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1Liunurse:Welcomewarmlythenursingdepartmentleadershipnurses,nursingsisterstoguidetheworkofourdepartment.Thecontentsispatient'scareofGallbladderstoneswithdiabetes.Aslimited,pleasegiveushelp,thankyou!hereistheresponsibilityofnurseXiangYanitodescribethecondition:刘护士长：热烈欢迎护理部领导、各位护士长、护士姐妹们来我科指导工作，我们查房的内容是胆囊结石合并糖尿病的护理，由于水平有限，准备时间不充分，不足之处，请给以帮助指导。下面请护士项娅妮介绍病情:XiangYani:Goodafternoon,Teachers,IamalevelonenurseXiangYani,Iwasthedayofthedutynurse,hereIintroducethepatient'scondition.项娅妮：各位老师，大家下午好，我是NI级护士项娅妮，同时也是患者的责任护士，下面我为大家介绍病人情况。NursingroundTheNursingoftheGallbladderstoneswithdiabetes护理查房胆囊结石合并糖尿病的护理Introduction:PatientswithSunZhiming'sdisease,male,57yearsold,thenumberofhospitalizedpatients:601498inMarch30,201511:20enteredtheward,withepigastricfullnessdiscomfortoverJanuary.Patientwithgallbladderstoneandcholecystitisincomemydivision.Gotoalreadyhealthypatients.Thereareatotalofmorethan30yearshistoryofsmokinganddrinking,nodrugallergyandotherallergichistory.Morethan40yearsagomeaslescausedbyhypertensionisblindinthelefteye,morethanthreeyears,regularlytakingmetoprolol,ale,FeiluodipingHuanshiPian,aspirin,aspirinhasbeendisabledforeightdays.Morethanoneyearfordiabetes,insulin,acarbose,prehospitaloutpatientBultrasoundtipofgallbladderstones.病情简介：患者孙志明，男，57岁，住院号：601498。患者于2015年3月30日11:20步入病房，主诉“上腹饱胀不适一月余”。门诊以胆囊结石并胆囊炎收入我科,患者有吸烟饮酒史30余年，已戒烟酒一年。无药物过敏及其他过敏史。40余年前因“麻疹”致左眼失明，右眼视力正常。高血压病史三年余，能遵医嘱按时服用倍他乐克、阿乐、非洛地平缓释片、阿司匹林等药物，阿司匹林已停用八天。糖尿病一年余，曾在内分泌科治疗，能自行注射甘精胰岛素，口服阿卡波糖，入院前门诊B超提示胆囊结石。T36.2℃,P72times/min,BP110/70mmHg.Thespiritofgood,normalappetite,physicalstrengthisnormal,normalsleep,urinenormal,nosignificantchangesinbodyweight,abdominalpalpation:abdomensoft,nomuscletension,withoutapparenttendernessandreboundtenderness,didnottouchbagpiece,thelowerboundofuntouchedliver,spleenwasnotpalpable.Limbmusclestrengthisnormal,nosensorydisability,ADLscoreof85points,scoring30pointsofskin.Fall/bedfallriskfactorscoreof10points,Fornutritionscore14points.Weretreatedwithantiinfection,protectingstomach,bloodglucosecontroltherapy(0.9%sodiumchloride100ml+2ceftazidimeintravenousinfusionof2Gfortwotimesaday,0.9%sodiumchloride100ml+pantoprazole80mgintravenousdriponceaday.Subcutaneousinjectionofinsulinbeforebreakfastanddinner4Uand9U).laboratoryexamination,fastingbloodglucose7.26tendencyforL,prescribedtodetectbloodsugar,March30,heartcolourtoexceedtip:leftventriculardiastolicfunctiontoreduce,pleaseheartmedicineconsultationSuggestions:bloodpressureisnormal,nospecialtreatment;OnMarch31,CTtip:rightlungbronchiectasiswithinfection,respiratorymedicineconsultation,pleaseadvice:afteranti-infectiontreatment;OnApril4,pleaseendocrinologyconsultationSuggestions:indiabetesdiet,hypoglycemictherapy,monitoringofbloodsugar.April5fingersonanemptystomachbloodsugarcontrolintendencyfor7.2/L,twohoursaftermealstendencyfor11.0/Lrespectively,andthetendencyfor8.7/L,thetendencyfor8.5L.April6,fastingbloodsugartendencyfor6.7/Lfinger,twohoursaftermealswere11.7tendencyL12.9tendencyL9.3tendency/L.IssurgeryonApril7,preoperativepreparation,onApril7,fingerbloodsugaronanemptystomachtendencyfor7.9L.查体：T36.2℃，P72次/分，R19次/分，BP110/70mmHg。精神食欲可，大小便正常，体重75KG，无明显增减，腹部触诊：腹软，无明显压痛、反跳痛、肌紧张，莫非氏征阴性。四肢肌力正常，无感觉障碍，ADL评分100分，皮肤评分30分。跌倒/坠床危险因子评分10分，营养评分为14分。入院后给予抗感染、护胃、控制血糖等治疗。完善术前相关检查，肺功能、胸片、心电图均正常，实验室检查基本正常，空腹血糖为7.26mmol/L,遵医嘱检测手指血糖。3月30日心脏彩超提示：左室舒张功能减低，请心内科会诊建议：血压正常，暂无特殊处理；于3月31日CT提示：右肺支气管扩张伴感染，请呼吸内科会诊后建议：行抗感染治疗；4月4日请内分泌科会诊建议：进糖尿病饮食，降糖治疗，监测血糖。4月5日空腹手指血糖控制在7.2mmol/L，三餐后两小时分别为11.0mmol/L，8.7mmol/L，8.5mmol/L。4月6日空腹手指血糖6.7mmol/L，三餐后两小时分别为11.7mmol/L，12.9mmol/L，9.3mmol/L。拟于4月7日手术行术前准备，4月7日空腹手指血糖为7.9mmol/L.OnApril7th08:00undergeneralanesthesiadownlinklaparoscopicgallbladderexcision(LC),finishoperationin,andgetbacktotheroom,postoperativeecgmonitoring,oxygeninhalation,thediet,anti-infection,protectingstomach,protectliver,nutritionsupporttreatment,suchasforpostoperativeADLscore20points,catheterslippageriskfactorscorefor1minute,fall/dropofbedriskfactorscoreof12points,nutritionscoreof12points,painscoreis6points,28pointsforskinpressuresoresscore.StoponApril8,ecgmonitoringandoxygenforADLscore85points,fall/dropbedriskfactorscoreof10points,painscoreof3points,catheterslippageriskfactorscoreof0.OnApril9semi-liquiddietisadministeredaftertheanusexhaust,fornutritionscore14points,ADLscoreof100points,tocurethehospitalonApril13,2015.于4月7日08:00在全麻下行腹腔镜下胆囊摘除术(LC术），于10:20术毕回房，麻醉清醒，切口敷料清洁干燥。术后给予心电监护，氧气吸入，禁饮食，抗感染，护胃，护肝，营养支持等治疗，术后ADL评分为20分，导管滑脱危险因子评分为1分，跌倒/坠床危险因子评分为12分,营养评分为12分,疼痛评分为6分,皮肤压疮评分为26分.于4月8日生命体征平稳，停止心电监护及氧3气,ADL评分为85分，跌倒/坠床危险因子评分为10分，疼痛评分为3分，皮肤压疮评分为28分，导管滑脱危险因子评分为0分。于4月9肛门排气后给予半流质饮食，营养评分为14分，ADL评分为100分,于2015年4月13日治愈出院。WangQing:Goodafternoon,Teachers,IamalevelonenurseWangQing,IamheretobriefyouontheEtiologyandpathologyofGallbladderstones.王青：各位老师，下午好，我是N1级护士王青，现在由我为各位介绍胆囊结石的病因病理。Etiologyandpathology:Gallstonebythecompositionofthestonesintocholesterolgallstones,bilepigmentcalculus,mixedstones.Gallbladderstonesarecholesterolstonesormixedstonestocholesteroldominated.Theetiologyofgallbladderstoneisverycomplex,istheresultofcomprehensivefactors.A