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Stroke in the Elderly课程教案、知识点、字幕

同学们 大家好

今天我们一起来学习一下

老年脑卒中病人的护理

今年

柳叶刀神经病学子刊发表了

关于2016年

全球疾病负担研究的一项分析显示

2016年

全球1370万人新发生中风

中国就占了40%

约为551万人

全球550万人因中风死亡

中国占了1/3

全球中风所致伤残调整生命年

为1.164亿

中国也占了1/3

根据国家

脑卒中高危人群筛查和干预项目

数据分析显示

40岁及以上人群

脑卒中标化患病率

由2012年的1.89%

上升至2016年的2.19%

现患人数达到1242万

首发病例的平均年龄为

60.9岁~63.4 岁

由此可见

脑卒中已经成为我国老年人口

死亡的第一大原因

其发病率 患病率整体上升趋势

也加重了脑卒中疾病的负担

那么 到底什么是脑卒中呢

脑卒中是指由急性起病

由于脑局部血液循环障碍

所致的神经功能缺损综合征

持续时间至少24h以上

包括脑梗死 脑出血 蛛网膜下腔出血等

老年人是脑卒中的高发人群

也是老年人群致残的主要原因

幸存者中约有75%丧失劳动能力

其中重度残疾的比例占到了40%

据《柳叶刀》杂志上

来自 32 个国家研究结果显示

全球 90.7% 脑卒中

与高血压 糖尿病 血脂异常

心脏疾病 吸烟 酒精摄入

不健康饮食 腹型肥胖 体力活动不足

和心理因素这 10 项

可纠正的危险因素相关

控制这些危险因素

可以减少至少75%的脑卒中发生

由于老年人脑卒中

以脑梗死和脑出血为主

本章节重点介绍

以上两种疾病的护理

一 脑梗死

脑梗死是指局部脑组织

因血液灌注障碍而发生的变性坏死

常表现为急性起病的局灶神经功能障碍

如脑血栓形成和脑栓塞

脑血栓约占脑卒中的60%

多在睡眠或安静的状态下发生

发病时患者一般神志清楚

局灶性神经系统损伤的表现

多数在数小时或2~3天内达到高峰

其中大脑中动脉闭塞最为常见

可出现典型的三偏症状

即对侧偏瘫

偏身感觉障碍

同向偏盲

而老年脑栓塞发作急骤

多在活动中发病

无前驱症状

意识障碍和癫痫的发病率较高

且神经系统的体征不明显

约占脑卒中的5~20%

通过医学影像检查

可尽早发现梗死部位

大小 程度及数量

并进行相应的治疗措施

对于老年脑梗死的治疗护理的目标

重点在于改善梗死区的血液循环

尽可能恢复神经功能

预防急性期并发症的发生

预防脑卒中的复发

尽早实施系统化康复指导

提高病人的生活质量

首先

患者应该取平卧位

尽量减少搬动

保持环境安静舒适并间歇给氧

持续观察患者的意识

生命体征 瞳孔 肌张力的变化

加强血气分析

心电图

血压的监测

防止低氧血症

心律失常及高血压的发生

其次

做好用药护理

应警惕是否发生颅内出血

或其他部位的出血倾向

严密监测凝血时间和凝血酶原时间

并记录24小时出入量

及心 肾等器官功能的情况

如有使用甘露醇降低颅内压时

应该选择较粗的血管

以保证药物的快速输入

再者

指导并帮助老年人

正确处理面临的困难

多给予鼓励和肯定

增强老年人战胜疾病的信心

同时教会家属照顾患者的方法和技巧

尽可能的减轻照顾者的负担

此外

除了生活指导之外

还要尽早开展康复训练

主要包括语言

运动和协调能力的训练

语言可以从发音开始

按照字 词 句 段的顺序训练讲话

对肢体瘫痪的老年人

可在从大关节的被动运动开始

幅度由小到大

逐步过渡到借助辅助器具

练习站立 转身 行走

协调能力训练

主要是锻炼肌肉的控制力

由近端肌肉至远端肌肉

注意保证患者的安全

好 那我们来看一下

第二部分 脑出血

脑出血是指原发于脑实质内的

非外伤性血管破裂出血

约有80%~90%的患者有高血压病史

由于某些外在因素

例如寒冷 情绪激动 饮酒

或用力排便等使得血压急剧地升高

而在脑小动脉管壁弹性降低

脆性增高的基础上

引起破裂致使脑出血的发生

老年人脑细胞的代偿能力较年轻人差

故临床表现更为严重

恢复差并发症多

死亡率也较高

对于脑出血患者

治疗护理的目的是防止继续出血

降低颅内压

防治并发症

通过康复训练

可以减少神经功能残疾程度

和降低复发率

首先

应保持安静的卧床休息坏境

适当的抬高床头15~30度

给予持续的鼻导管或面罩吸氧

如有发热者可以通过物理降温

降低脑代谢率

其次

持续地监测患者的意识情况

瞳孔 生命体征 饮食和排便等情况

警惕脑疝的发生

再者

积极防治并发症

为预防坠积性肺炎

泌尿系统感染

失用综合症等并发症的发生

可以指导老年人

在急性期生命体征平稳的情况下

进行被动运动

鼓励其早期下床活动

恢复自理能力

尤其要做好个人卫生

避免发生尿路感染

此外

作为护理人员

要积极的安抚和鼓励病人

减轻患者的应激反应

同时做好家属的心理疏导

提供相关知识和技能

增强护患合作

战胜疾病的勇气和信心

最后

同学们可以通过

脑卒中120

来识别脑卒中的发生

这是一种适用于国内的

迅速识别脑卒中和即刻行动的策略

1 代表

看到1张不对称的脸

2 代表

查两只手臂是否有单侧无力

0 代表

聆听讲话是否清晰

如果通过这三个步骤观察

怀疑患者是脑卒中

可立刻拨打急救电话

好了

以上就是这个章节的主要内容

谢谢大家

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

Stroke in the Elderly笔记与讨论

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