (1)

--Acute myocardial infarction (1)

--Acute myocardial infarction (2)

--Acute myocardial infarction (2)

--Acute myocardial infarction (3)

--Acute myocardial infarction (3)

--Coronary Artery Disease

--Difference between angina pectoris and myocardial infarction

-Chapter 5 Care of Patients with Hypertension

--Primary hypertension (1)

--Primary hypertension (1)

--Primary hypertension (2)

--Primary hypertension (2)

--Primary hypertension

--Safe nursing for patients with hypertension

-Chapter 6 Care of Patients with Myocardial Diseases

--Myocardial Diseases (1)

--Myocardial Diseases (1)

--Myocardial Diseases (2)

--Myocardial Diseases (2)

--Myocardial Diseases (3)

--Myocardial Diseases (3)

--Myocardial Diseases

-Unit Assignment: Cardiovascular System

Unit 6 Care of Patients with Digestive System Diseases

-Chapter 1 Overview of Digestive System

--Overview of digestive system(I)

--Overview of digestive system(I)

--Overview of digestive system(II)

--Overview of digestive system(II)

--Overview of Digestive System

-Chapter 2 Care of Patients with Peptic Ulcer

--Etiology and clinical manifestation of peptic ulcer

--Etiology and clinical manifestation of peptic ulce

--Treatment and nursing of peptic ulcer

--Treatment and nursing of peptic ulcer

--Recurrence of peptic ulcer

--Care of Patients with Peptic Ulcer

-Chapter 3 Care of Patients with Hepatic Cirrhosis

--Etiology and clinical manifestation of hepatic cirrhosis

--Etiology and clinical manifestation of hepatic cir

--Treatment and nursing of hepatic cirrhosis

--Treatment and nursing of hepatic cirrhosis

--Cirrhosis

--Care of Patients with Hepatic Cirrhosis

-Chapter 4 Care of Patients with Hepatic Encephalopathy

--Etiology and pathogenesis of hepatic encephalopathy

--Etiology and pathogenesis of hepatic encephalopath

--Clinical manifestation,treatment and nursing of hepatic encephalopathy

--Clinical manifestation,treatment and nursing of he

-- Care of Patients with Hepatic Encephalopathy

-Chapter 5 Care of Patients with Upper Gastrointestinal Hemorrhage

--Upper gastrointestinal hemorrhage(I)

--Upper gastrointestinal hemorrhage(I)

--Upper gastrointestinal hemorrhage(II)

--Upper gastrointestinal hemorrhage(II)

--Upper gastrointestinal hemorrhage(Ⅲ)

--Upper gastrointestinal hemorrhage(Ⅲ)

--Upper gastrointestinal hemorrhage

--Care of Patients with Upper Gastrointestinal Hemorrhage

-Unit Test: Digestive System

-Unit Assignment: Digestive System

Unit 7 Care of Patients with Urinary System Diseases

-Chapter 1 Overview of Urinary System

--Overview of Urinary System

--Overview of Urinary System

--Overview of Urinary System

-Chapter 2 Care of Patients with Glomerular Diseases

--Care of Patients with Glomerular Diseases

--Care of Patients with Glomerular Diseases

--Care of Patients with Glomerular Diseases

--Acute Glomerulonephritis

--Acute Glomerulonephritis

-- Acute Glomerulonephritis

-- Rapidly Progressive Glomerulonephritis

--Rapidly Progressive Glomerulonephritis

--Rapidly Progressive Glomerulonephritis

--Chronic Glomerulonephritis

--Chronic Glomerulonephritis

--Chronic Glomerulonephritis

-Chapter 3 Care of Patients with Nephrotic Syndrome

--Nephrotic Syndrome

--Nephrotic Syndrome

--Nephrotic Syndrome

Unit 8 Care of Patients with Urinary System Diseases

-Chapter 4 Care of Patients with Urinary Tract Infection

--Care of Patients with Urinary Tract Infection

--Care of Patients with Urinary Tract Infection

--Care of Patients with Urinary Tract Infection

--Care of Patients with Urinary Tract Infection

--Care of Patients with Urinary Tract Infection

-Chapter 5 Care of Patients with Chronic Renal Failure

--Care of Patients with Chronic Renal Failure

--Care of Patients with Chronic Renal Failure

--Care of Patients with Chronic Renal Failure

--Care of Patients with Chronic Renal Failure

--Care of Patients with Chronic Renal Failure

--Unit Assignment: Urinary System

-Chapter 6 Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

--Care of Patients with Systemic Lupus Erythematosus

Unit 9 Care of Patients with Hematologic and Hemopoietic System Diseases (Part One)

-Chapter 1 Overview of Hematologic System

--Overview of hemopoietic system diseases (I)

--Overview of hemopoietic system diseases (I)

--Overview of hemopoietic system diseases (II)

--Overview of hemopoietic system diseases (II)

--Overview of hemopoietic system diseases (I)

--Overview of hemopoietic system diseases (II)

-Chapter 2 Overview of Anemia

--Overview of Anemia

--Overview of Anemia

--Overview of Anemia

-Chapter 3 Care of Patients with Iron Deficiency Anemia

--Overview,etiology and pathogenesis,clinical manifestation,auxiliary examination and diagnosis of iron deficiency anemia

--Overview,etiology and pathogenesis,clinical manifestation,auxiliary examination and diagnosis of iron deficiency anemia

--Treatment and nursing of iron deficiency anemia

--Treatment and nursing of iron deficiency anemia

--Nutrition and Anemia

--Iron Deficiency Anemia (I)

--Iron Deficiency Anemia(II)

-Chapter 4 Care of Patients with Aplastic Anemia

--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia

--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia

--Treatment and nursing of aplastic anemia

--Treatment and nursing of aplastic anemia

--Pancytopenia

--Care of Patients with Aplastic Anemia

-Chapter 5 Care of Patients with Hemolytic Anemia

--Nursing of patients with hemolytic anemia

--Nursing of patients with hemolytic anemia

--Care of Patients with Hemolytic Anemia

Unit 10 Care of Patients with Hematologic and Hemopoietic System Diseases (Part Two)

-Chapter 6 Care of Patients with Hemorrhagic Diseases

--Overview of hemorrhagic diseases

--Overview of hemorrhagic diseases

--Nursing of patients with idiopathic thrombocytopenic purpura

--Nursing of patients with idiopathic thrombocytopenic purpura

--Nursing of patients with anaphylactoid purpura

--Nursing of patients with anaphylactoid purpura

--Overview of hemorrhagic diseases

--Nursing of patients with idiopathic thrombocytopenic purpura

--Nursing of patients with anaphylactoid purpura

-Chapter 7 Care of Patients with Leukemia

--Definition, etiology and classification of leukemia

--Definition, etiology and classification of leukemia

--Definition and clinical manifestation of acute leukemia

--Definition and clinical manifestation of acute leukemia

--Auxiliary examination of acute leukemia

--Auxiliary examination of acute leukemia

--Nursing of acute leukemia(I)

--Nursing of acute leukemia(II)

--Nursing of acute leukemia

--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia

--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia

--Treatment and nursing ofchronic myeloid leukemia

--Treatment and nursing ofchronic myeloid leukemia

--Bone Pain

--Care of Patients with Leukemia

-Chapter 8 Care of Patients with Lymphoma

--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma

--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma

--Superficial Lymphadenopathy

--Care of Patients with Lymphoma

-Unit Test: Hematologic System

-Unit Assignment: Hematologic System

Unit11 Care of Patients with Endocrine System Diseases and Metabolic Disorders

-Chapter1 Overview of Endocrine ystem

--Overview of Endocrine System

--Overview of Endocrine System

--Overview of Endocrine System

-Chapter2 Care of Patients with Hypercortisolism

--Care of Patients with Hypercortisolism 1

--Care of Patients with Hypercortisolism 1

--Care of Patients with Hypercortisolism 2

--Care of Patients with Hypercortisolism2

--Care of Patients with Hypercortisolism

--Care of Patients with Hypercortisolism

-Chapter3 Care of Patients with Hyperthyroidism

--Care of Patients with Hyperthyroidism 1

--Care of Patients with Hyperthyroidism 1

--Care of Patients with Hyperthyroidism 2

--Care of Patients with Hyperthyroidism 2

--Care of Patients with Hyperthyroidism

--Care of Patients with Hyperthyroidism

-Chapter4 Care of Patients with Diabetes Mellitus

--Care of Patients with Diabetes Mellitus1

--Care of Patients with Diabetes Mellitus 1

--Care of Patients with Diabetes Mellitus2

--Care of Patients with Diabetes Mellitus 2

--Care of Patients with Diabetes Mellitus 3

--Care of Patients with Diabetes Mellitus 3

--Care of Patients with Diabetes Mellitus 4

--Care of Patients with Diabetes Mellitus 4

--Care of Patients with Diabetes Mellitus 5

--Care of Patients with Diabetes Mellitus 5

--Care of Patients with Diabetes Mellitus

--Care of Patients with Diabetes Mellitus

-Unit Review: Endocrine System

--Unit Assignment: Endocrine System

--Unit Test: Endocrine System

Unit 12 Care of Patients with Infectious Diseases (Part One)

-Chapter 1 Overview of Infectious Diseases

--Overview of Infectious Diseases 1

--Overview of Infectious Diseases 1

--Overview of Infectious Diseases 1

--Overview of Infectious Diseases 2

--Overview of Infectious Diseases 2

--Overview of Infectious Diseases 2

--Overview of Infectious Diseases

-Chapter 2 Care of Patients with Viral Hepatitis

--Care of Patients with Viral Hepatitis 1

--Care of Patients with Viral Hepatitis 1

--Care of Patients with Viral Hepatitis 1

--Care of Patients with Viral Hepatitis 2

--Care of Patients with Viral Hepatitis 2

--Care of Patients with Viral Hepatitis 2

--Care of Patients with Viral Hepatitis 3

--Care of Patients with Viral Hepatitis 3

--Care of Patients with Viral Hepatitis 3

--Care of Patients with Viral Hepatitis 4

--Care of Patients with Viral Hepatitis 4

--Care of Patients with Viral Hepatitis 4

--Care of Patients with Viral Hepatitis

-Chapter 3 Care of Patients with Hemorrhagic Fever with Renal Syndrome

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2

--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2

-Chapter 4 Care of Patients with Acquired Immune Deficiency Syndrome

--Care of Patients with Acquired Immune Deficiency Syndrome 1

--Care of Patients with Acquired Immune Deficiency Syndrome 1

--Care of Patients with Acquired Immune Deficiency Syndrome 1

--Care of Patients with Acquired Immune Deficiency Syndrome 2

--Care of Patients with Acquired Immune Deficiency Syndrome 2

--Care of Patients with Acquired Immune Deficiency Syndrome 2

-Chapter 5 Care of Patients with Rabies

--Care of Patients with Rabies 1

--Care of Patients with Rabies 1

--Care of Patients with Rabies 1

--Care of Patients with Rabies 2

--Care of Patients with Rabies 2

--Care of Patients with Rabies 2

--Care of Patients with Rabies

Unit 13 Care of Patients with Infectious Diseases (Part Two)

-Chapter 6 Care of Patients with Epidemic Encephalitis B

--Care of Patients with Epidemic Encephalitis B 1

--Care of Patients with Epidemic Encephalitis B 1

--Care of Patients with Epidemic Encephalitis B 2

--Care of Patients with Epidemic Encephalitis B 2

--Care of Patients with Epidemic Encephalitis B

-Chapter 7 Care of Patients with Epidemic Cerebrospinal Meningitis

--Care of Patients with Epidemic Cerebrospinal Meningitis 1

--Care of Patients with Epidemic Cerebrospinal Meningitis 1

--Care of Patients with Epidemic Cerebrospinal Meningitis 2

--Care of Patients with Epidemic Cerebrospinal Meningitis 2

--Care of Patients with Epidemic Cerebrospinal Meningitis

-Chapter 8 Care of Patients with Cholera

--Care of Patients with Cholera

--Care of Patients with Cholera

--Care for patients with cholera

-Chapter 9 Care of Patients with Bacillary Dysentery

--Care of Patients with Bacillary Dysentery

--Care of Patients with Bacillary Dysentery

--Care of Patients with Bacillary Dysentery

-Chapter 10 Care of Patients with Schistosomiasis

--Care of Patients with Schistosomiasis 1

--Care of Patients with Schistosomiasis 1

--Care of Patients with Schistosomiasis 2

--Care of Patients with Schistosomiasis 2

--Care for patients with schistosome

-Chapter 11 Care of Patients with COVID-19

--Care of Patients with COVID-19

--Care of Patients with COVID-19

-Chapter 12 Psychological Coping Modes to the Epidemic of COVID-19

--Psychological Coping Modes to the Epidemic of COVID-19

--Psychological Coping Modes to the Epidemic of COVID-19

-Unit Test: Infectious Diseases

--Unit Test: infective disease

-Unit Assignment: Infectious Diseases

--Unit Assignment: Infectious Diseases

Unit 14 Care of Patients with Nervous System Diseases (Part One)

-Chapter 1 Overview of Nervous System Diseases

--Overview of Nervous System Diseases(I)

--Overview of Nervous System Diseases(I)

--Overview of Nervous System Diseases(I)

--Overview of Nervous System Diseases(II)

--Overview of Nervous System Diseases(II)

--Overview of Nervous System Diseases(II)

-Chapter 2 Care of Patients with Facial Neuritis

--Care of Patients with Facial Neuritis

--Care of Patients with Facial Neuritis

--Care of Patients with Facial Neuritis

-Chapter 3 Care of Patients with Cerebrovascular Diseases (Episode 1)

--Overview of Cerebral Vascular Diseases (I)

--Overview of Cerebral Vascular Diseases (I)

--Overview of Cerebral Vascular Diseases (I)

--Overview of Cerebral Vascular Diseases(II)

--Overview of Cerebral Vascular Diseases(II)

--Overview of Cerebral Vascular Diseases(II)

--Intracerebral Hemorrhage(I)

--Intracerebral Hemorrhage(I)

--Intracerebral Hemorrhage(I)

--Intracerebral Hemorrhage(II)

--Intracerebral Hemorrhage(II)

--Intracerebral Hemorrhage(II)

Unit 15 Care of Patients with Nervous System Diseases (Part Two)

-Chapter 4 Care of Patients with Cerebrovascular Diseases (Episode 2)

--Subarachnoid Hemorrhage

--Subarachnoid Hemorrhage

--Subarachnoid Hemorrhage

--Transient Ischemic Attack

--Transient Ischemic Attack

--Transient Ischemic Attack

--Cerebral Thrombosis(I)

--Cerebral Thrombosis(I)

--Cerebral Thrombosis(I)

--Cerebral Thrombosis(II)

--Cerebral Thrombosis(II)

--Cerebral Thrombosis(II)

-Chapter 5 Care of Patients with Epilepsy

--Care of Patients with Epilepsy(I)

--Care of Patients with Epilepsy(I)

--Care of Patients with Epilepsy(II)

--Care of Patients with Epilepsy(II)

--Care of Patients with Epilepsy

-Chapter 6 Care of Patients with Parkinson Disease

--Care of Patients with Parkinson Disease(I)

--Care of Patients with Parkinson Disease(I)

--Care of Patients with Parkinson Disease(II)

--Care of Patients with Parkinson Disease(II)

--Care of Patients with Parkinson Disease

-Unit Assignment: Nervous System

--Unit Assignment: Nervous System

Upper gastrointestinal hemorrhage(II)笔记与讨论

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